Instruction: Generate impression based on findings.

Input: There is a stable enhancing nodule in the posterior paramedian right cerebellum that measures approximately 6 x 4 mm. This lesion demonstrates a susceptibility signal and is most consistent with previous hemorrhagic metastatic lesion. The lesion is unchanged since the previous study.The nonenhancing focus that was seen in the left posterior temporal lobe in the previous study is still visualized; however it is less conspicuous with decreased enhancement. The remaining tiny metastatic lesions that were seen in the previous study in the supratentorial and in the cerebellum are no longