Instruction: Generate impression based on findings.

Input: Female, 44 years old, with history of recurrent triple negative breast cancer with right pectoralis muscle tumor causing paresthesias and weakness of the right arm. Evaluate for extent of tumor involvement in the plexus and nearby supraclavicular and axillary disease. After radiation treatment and Xeloda. For potential surgery planning. The large centrally necrotic tumor aggregate in the right subpectoral axilla is stable to slightly reduced in size since the previous examination. In the axial plane, it measures 9.2 cm x 7.5 cm compared to 11.1 cm x 9.0 cm previously. The lesion, however, is more necrotic than previously with less solid, peripheral tissue. Relationship to adjacent structures has not significantly changed. The mass is still contiguous with the chest wall and extends laterally almost to the humeral cortex but with no evidence of osseous invasion. Superiorly, it extends just above the clavicle, and inferiorly it indents the breast implant.The much smaller discontiguous tumor deposits are evident within the right supraclavicular fossa and lower neck and not significantly changed.The above lesion resides predominantly at the level of the cords and terminal branches of the right brachial plexus. The plexus is difficult to track with certainty, but the neurovascular structures can in general be followed as they are displaced posteriorly by the mass. No clear evidence of neurovascular encasement is seen. Numerous lung nodules and perihilar adenopathy are also present.

Output: The bulky necrotic right axillary mass is stable to slightly reduced in size but shows decreasing solid enhancement and increasing necrosis which may reflect response to treatment. The components of the brachial plexus remain visible as they're displaced along the posterior margin of the lesion. As before, no definite evidence of neurovascular encasement is seen.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, history of metastatic melanoma with new metastatic lesion at T7 on recent CT. A bulky tumor deposit is evident centered on the proximal right T2 rib measuring up to 59 x 35 mm in the axial plane. This lesion encases the proximal rib with extension into the right hemithorax and also into the right posterior paraspinal musculature. Furthermore, this lesion involves the right aspect of the T2 vertebral body, and extends into the right lateral epidural space. The spinal canal is mildly narrowed and the spinal cord is mildly displaced towards the left but not frankly impinged. There is no convincing evidence of any abnormal cord signal intensity. The right T1-2 and T2-3 neural foramina are encroached upon by tumor.A metastatic deposit is present within the left aspect of the T4 vertebral body. This results in mild osseous expansion and very slight tumor invasion of the left ventral epidural space. There is no significant spinal canal stenosis, cord impingement or cord signal abnormality seen. The neural foramina remain patent at this level.A metastatic deposit within the right posterior aspect of the T7 vertebral body is seen. This lesion also results in very mild encroachment upon the right ventral thecal sac with mild displacement of the spinal cord but no significant stenosis or cord impingement and no evidence of cord signal abnormality.Small lesions are suspected within the T9 and T10 vertebral bodies without epidural disease extension.The T11 vertebral body shows diffuse marrow replacement and pathologic enhancement compatible with metastatic involvement. No epidural disease extension is seen at this level. However, there does appear to be tumor extending from the marrow space into the retrocrural space just anterior to the vertebral body.Bulky left hilar tumor is demonstrated. Small pleural effusions are present. Bulky hepatic metastases are partially visualized.Spinal alignment is grossly anatomic. Vertebral body heights are also grossly preserved. Mild degenerative findings are seen throughout the thoracic spine without significant resulting spinal canal stenosis.

Output: 1.Bulky tumor is present centered on the proximal right T2 rib. This lesion involves the right aspect of the T2 vertebral body and extends into the right lateral epidural space. The spinal canal is mildly narrowed and the spinal cord is displaced towards the left. No evidence of cord impingement or cord edema is seen. The right T1-2 and T2-3 neural foramina are narrowed by tumor.2.Metastatic disease within the T4 vertebral body results in very mild encroachment upon the left ventral epidural space without significant canal stenosis or cord impingement.3.Diffuse tumor involvement of the T11 vertebral body. Tumor extends into the retrocrural space just anterior to the vertebral body, but no epidural disease involvement is seen at this level.4.Small metastatic deposits are evident at additional levels as above.5.Left hilar and hepatic tumors are partially visualized.


Instruction: Generate impression based on findings.

Input: Male, 57 years old. Reason: Mass left upper posterior thoracic shoulder History: enlarging mass There is a mass within the subcutaneous fat of the upper back posterior to the left scapula which follows fat signal on all sequences, appears multilobulated, and has no significant enhancement aside from very thin septations. No nodular component is identified. The mass measures approximately 13.9 x 6.5 cm in transverse dimension (series 14, image 19, and measures approximately 13.1 cm in craniocaudal dimension (series 15, image 23). These findings are compatible with a benign lipoma. No additional mass lesion or other significant abnormality is noted.

Output: Large lipoma within the subcutaneous tissues posterior to the left scapula as described above. No other significant abnormality is noted.


Instruction: Generate impression based on findings.

Input: Vision changes. Orbits: There is protrusion of the bilateral optic nerve discs. Otherwise, there is no abnormal signal or enhancement in the optic nerves. The extraocular muscles and orbital fat appear unremarkable bilaterally. There are no orbital mass lesions.Brain: There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There appears to be constriction of the bilateral transverse sinuses laterally. The major cerebral flow voids are otherwise intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable, aside from excessive adipose tissue in the subcutaneous tissues.

Output: 1. Findings suggestive of pseudotumor cerebri.2. No evidence of optic neuritis or intracranial demyelinating lesions.3. No evidence of intraorbital or intracranial mass lesions.


Instruction: Generate impression based on findings.

Input: Knee pain Note the examination is limited by large size of the patient's knee.MENISCI: There is intrasubstance degeneration of the lateral meniscus without discrete tear. There is maceration of the body and posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is severe full-thickness cartilage loss of the medial compartment with bone-on-bone apposition of the tibial plateau and femoral condyle. Tricompartmental osteophytes are noted. There is severe cartilage loss of the patellofemoral compartment and lateral compartments as well.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Limited exam secondary to body habitus patient motion. Within the limits of the exam, there is no evidence of osteomyelitis or septic arthritis.2. Diffuse increased signal within the muscles of the calf which are nonspecific in nature but could relate to myositis or diabetic myopathy.3. Additional findings of the knee are described above.


Instruction: Generate impression based on findings.

Input: 76 year-old and status-post fall Multiple small parenchymal hematomas in the right frontal lobe in the mid to high convexity are noted. The largest hematoma measures 8.8-mm x 14.6-mm measured on axial image 17. Minimal surrounding vasogenic edema is noted. Minimal amount of blood in the subarachnoid space in the right and left frontal region is also noted.Hematoma within the medial aspect of left temporal lobe at the level of the edge of the tentorium measures 30-mm times 18-mm in transaxial dimension on axial image 12. There is evidence of extension of blood into the trigone of left lateral ventricle. Minimal amount of blood within the perimesencephalic cistern is also noted. A small area of contusion with surrounding vasogenic edema within the inferior aspect of the right frontal lobe at the level of the floor of the right anterior cranial fossa is also present.Extensive patchy areas of low attenuation in the periventricular white matter of both cerebral hemispheres is consistent with small vessel disease.Large area of CSF collection in the right middle cranial fossa is contiguous with trigone of the right lateral ventricle and is believed to represent ex vacuo dilation of the right temporal horn. This area can be better evaluated with an MRI exam. No hydrocephalus or midline shift.No evidence of abnormality of the paranasal sinuses or mastoid air cells. Calvarium remains essentially unremarkable. Soft tissue density containing multiple foci of increased density within the high convexity right frontal scalp is noted. This lesion measures 15.5-mm x 18 0.2-mm. there is no evidence of associated bony changes with this finding and soft tissues of the scalp adjacent to these lesion demonstrate no evidence of edematous changes. The exact etiology of this finding is not clear however the finding less likely to represent a hematoma and possibly could represent a sebaceous cyst or a soft tissue mass of the scalp.

Output: 1.Multiple areas of hemorrhagic contusion of the brain in both cerebral hemispheres as detailed.2.Extension of blood from the left middle temporal lobe hematoma into the trigone of left lateral ventricle.3.Significant ex vacuo dilation of right temporal horn of uncertain etiology. This finding can be further monitored with a dedicated MRI.4.Small vessel disease of indeterminate age.5.Notice of fracture.6.Well pneumatized mastoid air cells and paranasal sinuses.


Instruction: Generate impression based on findings.

Input: 68-year-old with history of mammographically occult breast cancer. The patient is status post right partial mastectomy and sentinel lymph node biopsy in 2009 for breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. Postsurgical volume loss of the right breast is again noted.No suspicious enhancement is seen in either breast. Note is made of the right breast seroma which is similar in size. A tubular high T2 signal area with thin peripheral enhancement projecting anterior to the seroma is if anything less prominent on this exam.No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 86-year-old female patient with history of metastatic medullary thyroid cancer. Compare to prior examination. ABDOMEN:LIVER, BILIARY TRACT: Several enhancing liver lesions are again noted, stable compared to prior examination. Index right hepatic lobe lesion measures 2.4 x 2.1 cm (series 10 image 40), unchanged. The common hepatic duct is dilated up to 1.2 cm in diameter, unchanged. No evidence of cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left upper pole simple cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Incidentally noted on a single series is a lobulated, predominantly low T2 signal mass that is incompletely imaged and appears to be separate from the uterus.

Output: 1.Multiple enhancing hepatic lesions compatible with metastatic disease are unchanged compared to prior examination.2.Incidentally noted on a single series is a lobulated, predominantly low T2 signal mass that is incompletely imaged and appears to be separate from the uterus. Dedicated pelvic ultrasound can be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: rule out structural lesions History: seizures. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. A fusiform shaped area of increased T2 signal, increased FLAIR signal, and decreased T1 signal along the left external capsule is favored to reflect an atypical prominent perivascular space. There are a a few additional punctate foci of increased T2/FLAIR signal scattered through the subcortical white matter which are nonspecific. Brain parenchymal signal is otherwise within normal limits. Thin sections through the temporal lobes demonstrate mild asymmetric prominence of the temporal horn of the left lateral ventricle without associated hippocampal signal abnormality. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal patchy opacification within the paranasal sinuses.

Output: 1.A few punctate foci of increased T2/FLAIR signal within the subcortical white matter are seen which are nonspecific but atypical for age. Differential considerations include gliosis, demyelination, sequelae of prior inflammation, or vascular/ischemic etiologies. 2.Questionable asymmetric hippocampal structures with the left smaller than the right without associated signal abnormality and of uncertain clinical significance.


Instruction: Generate impression based on findings.

Input: Left sided PTA. Neck CT:There is soft tissue thickening and enlargement of the left palatine tonsil, with soft tissue thickening and edema extending to the rest of the oropharynx and hypopharynx resulting in effacement of the left piriform sinus. The edematous soft tissue abnormality extends into the left submandibular and sublingual space. Cervical lymphadenopathy is seen in the neck bilaterally, greater on the left.No discrete fluid collection is seen to suggest abscess.There is mild diffuse sclerosis of the cervical spine bony structures, but no focal lesion is seen.There is a cystic lesion in the right middle cranial fossa, and may represent an arachnoid cyst. It is incompletely visualized, and can be further evaluated with MRI brain.

Output: 1. Extensive soft tissue abnormality involving the left palatine tonsils, oro- and hypopharynx, with edematous soft tissue thickening extending into the left submandibular and sublingual space. Findings suggest most likely infectious / inflammatory process. Please also correlate clinically.2. Cerivcal adenopathy greater on the left, probably reactive.3. Mild diffuse sclerosis of cervical spine may be seen in patients with metabolic and endocrine disease. Please correlate with clinical parameters.4. Right middle cranial fossa arachnoid cyst. Further imaging can be obtained with MRI brain.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of maxillary sinus [C31.0], Reason for Study: ^Reason: sinus tumor History: headache and diplopia. There is relatively well circumscribed left frontal sinus mass which extends toward left ethmoid sinus through the left frontoethmoidal recess. The mass shows low signal intensity on both T1 and T2 images. It demonstrates grossly homogenous enhancement with some central non-enhancing area indicating possible central necrotic area. The mass is measured about 19.3mm (RL) x 29.5mm (AP) x 27.9mm (CC).The mass bulges into the orbit and pushes left side orbital fat and left superior oblique muscle. There is no fat place seen between the mass and superior oblique muscle about 9mm length especially anterior aspect (series 1201, image 12 to 14).The left medial rectus appears to be clearly separated from the mass with orbital fat plane. Thin linear low signal intensity at both left lamina papyracea and posterior wall of frontal sinus on T2 images indicating remained intact cortical bone. However, the boney intactness can be better evaluated through thin section CT scan.There are evidence of bilateral maxillary sinus antrostomy with mucosal thickening at the left maxillary sinus.T2 high signal intensities at the superior aspect of the left frontal sinus is likely represent trapped sinus space due to sinus mass described above. Imaged brain appears to be unremarkable except multiple tissue losses on the right cerebellar hemisphere indicating prior ischemic infarction.

Output: Interval growth of the left frontal sinus enhancing mass extends toward left ethmoid sinus and left mesial aspect of the orbit indicating recurrent sinus tumor. Other differential diagnosis include new slowly growing sinus tumor or metastasis. The possibility of inflammatory or infectious lesion is unlikely.


Instruction: Generate impression based on findings.

Input: 41-year-old female with a history of sphincter I. is unchanged, chronic abdominal pain. Rule-out pancreatic duct stricture are changes consistent with chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of intra-or extrahepatic biliary ductal dilation. There are no focal mass lesions identified within the liver. There are multiple fluid signal intensity lesions within the liver, most consistent with simple cysts. SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal in appearance. There is no evidence of acute or chronic pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

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


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarct. There is a small 1 mm thick T1 hyperintense extra-axial fluid collection along the right cerebellar hemisphere compatible with subacute subdural blood product. There are a few scattered punctate foci of T2 hyperintensity supratentorially that likely represent age-related white matter changes/chronic small vessel ischemic disease. There is T1 hyperintensity within the basal ganglia compatible with manganese deposition related to chronic liver dysfuntion. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal fluid within the mastoid air cells. There is a nasogastric tube and fluid within the nasopharynx.

Output: 1.No evidence of acute infarct.2.Trace subacute subdural hematoma along the right cerebellar hemisphere.3.Findings compatible with basal ganglia manganese deposition, related to chronic liver disease.4.Fluid within the nasopharynx surrounding a nasal gastric tube.


Instruction: Generate impression based on findings.

Input: 24 years, Female, with an intracranial mass incompletely evaluated on orbital MRI. History of right orbital hemangiopericytoma, status post resection. The patient presented with right proptosis. There is a 5.7 x 5.4 x 6.6 cm slightly lobulated T1 hypointense and T2 hyperintense avidly enhancing extra-axial centered in the right frontal skull adjacent to the right frontal lobe. The mass causes severe compression of the right frontal lobe. There is mild underlying edema in the right frontal lobe white matter. A well-defined T2 hypointense surrounding the majority of the mass is again demonstrated with a few discontinuous areas of irregular enhancement extending beyond the margin of the capsule into the surrounding right frontal lobe parenchyma, especially inferiorly along the posterior margin. The mass extends inferiorly into the right orbit and causes severe compression of the intraorbital contents. Severe right exophthalmos and inferior displacement of the right globe are unchanged.No restricted diffusion to suggest acute infarct. No intracranial hemorrhage is evident. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and left orbit are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Postsurgical changes related to previous right frontotemporal craniotomy are redemonstrated. Bone marrow signal is otherwise within normal limits.

Output: Redemonstrated large lobulated extra-axial mass centered in the right frontal skull most consistent with recurrent hemangiopericytoma. Unchanged findings concerning for locally invasive spread into the right frontal lobe.


Instruction: Generate impression based on findings.

Input: 69 yo man with hx of recent TECAB (LIMA to LAD/D1 and RIMA to OM1) who has a CTO of distal RCA that was previously patent. MRI to assess for ischemia in RCA territory to help decide on whether CTO PCI is warranted. First Pass PerfusionDuring hyperemia, there is presence of perfusion defect in the mid and basal inferior and inferolateral walls. The overall ischemia score is 3 out of a possible 32. Approximately 9% of the myocardium is ischemic. Viability/ Myocardial ScarThere is no evidence of myocardial infarction. The entire myocardium is likely to be viable. Left VentricleThe left ventricle is normal in size with mild to moderately decreased systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 150 ml/m2 (normal range: 74+/-15), the LVEDV is 306 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 126 ml (normal range 47+/-19). There is hypokinesis of the basal to mid inferior and inferolateral walls. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 211 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 95 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 moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The basal to mid inferior and inferolateral walls are hibernating, ischemic, and viable. 2. There is no evidence of myocardial infarction. The entire left ventricle is viable. 3. Normal LV size with mild to moderately decreased systolic function. (LVEF 41%).4. Normal RV size and systolic function (RVEF 55%).5. Moderate mitral regurgitation.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, elbow mass Note that this exam was not tailored for evaluation of the internal structures of the elbow.Within the volar and radial soft tissues of the elbow between the brachioradialis and brachialis muscles and along the expected course of the radial nerve is a well-circumscribed mass measuring 1.7 x 1.4 x 2.7 cm in the greatest transverse, AP, and craniocaudal dimensions. The mass is predominantly hyperintense to skeletal muscle on T2-weighted sequences (although contains a small rounded focus of low signal intensity) and isointense to skeletal muscle on T1 sequences. The mass does not appear to invade the surrounding fat planes and is and otherwise does not demonstrate aggressive features. Following contrast administration, there is central, solid target-like enhancement. This mass was evident on the comparison examination from 2011 and has increased from that exam when it measured approximately 1.5 x 1.2 x 2.1 cm.A second similar appearing mass is identified within the long head of the triceps muscle along the expected course of the ulnar nerve. This mass measures approximately 1.6 x 1.8 x 2.6 cm in the greatest transverse, AP, and craniocaudal dimensions. Following contrast administration, there is predominantly central, solid enhancement. This mass was evident on the comparison examination from 2011 and has increased from that exam when it measured 1.1 x 1 x 2.5 cm.A third smaller mass demonstrating similar signal characteristics and enhancement is only partially visualized along the radial portion of the distal forearm and measures at least 1 x 1 cm. This mass was partially visualized on the comparison examination from 2011 but has also appear to increase from that exam when it measured less than 1 cm.The underlying marrow signal of the distal humerus and proximal forearm are normal. Within the limits of this exam, the ligaments and tendons of the elbow appear normal. There is no joint effusion.

Output: Multiple soft tissue masses consistent with peripheral nerve sheath tumors. These have increased in size from a comparison exam of the right humerus dated 4/6/2011.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 53-year-old male patient with left shoulder pain and history of prior SLAP tear repair. ROTATOR CUFF: The supraspinatus, subscapularis, infraspinatus, and teres minor muscles and tendons are intact. Contrast remains within the joint capsule.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is intact without significant abnormality or metal artifact identified.BICEPS TENDON: There is mild thickening of the bicipital labral complex and proximal biceps tendon with intermediate T2 signal intensity. This may represent postsurgical changes or mild tendinopathy. ADDITIONAL

Output: 1.Mild thickening of the bicipital labral complex and proximal biceps tendon with intermediate T2 signal intensity. This may represent postsurgical changes or mild tendinopathy. 2.The labrum and rotator cuff are intact.


Instruction: Generate impression based on findings.

Input: 48 years Female (DOB:2/22/1968)Reason: change in right frontal lesion, probable cavernoma? History: headachesPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON There is a ringlike focus of susceptibility effect present also identified on the T2 and T1 images measuring approximately 5 mm in diameter. It is associated with susceptibility effect. There is also associated with a developmental venous anomaly. This is stable compared to prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Findings are compatible with a small cortically based cerebral cavernous malformation associated with a developmental venous anomaly involving the right frontal lobe anteriorly and adjacent to the midline. The patient has a known history of thyroid cancer. Although this remains in the differential diagnosis, the association with developmental venous anomaly supports cerebral cavernous malformation.


Instruction: Generate impression based on findings.

Input: 70 years Male (DOB:4/15/1946)Reason: eval pineal tumor and flow from 3vc, please include cine flow History: eval pineal tumor and flow from 3vc, please include cine flowPROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG There is a heterogeneous enhancing mass centered in the pineal region and quadrigeminal plate which is associated with narrowing of the aqueduct and ventriculomegaly. This was demonstrated on prior exams. There is associated surrounding T2 signal hyperintensity within the thalami and midbrain. There is associated susceptibility effect within the lesion. The mass itself currently measures 42 x 32 mm axial dimensions and on the 11/24 exam measured 39 x 29 mm axial dimensions. It has a central nonenhancing component on the current exam which was smaller on the prior exam. This nonenhancing component is heterogeneous on T2 and predominantly hypointense on T1. It is associated with susceptibility effect and some T1 hyperintensity suggesting products.The patient is status post right occipital craniotomy.There are multiple foci of susceptibility effect within the lateral ventricles with fluid fluid levels.A ventriculostomy tube is present coursing the right frontal lobe into the right lateral ventricle with a tip adjacent to the septum pellucidum within the frontal horn of the right lateral ventricle. A ventriculostomy tract course of the right frontal lobe into the body of the right lateral ventricle. Biventricular diameter on the current exam is proximal 43 mm prior exams is likely 45 mm. the temporal horns of lateral ventricles remain dilated.There is a right-sided subdural effusion present measuring 8 mm in thickness which was smaller on the prior exam measured 2 mm. There is a mild to moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This has not changed substantially compared the prior examNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of a cystic lesion most likely representing a sebaceous cyst along the left occipital scalp tissues. This also present on previous exams and is unchanged. It extends to the skin surface and distorts the skin surface.The exam is somewhat degraded due to motion artifact.CSF flow study demonstrates biphasic flow at the level of foramen of Monro but no flow clearly seen in the aqueduct. A third ventriculostomy is not readily visualized current exam.

Output: 1.Quadrigeminal plate and pineal region mass. Since the prior exam the mass has mildly enlarged and is now associated with the central hemorrhagic component. Surrounding edema has also increased relative to the prior exam.2.Ventriculomegaly. A ventriculostomy tube is in place. There are some blood products present within the lateral ventricles. The lateral ventricles are minimally smaller on the current exam compared to the prior exam. There is no convincing evidence for flow through the aqueduct. A third ventriculostomy is not readily seen on this exam.3.A right-sided subdural collection has enlarged compared to the previous exam. There is minimal shift of the septum pellucidum.4.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no stenoses or developmental anomalies.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at the mid L3 level, unchanged. There is no fat signal material within the filum terminale. Upon prone positioning, the conus translates anteriorly. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no stenoses or developmental anomalies.

Output: 1.Negative noncontrast thoracic spine MRI.2.The conus is normal in signal and morphology and terminates at the mid L3 level, unchanged. There is no fat signal material within the filum terminale. Upon prone positioning, the conus translates anteriorly.


Instruction: Generate impression based on findings.

Input: 72 year old diabetic male patient with stable coronary artery disease and distal RCA CTO, HTN, HLD, worsening symptoms on medical therapy, referred for cardiac stress MRI to assess perfusion and scar.MEDICATIONS: Advair, Proair, alfuzosin, ASA, dutasteride, glipizide, Imdur, losartan, metoprolol (held), nitroglycerine, omeprazole, pravastatin, tizanidine, dyazide. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is no late gadolinium enhancement suggestive of prior myocardial infarction. The entire myocardium is viable. Minimal mid myocardial late gadolinium enhancement in the basal septum seen only on 4 chamber view, possibly artifact.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 157 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 53 g/m2, and the LV mass is 115 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 190 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is mildly dilated (39mm at the sinuses of valsalva). There is a left sided bovine aortic arch.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (35mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLeft posterior diaphragmatic hernia noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. Minimal mid myocardial late gadolinium enhancement in the basal septum seen only on 4 chamber view, possibly artifact.3. Normal LV size and systolic function (LVEF 55%).4. Normal RV size and systolic function (RVEF 51%).


Instruction: Generate impression based on findings.

Input: Reason: evaluate for chronic pancreatis History: abd pain from sternum to umbilicus with eating, elevated Lipase. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. Normal intrinsic T1 signal is preserved. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing subcentimeter T2 hypointense T1 hyperintense lesion likely represents a proteinaceous cyst. Punctate bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific evidence of chronic pancreatitis. If clinical concern persists, a secretin stimulated MRCP for further evaluation may be considered.2.Probable proteinaceous left renal cyst.


Instruction: Generate impression based on findings.

Input: History of prostate cancer and bilateral lower extremity weakness. Rule out cord compression. This is a limited exam secondary to patient motion. Repeated imaging could not be obtained secondary to the patient's refusal to continue the exam. Given this caveat, there is no evidence of acute cord compression.Extensive metastatic osseous disease is again noted throughout the spine. There is no significant loss of vertebral body height. There are multilevel disc bulges in the cervical spine with mild to moderate spinal canal stenosis but this is grossly unchanged compared with the previous dedicated cervical spine MRI from 2/1/2014. Although severely limited by motion, there is some new bulging of an osseous lesion in the posterior L4 vertebral body which causes mild-to-moderate spinal canal stenosis. However there is no evidence of significant cauda equina compression.

Output: 1.This is a limited exam secondary to patient motion. Repeated imaging could not be obtained secondary to the patient's refusal to continue the exam. Given this caveat, there is no evidence of acute cord compression.2.Diffuse osseous metastatic lesions in the spine without significant loss of vertebral body height.3.Grossly stable central spinal canal stenosis at the cervical level secondary to degenerative disease. 4.New posterior bulging of an L4 vertebral body lesion which causes mild to moderate spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: 60 year old female who presents with seizure with a history of a lung mass. Evaluate for intracranial hemorrhage or metastases. Given the lack of intravenous contrast, evaluation for metastatic lesions is limited. Given these limitations, the following observations are made:Brain:There is a large area of hypoattenuation in the high convexity of the left frontal lobe. There is associated subtle ex vacuo dilatation of the lateral ventricle and loss of surrounding cortex. These findings may represent a remote infarct and encephalomalacia, however, metastatic disease cannot be excluded on this noncontrast examination. There is a area of hypodensity in the right posterior subcortical periventricular white matter adjacent to the right trigone. There is no associated mass effect, ex vacuo dilation, or enlargement of the sulci. These findings likely represent vasogenic edema. It is less likely a remote infarct. Additionally, there is an area of hypodensity within the left cerebellum. This likely represents encephalomalacia from prior infarct, however, these findings may possibly represent an arachnoid cyst. There is no evidence of intracranial hemorrhage or mass.There are multiple scattered hypodensities within the periventricular and deep white matter which are age indeterminate and nonspecific but may be related to chronic small vessel ischemic disease. It should be noted that CT is insensitive in detecting acute ischemic infarct an MRI can be considered for further evaluation if clinically indicated.The basal cisterns are normal in size and configuration. There is no effacement of the cortical sulci. There is no mass effect or midline shift.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Neck/cervical spine:No evidence of malalignment or acute fracture. A lytic lesion is noted in the T2 vertebral body. The posterior cortex of the vertebral body is eroded. There is no associated soft tissue abnormality on this limited non-infusion study. No evidence of canal stenosis. There is multi-level mild degenerative disk disease. There is multi-level disk bulge from C3/C4 to C6/C7. There is no evidence cervical spinal canal stenosis. The neuroforamina are patent bilaterally.

Output: 1. Hypoattenuation in the left frontal lobe and right posterior temporal lobe. These findings likely represent vasogenic edema secondary to metastatic disease versus encephalomalacia from a remote infarct. Given the limitations in detecting metastatic disease in a non-enhanced CT examination, further evaluation with contrast-enhanced CT or MRI is recommended. These findings and recommendation were relayed to the emergency department via the STAT consult system.2. There is a lytic lesion in the T2 vertebral body which may represent a metastatic lesion. A bone scan may help further evaluate.  3. Multiple scattered hypodensities within the periventricular and deep white matter, which are age indeterminate and nonspecific but may be related to chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage. It should be noted that CT is insensitive in detecting acute ischemic infarct and MRI can be considered for further evaluation if clinically indicated.4. Hypodensity within the left cerebellum. This likely represents encephalomalacia from a prior infarct, however, these findings may possibly represent an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 68-year-old woman with history of cervical squamous cell carcinoma. PELVIS:UTERUS, ADNEXA: There are large uterine fundal fibroids which displaced the uterus towards the right. There is a predominantly T1 hyperintense and T2 heterogeneous signal mass centered in the cervix (series 11, image 29) which measures 79 x 73 mm. There is peripheral enhancement on the post contrast images, however the central portions are relatively hypoenhancing suggesting necrosis.The tumor does appear to invade the posterior wall of the bladder (series 7, image 19). Additionally, the lesion sits along the right pelvic sidewall and there is apparent invasion of an internal iliac vein (series 11, image 27).This tumor is seen abutting the rectum (series 11, image 24), however there is no evidence of invasion. No osseous involvement identified.BLADDER: See above for probable posterior bladder wall involvement. The bladder is otherwise normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The aforementioned tumor abuts the rectosigmoid colon, however there is no evidence of invasion.BONES, SOFT TISSUES: There is mass effect on the vagina, otherwise the vagina is unremarkable.OTHER: No significant abnormality noted.

Output: Large, necrotic cervical mass with apparent invasion of the posterior bladder wall, right pelvic sidewall, and an internal iliac vein.


Instruction: Generate impression based on findings.

Input: 63 years, Female, seizures, rule out structural lesion. There is no restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are multiple foci of susceptibility consistent with chronic microhemorrhage including the bilateral thalami, pons, and bilateral cerebellar hemispheres. Multiple foci of chronic microhemorrhage are also seen in the peripheral lobar distribution. Slightly larger area of susceptibility is seen involving the right thalamus likely related to chronic hemorrhage.There are patchy areas and scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes. More focal areas of volume loss are seen including the bilateral corona radiata, left thalamus, and bilateral cerebellar hemispheres consistent with chronic infarcts. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct, intracranial mass or mass effect.2. Moderate chronic small vessel ischemic disease with multiple small infarcts including the corona radiata, left thalamus, and bilateral cerebellar hemispheres. There also multiple foci of chronic microhemorrhage with a distribution compatible with chronic hypertension and/or amyloid angiopathy. There is a relatively larger focus of chronic hemorrhage involving the right thalamus.


Instruction: Generate impression based on findings.

Input: Breast cancer with brain metastases: surveillance. There are multiple predominantly ring-enhancing lesions in the bilateral cerebral hemispheres and right cerebellar hemisphere, which are stable to decreased in size. For example, a left anterior cingulate gyrus lesion measures up to 10 mm, previously 13 mm, while a right nasal ganglia lesion measures up to 12 mm, previously also 12 mm. In addition, the degree of with associated vasogenic edema has diminished, accounting for differences in technique. The ventricles appear to be similar in size and configuration. There is no midline shift or herniation. The orbits are unremarkable. There is a newly apparent subcentimeter nodule in the apical scalp, perhaps with mild enhancement.

Output: 1. The multiple intracranial metastases and associated vasogenic edema are stable to decreased in size, accounting for differences in technique. 2. A newly apparent subcentimeter nodule in the apical scalp is nonspecific, but may represent a metastatic lesion, for example.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The cerebellar tonsils are in normal position. The spinal cord displays normal signal and morphology. There are small multilevel disk protrusions at C2/3 through C5/6 and mild disc bulges at C6/7 and C7/8, causing minimal effacement of the ventral thecal sac, but no significant canal stenosis at any level. There is moderate multilevel facet hypertrophy, which in combination with disk disease, causes multilevel neural foraminal stenosis, mild on the right C3/4, moderate on the right C6/7, and severe on the left C6/7.The paravertebral soft tissues are unremarkable.

Output: Moderate degenerative changes with multilevel neural foraminal narrowing, most severe on the left at C6/7.


Instruction: Generate impression based on findings.

Input: 43 year old with strong family history of breast cancer There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Increased leg and back pain. There is a catheter that enters the spinal canal at the L1-2 level. There are small disc bulges at L3-4 and L4-5, including an annular fissure at L4-5, which in combination with mild facet hypertrophy result in mild neural foraminal stenoses at these levels, but no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a T2 hyperintense right renal lesion that measures up to approximately 3 cm.

Output: 1. Small disc bulges at L3-4 and L4-5, which in combination with mild facet hypertrophy result in mild neural foraminal stenoses at these levels, but no significant spinal canal stenosis.2. A right renal T2 hyperintense lesion that measures up to approximately 3 cm likely represents a cyst, but is incompletely characterized. A renal ultrasound may be useful for further characterization.3. A catheter enters the spinal canal at the L1-2 level.


Instruction: Generate impression based on findings.

Input: Clinical question: Postop tumor resection. Evaluate of resection of the one out of two tumors. Signs and symptoms: Postop craniotomy. Pre and post enhanced brain MRI:Examination demonstrates expected postoperative changes of a large right temporal and frontal craniotomy for tumor debulking. There is partial resection of a large necrotic tumor in the right temporal lobe. The surgical cavity demonstrates small amount of hemorrhage and expected postoperative air. Postcontrast images demonstrate extensive residual thick irregular rim enhancing tumor. The remaining tumor and postoperative changes measures approximately 28 x 38 mm in transaxial dimensions. Fairly extensive surrounding vasogenic edema demonstrate no significant change.A second necrotic rim-enhancing tumor in the right frontal operculum measuring approximately at 25 x 29 mm in transaxial dimensions. The constellation of postop, residual tumor and right frontal mass results in leftward deviation of midline of approximately 8 mm which has not significantly changed since prior study. There is no evidence of ventriculomegaly.Findings suggestive of mild chronic small vessel ischemic strokes without significant change.

Output: 1.Postoperative changes of debulking/partial removal of right temporal lobe tumor with extensive residual tumor as detailed.2.Stable large necrotic ring-enhancing tumor in the right frontal operculum since prior exam.3.Constellation of above findings and extensive residual vasogenic edema results in approximately 8 mm leftward midline shift as detailed.


Instruction: Generate impression based on findings.

Input: 88 years Female (DOB:12/6/1927)Reason: stroke History: Left MCA syndromePROVIDER/ATTENDING NAME: KEEGAN CHECKETT AGNIESZKA ANNA ARDELT MRI of the brainThere is a focus of diffusion restriction involving the right SCA territory measuring 40x28mm axial dimensions. There is a focus of diffusion restriction involving the left thalamus measuring 18x12mm axial dimensions. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is occlusion of a short segment of the basilar artery distal to AICA origin which does not involve the top of the basilar artery. The right PCOMA is medium sized and supplies the top of the basilar artery. There is occlusion of the right SCA and the left PCA. There is narrowing of the distal right RVA at the VB junction.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Acute infarctions involving the right SCA territory and the left thalamus. The brainstem is not involved.2.Occlusion of the distal basilar artery, the right SCA and the left PCA. The top of the basilar artery is supplied by the right PCOMA.3. Findings were discussed with Dr Ardelt at the time of the exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 40 year old male with status epilepticus now with ST elevations on the monitor. Mental status changes. The previously seen right frontal hematoma has resolved. The surrounding encephalomalacia demonstrates some evolutionary change. Subtle left occipital low attenuation posteromedial to the left occipital horn indicates an area of previous hemorrhage better seen on prior MRI.There is very subtle loss of gray-white matter differentiation at the left parietal-occipital region which probably corresponds to the cortical signal abnormality reported on prior MRI.There is no evidence of new intracranial hemorrhage. Prominent ventricles; unchanged. There is no extra-axial fluid collection.The visualized osseous structures are unremarkable except for a Burr hole in the right frontal bone. Prominent cerebellar folia indicating volume loss.

Output: 1. Further resolution of the previously identified right frontal hematoma, with associated right frontal encephalomalacia. 2. Left posterior parietal encephalomalacia; unchanged from previous.3. No new hemorrhage is identified.4. Subtle loss of gray-white matter differentiation at the left parietal-occipital region probably corresponds to the cortical signal abnormality reported on prior MRI. Follow-up with MRI should be considered for better evaluation.


Instruction: Generate impression based on findings.

Input: Reason: r/o stroke History: aphasia MRI of the brainarea of diffusion traction is present which involves the posterior aspect of the insular cortex, adjacent left superior temporal gyrus, adjacent left some central lobular and adjacent left supramarginal gyrus. There are additional punctate foci of diffusion restriction in the left postcentral gyrus and inferior parietal lobule.There is signal loss on susceptibility weighted imaging within the left medullary draining veins.On susceptibility imaging there are foci of signal loss present in the basal ganglia and in the right frontal subcortical white matter indicative of prior microhemorrhages. The there are T2 signal hyperintensities in the basal ganglia at these foci of basal ganglia microhemorrhage.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There are subdural effusions present in the posterior fossa and supratentorial brain probably related to atrophy.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal right internal carotid artery, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left internal card artery is occluded and reconstituted via the left posterior communicating artery.There is occlusion of the left middle cerebral artery at the distal M1 segment involving a divisional branch each which includes the left posterior parietal artery. There is antegrade flow in the some of the superior division branches as well as some of the inferior division branches. It is suspected this represents a partial occlusion of inferior division trunk with complete occlusion of the posterior parietal artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are medium sized. The vertebral arteries are asymmetric with the right larger than left. Extracranially the left vertebral artery appears to be occluded.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. The left common artery originates from the innominate artery.There is high-grade stenosis present at the proximal right vertebral arteryThere is 60% stenosis present along the proximal left subclavian artery.Complete occlusion of the origin of the left internal carotid artery.Complete occlusion at the origin of the left vertebral arteryOn the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation.

Output: 1.Occlusion of the left internal card artery at its origin without distal reconstitution of the communicating segment via the left posterior communicating artery.2.Occlusion at the inferior division of the left middle cerebral artery with complete occlusion of branches centered around the left posterior parietal artery.3.Occlusion of the left vertebral artery proximally with distal reconstitution via the vertebrobasilar junction.4.Acute infarction in in the left middle cerebral artery territory centered around the left posterior parietal artery territory.5.There is high-grade stenosis present at the proximal right vertebral artery6.There is 60% stenosis present along the proximal left subclavian artery.7.The findings are suggestive of hypoxia to the left hemisphere.8.Old lacunar infarcts in the basal ganglia are likely associated with prior hemorrhage.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with thyroid cancer metastatic to the thoracic lumbar spine, on therapy evaluation. Also with hypermetabolic lymph node in the neck on PET scan. Neck:Evidence of total thyroidectomy is seen. No suspicious soft tissue lesions are demonstrated in the thyroidectomy bed. Scattered small lymph nodes are present in the neck but none of these meets imaging criteria for pathologic enlargement. The aerodigestive mucosa is unremarkable. The right submandibular gland has likely been resected. The remaining salivary glands are unremarkable. The aerodigestive mucosa is free of any masslike lesion.Thoracic spine:An enhancing lesion within the T5 vertebral body is unchanged measuring approximately 13 x 8 mm in the axial plane. Enhancing slightly expansile lesions within the left transverse process and pars interarticularis of T5 and T6 are also unchanged. Postsurgical findings are redemonstrated from T10 to T12 including left lateral fusion and partial corpectomy of T11. The residual T11 vertebral body continues to show diffuse marrow replacement and enhancement. A mild kyphotic deformity centered at T11 is unchanged. Fatty replacement of the marrow in the lower thoracic spine is redemonstrated compatible with prior radiation. No new lesions are identified.Lumbar spine:Enhancing lesions are redemonstrated within the L2, L3 and L5 vertebral bodies. No significant interval change in size is noted. The reference L5 lesion continues to measure 18 x 16 mm in the axial plane.Fatty replacement of the vertebral body marrow is again seen compatible with prior radiation. No new lesions are detected. Mild degenerative findings are stable and unchanged with no areas of significant spinal canal or foraminal stenosis.

Output: 1.Evidence of thyroidectomy is seen with no lesions in the neck suspicious for recurrent tumor or pathologic adenopathy.2.Stable metastatic lesions in the thoracic and lumbar spine. No new osseous lesions are identified.


Instruction: Generate impression based on findings.

Input: Female 66 years old Reason: cuff tear History: pain ROTATOR CUFF: There is complete full thickness tearing of the supraspinatus muscle. There is also full thickness tearing of the infraspinatus muscle. There may be some intact anterior fibers. There is fraying and irregularity of the torn tendon fibers which demonstrate background tendinosis. There is retraction of approximately 3.6 cm. There is complete full thickness tearing of the subscapularis tendon. The teres minor muscle and tendon are unremarkable. There is marked edema within and atrophy of the supraspinatus, infraspinatus and subscapularis muscles.SUPRASPINATUS OUTLET: There are severe degenerative changes of the acromioclavicular joint with marked synovial hypertrophy. Note is made of an os acromiale.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a high riding humeral head. There is diffuse fragmentation of the labrum and loss of the normal articular cartilage.BICEPS TENDON: There is complete full thickness tearing of the long head of biceps tendon with the retracted tendon identified at the level of the humeral neck.ADDITIONAL

Output: 1. Complete full thickness rotator cuff tear as described above with retraction of approximately 3.6 cm.2. Complete full thickness tearing of the long head of biceps tendon with retraction.2. Diffuse fragmentation of the the glenoid labrum with associated loss of the normal articular cartilage.3. Other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: Patient with large right renal mass and concern for IVC extension possibly thoracic. Has new onset SOB and need MRI for surgical planning. History: As above. Limited exam without intravenous contrast.LUNGS AND PLEURA: Left lower lobe pulmonary nodule measures 1.0 x 1.0 cm (series 601 image 8). Patchy opacity in the left upper lobe. Moderate left and small right pleural effusions.MEDIASTINUM AND HILA: Filling defects in the lower pulmonary arteries bilaterally from the right segmental level and the left lobar level compatible with history of pulmonary emboli. CHEST WALL: Degenerative changes. Scattered synovial or perineural cysts. T2 hyperintense, T1 hypointense lesion in the left L1 vertebral body with extension into the left pedicle suspicious for metastasis. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. See separately dictated MRI abdomen.

Output: 1.Right lower segmental and left lower lobar pulmonary emboli. Malignant thrombi cannot be excluded.2.Left lower lobe pulmonary nodule suspicious for metastasis. See recent CT chest. 3.Left L1 metastasis. 4.Left upper lobe patchy opacity may represent infarction, atelectasis, or infection.5.Moderate left and small right pleural effusions.


Instruction: Generate impression based on findings.

Input: Female 23 years old. Reason: MRI arthrography as recommended to follow up plain film History: Right shoulder popping instability and pain. ROTATOR CUFF: Intermediate T2 signal in the supraspinatus tendon with some undersurface fraying indicating mild tendinosis. There is no full-thickness rotator cuff tear.The remainder of the cuff tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is no evidence of a labral tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild tendinosis of the supraspinatus tendon without evidence of a full-thickness rotator cuff tear. No evidence of a labral tear.


Instruction: Generate impression based on findings.

Input: Knee pain and swelling MENISCI: There is mild increased signal within the posterior horn of the medial meniscus representing intrasubstance degeneration however there is no discrete tear of the medial or lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness cartilage loss of the medial femoral condyle above the posterior horn of the medial meniscus. There is focal near full-thickness to full-thickness articular cartilage loss of the femoral trochlea both centrally and inferiorly with mild fraying of the superior portion of the lateral patellar facet.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Degenerative articular cartilage loss of the patellofemoral and medial compartments as described above. There is no evidence of a discrete meniscal tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for postop hemorrhage. Signs and symptoms: Headache. Nonenhanced head CT: Examination demonstrates a surgical cavity in the right frontal lobe containing fluid and air density as well as very minimal blood product. It measures approximately 35 x 36 -mm in size.There is a small focus of high density measuring approximately 4 x 4.5-mm in size suspected of a small acute hematoma immediately lateral to the surgical cavity in the right frontal lobe.Extensive residual surrounding vasogenic edema and very minimal subarachnoid hemorrhage is present. A small residual vasogenic edema in the left frontal lobe is also present and unchanged since prior brain MRI from 5 -- 3 -- 13. The overall mass effect of this finding and resultant midline shift to the left immediately adjacent to the tumor remains fairly similar to preoperative study. Stable normal size of the supratentorial ventricular system and unchanged since prior study.Expected postoperative changes of right frontal craniotomy.

Output: 1.Surgical cavity at the site of previously known right frontal lobe tumor with fluid/air and very minimal blood content.2.Minimal subarachnoid hemorrhage in the vicinity of surgical cavity and an approximately 4 x 4.5-mm accurate hematoma lateral to the surgical cavity.3.Postop changes and residual vasogenic edema extensively in the right frontal and minimally in the left frontal and associated mass effect remains similar to prior study.


Instruction: Generate impression based on findings.

Input: Gastric carcinoid with liver lesions of questionable clinical significance, evaluate for interval change ABDOMEN:LIVER, BILIARY TRACT: Again visualized are arterially enhancing liver lesions, difficult to characterize secondary to small size.Accounting for differences in technique, unchanged in size 0.6 cm area of enhancement in hepatic segment 2, image 40 series 10, appears less pronounced in degree of enhancement. Surrounding more wedge-shaped enhancement less pronounced.Similar findings demonstrated by additional hepatic segment 7/8 focus also seen on prior study, measures 0.8 x 0.7 cm, image 40 series 10, unchanged in size, remeasured on earlier exam at 0.9 x 0.6 cm.These lesions retain contrast on subsequent delayed imaging. No corresponding T2 signal abnormality delineated.Hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Stable exam as above.


Instruction: Generate impression based on findings.

Input: Low back pain There is perhaps mild narrowing of the L5-S1 disc space posteriorly. Otherwise the lumbar spine appears normal with preserved alignment and vertebral body heights.

Output: Possible mild narrowing of the L5-S1 disc space but otherwise normal radiographic appearance of the lumbar spine.


Instruction: Generate impression based on findings.

Input: 70 year old male patient with history of prostate cancer, status post ablation, and elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.7 x 2.7 x 4.7 cm (transverse x AP x craniocaudal). Peripheral Zone: The left peripheral zone is atrophied with linear T2 hypointensity and ADC hypointensity within the region of ablation compatible with post-treatment related changes/scarring. Enhancement adjacent to the area of scarring within the medial left apex is also likely post-treatment related.There is a focus of T2 hypointensity with ADC hypointensity and questioned early enhancement within the right mid gland of the peripheral zone (image 20, series 501). Central Gland: The central gland is heterogeneous.Seminal Vesicles: No definite involvement.Extracapsular Extension: No definite extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post-treatment related changes to the left peripheral zone.2.2 mm focus of signal abnormality within the right mid gland; follow up is recommended.


Instruction: Generate impression based on findings.

Input: History of liver transplant with recurrent hepatocellular carcinoma and extensive retroperitoneal metastatic lymphadenopathy. The study is limited by extensive susceptibility artifact from the patient's surgical hardware.ABDOMEN:LIVER, BILIARY TRACT: Orthotopic liver transplant. A large portion of the liver cannot be evaluated due to susceptibility artifact from patient's stent.Multiple new liver lesions are noted. Many of these are intrinsically T1-weighted hyperintense. Of these, several demonstrate arterial enhancement and washout, compatible with multifocal HCC in additional to multiple dysplastic nodules.For future reference a segment 5/6 lesion measures approximately 1 cm (series 100/50 and series 102/50). 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: Bilateral heterogeneous periaortic masses. The right-sided mass measures 9.6 x 7.2 cm (series 3/17) compared to 11.7 x 10.2 cm previously. The left-sided mass measures 9.3 x 10.2 cm (series 3/17), compared to 10.2 x 9.4 cm previously. The masses displace loops of small bowel.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Incisional fat-containing hernia.OTHER: Large right-sided pleural effusion with right lower lobe compressive atelectasis. Enhancing pleural nodule (series 1 102/84) measures 1.6 x 1.2 cm, unchanged.

Output: 1.Mild interval decrease in the large bilateral periaortic lymph node masses.2.Multiple new liver lesions some of which meet imaging criteria for multifocal HCC. Others may represent dysplastic nodules and/or early-HCC. Consider CT evaluation to evaluate for the central aspect of the liver which is obscured by artifact.3.Large right-sided pleural effusion with a 1.6 cm enhancing pleural nodule.


Instruction: Generate impression based on findings.

Input: 34-year-old man with left hip pain and signs of impingement, evaluate for labral tear. ACETABULAR LABRUM: There is no significant abnormality, specifically no labral tear.ARTICULAR CARTILAGE AND BONE: Mild bony prominence of the femoral head and neck junction is noted, likely representing a cam deformity of femoral acetabular impingement. However the underlying cortical and marrow signal appears normal. The articular cartilage appears normal. SOFT TISSUES: The musculature of the hip appears normal without signs of atrophy or tendinopathy. ADDITIONAL

Output: 1.No labral tear.2.Mild prominence of the femoral head and neck junction suggestive of cam deformity.


Instruction: Generate impression based on findings.

Input: Reason: 72y F with lung adenocarcinoma History: lung adenocarcinoma staging. Please note several post gadolinium sequences are motion degraded limiting sensitivity for small lesions. There is residual enhancing lesion involving the posterior aspect of the right superior temporal gyrus measuring 6 x 7 mm. There is also an enhancing lesion involving the left lateral occipital lobe measures approximately 7 x 5 mm, axial image 15 of series 10. These lesions demonstrate mild restricted diffusion. There are multiple additional foci of mild restricted diffusion including the medial aspect of the right thalamus as well as involving the right posterior frontal lobe without definite enhancement appreciated on the limited post gadolinium sequences.There is focus of susceptibility effect involving the left temporal white matter which is compatible with a chronic microhemorrhage and nonspecific. There is mild to FLAIR hyperintensity associated with the above-mentioned lesions without evidence of significant edema or mass effect. There are scattered foci of T2 hyperintensity within the periventricular and subcortical white matter, which are nonspecific but compatible with mild chronic small vessel ischemic disease. No hydrocephalus. No extra-axial collections. No midline shift or herniation. Bone marrow signal and intracranial soft tissues are unremarkable.

Output: Motion degraded postcontrast sequences limit sensitivity for small lesions. There are at least 2 subcentimeter enhancing lesions involving the right temporal and left occipital lobes which are suspicious for metastatic disease. There is mild restricted diffusion associated with these lesions. There are also at least 2 other foci of restricted diffusion without definite enhancement appreciated. As such, these may represent additional metastatic foci versus punctate infarcts. There is a small possibility that two enhancing lesions are related to subacute infarcts but is felt to be less likely. Follow-up MRI with contrast with sedation would be helpful for differentiation.No significant edema or mass effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no degenerative changes or stenoses.

Output: Negative noncontrast MRI of the cervical spine. Specifically, there are no cervical spine findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 14 year-old history of complex partial epilepsy secondary to cortical dysplasia and ganglioglioma status post surgical intervention. Additional history of ganglioglioma resection in 2011. Post surgical changes from resection of the left temporal and occipital lobes. There is also encephalomalacia involving the mesial left parietal lobe with adjacent white matter gliosis presumably postsurgical in etiology. There is ex vacuo dilatation of the left lateral ventricle as well as 3 mm leftward midline shift.No abnormal enhancement on the postcontrast images. No areas of cortical dysplasia are identified. The expected intracranial vascular flow voids are present.Left maxillary sinus mucous retention cyst. There is partial opacification of the left mastoid air cells. The orbits are unremarkable.

Output: 1. Expected post surgical changes from left parietal, occipital and temporal resection for management of refractory epilepsy. No unexpected structural abnormality or enhancing mass is identified.2. Left maxillary sinus mucous retention cyst.


Instruction: Generate impression based on findings.

Input: Clinical question: Structural cause for migraine. Signs and symptoms: Headache. Nonenhanced brain MRI:Diffusion weighted images demonstrate no abnormalities.There is normal anatomical morphology and signal intensity to brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: Negative nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Spina bifida with hydrocephalus, unspecified region [741.00], Reason for Study: ^Reason: eval for pathology s/p Chiari decompression, LUE weakness History: LUE weakness, parenthesis There is evidence of decompressive suboccipital craniectomy.There is evidence of buckling of operation site dura indicating postoperative status.Focal acute hemorrhage on the lower medulla extended toward cervical medullary junction with the surrounding edema is seen.Central canal from C5 to T1 shows prominency and there is overt central canal dilatation from T6 to T9. Therefore, both C5 to T1 and T6 to T9 might represent syringomyelia. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal .There are minimal bulging of discs at the level of C45 and C56 without imaging evidence of spinal stenosis.

Output: 1. Left posterior lower medullary hemorrhage which extends toward left cervicomedullary junction with surrounding edema as described above.2. Syringomyelia from lower cervical and mid thoracic level as described above.3. Minimal disc bulging at the level of C45 and C56.4. Unremarkable thoracic discs and spinal canal.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There is an approximately 1.0 x 1.1 cm round area of ill-defined enhancement in the right insular cortex with surrounding vasogenic edema. There is gradient susceptibility in this area suggestive of hemorrhage, similar to prior examination.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are no new foci of diffusion restriction to suggest acute or subacute ischemia. Small area of FLAIR signal abnormality measuring approximately 1.0 x 1.4 cm demonstrated in the left parahippocampal gyrus, increased in size from prior examination when it measured 0.7 cm. There is no significant diffusion hyperintensity remaining, and ADC images are unremarkable. There are postsurgical changes consistent with right-sided craniotomy of uncertain etiology despite review of EMR. There is T2 and FLAIR signal hyperintensity present along the anterior aspect of the right inferior frontal gyrus with associated volume loss. Punctate foci of signal loss on susceptibility weighted imaging is present in the left inferior parietal lobule and another in the left superior frontal gyrus. Additional small foci of susceptibility artifact are demonstrated in the bilateral cerebellar hemispheres. The visualized portions of the paranasal sinuses demonstrate partial opacification of the left maxillary sinus. Left maxillary mucosal retention cyst again seen.MRA Head:There is diffuse dolichoectasia of the intracranial vasculature. The intracranial internal carotid arteries are normal in course. The middle cerebral arteries and anterior cerebral arteries are unremarkable. A right middle cerebral artery branch does course in the location of the right subinsular abnormality although it appears unremarkable. The vertebral arteries and posterior cerebral arteries are normal in course. There is no evidence of flow-limiting stenosis or aneurysm.MRI Neck:There is an approximately 5.6 x 4.0 x 3.5 cm ovoid enhancing mass in the right submandibular region, previously 2.5 x 2.4 cm. This mass demonstrates diffusion restriction. The mass is located along the lateral aspect of the submandibular gland and is inseparable from the submandibular gland itself. No significant lymphadenopathy is appreciated within the neck. No additional masses are identified.There is a medialized left vocal cord with thickening of the aryepiglottic fold with a small area of fat just cranially, which may relate to chronic atrophy from paralysis.A small cyst is incidentally noted involving the facial soft tissues overlying the left maxilla (series 18, image 6). There is multilevel spondylosis of the cervical spine with reversal of the cervical lordosis at C3-C4 level. There is moderate spinal stenosis at the C3-C4 level. Multilevel loss of intervertebral disc spaces is demonstrated.

Output: 1. Rounded 1.1 cm hemorrhagic focus with associated ill-defined enhancement in the right insula is again seen with surrounding FLAIR hyperintensity and is suspicious for hemorrhagic metastatic disease versus hemorrhage of other etiology, potentially amyloid angiopathy. 2. Small hemorrhagic foci are again seen in the right and left cerebellar hemisphere as well as smaller hemorrhagic lesions in the left frontal lobe and left parietal lobe. These are nonspecific and could relate to chronic hemosiderin deposition or mineralization, potentially from amyloid angiopathy.3. Small focal area of signal abnormality in the left parahippocampal gyrus has slightly increased in prominence but remains nonspecific. Previous diffusion hyperintensity is no longer conspicuous, and findings could represent an evolving area of ischemia. 4. Findings suggest encephalomalacia along the right prefrontal artery territory. This could be a result of prior vascular event or possibly related to the previous unknown surgery. 5. There is an approximate 5.6 cm lobular enhancing mass in the right submandibular region with diffusion restriction, increased in size from prior CT dated 6/11/2016, consistent with known neoplasm. Adjacent lobulated enhancement may represent additional components of the mass versus adjacent lymphadenopathy.6. There is redemonstration of a medialized left vocal cord with thickening aryepiglottic fold, which may relate to chronic paralysis.7. MRA of the head demonstrates no aneurysm or flow-limiting stenosis. Diffuse dolichoectasia of the intracranial vessels.


Instruction: Generate impression based on findings.

Input: Seizures. There is T2 hyperintensity and volume loss involving the left medial temporal sclerosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with left medial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: Clinical question:Preop planning. Signs and symptoms: Epilepsy. Going for surgery. Pre- and post enhanced treatment planning MRI:Limited nonenhanced portion of the exam demonstrate a laser ablation device entering the calvarium via a left posterior temporal burr hole and tip of the device in the left hippocampus. No evidence of hemorrhage. Focus of T2 hyperintensity at the level of burr hole is again identified.Post enhanced images demonstrate patchy and linear enhancement extending from the left hippocampus posteriorly along the medial aspect of left anterior and mid temporal lobe along the course of the laser ablation device.Minimal dural thickening and enhancement at the level of the burr hole is also noted.Subtle dural thickening and enhancement along the left anterior temporal burr hole is also noted.Ventricular system remain within normal and without deviation of midline.

Output: 1.Placement of a laser ablation device entering from the left posterior temporal burr hole with the tip in the left hippocampus.2.Post enhanced images demonstrate patchy linear enhancement of the left hippocampus and extending posteriorly along the course of the laser ablation device as detailed.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with history of pituitary adenoma. A lesion is redemonstrated within the left inferior aspect of the sella demonstrating slight hyperenhancement relative to the surrounding native pituitary gland. The lesion measures 8 mm AP, 8 mm CC and 10 mm TV showing no significant interval change from the prior examination. No definite cavernous sinus or suprasellar extension is seen. The native pituitary gland appears to drape over this lesion and is otherwise unremarkable. The pituitary stalk sits at midline and shows normal enhancement.

Output: Stable pituitary lesion which would be compatible with an adenoma.


Instruction: Generate impression based on findings.

Input: 25-year-old female with history of ulcerative colitis presenting with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large colonic stool burden, compatible with constipation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large colonic stool burden, compatible with constipation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Constipation but otherwise unremarkable examination.


Instruction: Generate impression based on findings.

Input: Ms. Lee is a 68-year-old female with biopsy-proven multicentric disease of the right breast (IDC/DCIS). She presents today for MR imaging for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST: No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.LEFT BREAST:There is extensive clumped nonmass enhancement identified in the left lateral breast, measuring approximately 7.1 x 3.0 x 3.7 cm (AP x ML x SI). This enhancement extends up to the left nipple base. Susceptibility artifact from Hydromark clip is seen in the central aspect of this clumped nonmass enhancement. Susceptibility artifact from ribbon biopsy marker clip is seen at the posterior aspect of this enhancement. The distance between the 2 clips on the diagnostic mammogram is approximately 5.3 cm in the AP dimension. No abnormal axillary lymph nodes are identified in the left axillary region.Few scattered nonenhancing T2 hyperintense lesions are identified in the liver, which may represent simple cysts versus hemangiomas.

Output: (1) 7 cm span of abnormal clumped non-mass enhancement in the left breast, extending up to the left nipple base, corresponding to the mammographically detected abnormality. Two biopsy marker clips are located approximately 5.3 cm apart in the AP dimension.(2) No abnormal left axillary lymph nodes.(3) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male 74 years old Reason: 73M w/ stage 3 rectal CA , urothelial CA and prostate adenoCA, evaluate surrounding structures History: as above PELVIS:PROSTATE/SEMINAL VESICLES: Changes secondary to transurethral resection. This study is notA dedicated prostate study, therefore, prostate cancer cannot be optimally evaluated. No evidence of extension of prostate cancer to the rectum. The fat plane between the prostate and the rectum is not preserved posteriorly in the midline and towards the right side, best seen on image #34, series #3. However, this a nonspecific finding and may be secondary to surgery or biopsy, although, invasion to the anterior rectal wall cannot be entirely excluded. A dedicated prostate MRI with endorectal coil may be helpful for better characterization.BLADDER: Bladder wall is diffusely thickened, however, no evidence of any focal mass that can be seen on MRI.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: 1. No evidence of mass in prostate or bladder. Fat plane between prostate and rectum is not well seen focally, posteriorly on the right side. This is a nonspecific finding. If there is any clinical concern for prostate cancer, further evaluation with dedicated prostate MRI with endorectal colon is recommended.


Instruction: Generate impression based on findings.

Input: Metastatic tonsil squamous cell carcinoma to the brain status post resection and post-operative SRS: surveillance MRI. There are post-treatment findings in the left temporal region with minimal residual enhancement and confluent T2 hyperintensity in the left lateral temporal lobe. However, there are new 5 mm enhancing lesion sin the left occipital lobe and right precentral gyrus. There is a small area of high T2 signal and restricted diffusion in the right middle frontal gyrus. There are otherwise unchanged scattered nonenhancing foci of cerebral white matter T2 hyperintensity. There is an unchanged punctate focus of susceptibility effect in the right centrum semiovale. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Post-treatment findings in the left temporal region without evidence of measurable tumor.2. New subcentimeter lesions in the left occipital lobe and right precentral gyrus may represent metastases. 3. A mall area of high T2 signal and restricted diffusion in the right middle frontal gyrus may represent a recent infarct.


Instruction: Generate impression based on findings.

Input: Focus for new GM seizure. Nocturnal seizures and +ANA. There is a circumscribed 9 x 9 mm round T2 hyperintense focus involving the posterior aspect of the right inferior temporal gyrus. There is associated enhancement. Medial to it is a smaller nodule with T2/FLAIR hyperintensity with mild enhancement suspected on the coronal post gad sequence.Remainder of the brain appears unremarkable with no other areas of abnormal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is asymmetry in size involving the lateral ventricles which is a normal variant. No hydrocephalus. No extra-axial collections. Bone marrow signal is within normal limits. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. There are ovoid enhancing nodules in the occipital scalp, left relatively larger than right measuring up to 18 x 13 mm on the left in the coronal plane. Presumably these represent enhancing lymph nodes.

Output: 9 mm cortical/subcortical focus of T2 hyperintensity with enhancement and adjacent more linear focus of T2 hyperintensity involving the right posterior right temporal lobe. Finding may be represent neoplasm such as a ganglioglioma or DNET with associated cortical dysplasia. Infection also remains a possibility especially chronic low-grade infection given absence of surrounding edema. There is an 18 x 13 mm enhancing nodule in the left occipital soft tissues which likely represents a mildly enlarged lymph node and is nonspecific. Unclear if this is related to the right posterior temporal lesion.


Instruction: Generate impression based on findings.

Input: Ms. Villa is a 67 year-old female with left breast ILC/LCIS status post lumpectomy with positive margins. MRI demonstrated abnormal enhancement separate from the lumpectomy bed. On subtraction images, an area of clumped nonmass enhancement was identified extending antero-medially from the superior aspect of the lumpectomy bed. This was chosen as the target for the MRI-guided biopsy.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 12 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a left unilateral mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed at 2 o'clock position with no evidence of any complications due to the procedure. Adjacent surgical clips and post-operative seroma are seen in the left upper outer breast, posterior depth. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Drs. Sheth and McCann, Dr. Sheth was present throughout the procedure.

Output: Successful MR guided core needle biopsy of the left breast clumped non-mass enhancement extending antero-medially from the superior aspect of the lumpectomy site with clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 6-month-old male with history intraventricular hemorrhage. Rule out hydrocephalus. Slight decrease in size of extra axial fluid which remains moderate on the left and mild on the right. Slight decrease in size of left porencephalic cyst. Prominent ventricular volumes are stable except in the frontal horn of the left lateral ventricle which has increased in size secondary to ex vacuo dilatation as adjacent left cerebral mass containing internal calcification has decreased in size.No new hemorrhage identified.Within the porencephalic cyst anteriorly (image 29, series 2) there is a rounded density that appears slightly larger than the prior study. This may represent organizing hematoma and can be further evaluated with an MRI. The calvaria and skull base are radiographically normal.

Output: 1. Decrease in size of extra-axial fluid collection, porencephalic cyst, and left cerebral mass representing hematoma2. Rounded density within the anterior aspect of the porencephalic cyst is slightly larger than the prior study and may represent an organizing hematoma. Further evaluation may be performed with a brain MRI.


Instruction: Generate impression based on findings.

Input: 49-year-old female with left lower quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific hypodense lesions in the liver. Their etiology is unknown. MRI of the liver may be helpful for further evaluation. An index lesion in the left lobe adjacent to the falciform ligament measures 2.2 x 2.1 cm image number 40, series number 3.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Nonspecific borderline enlarged retroperitoneal lymph nodes. An index left para-aortic node measures 1 x 1 cm image number 84, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There is multiloculated cystic collections in the left adnexa associated with surrounding fat stranding. Left ovary cannot be seen separate from these collections. One of the large pockets in the level quadrant measures 5.7 x 2.8 cm image number 119, series number 3. Medial to the peripheral enhancing fluid collection, best seen on coronal images there is a multiloculated left adnexal mass measuring 8 x 6.3 cm image number 63.Right ovary is enlarged. There is a 2 x 1.3 cm hypodense focus within the lower uterus/cervix. The etiology is unknown.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is diffuse wall thickening of the sigmoid colon, best image number 107, series number 3. This may represent colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the pelvis.

Output: Multiloculated fluid collections in the left lower quadrant associated with surrounding fat stranding. These findings may represent an abscess. Etiology is unknown. This may be a tubo-ovarian abscess versus an abscess secondary to sigmoid colitis or diverticulitis. An underlying ovarian neoplasm cannot be excluded.Enlarged right ovary.Nonspecific retroperitoneal borderline enlarged lymph nodes.Liver MRI with focal nodular hyperplasia protocol is recommended for further evaluation of the nonspecific hypodense liver lesions.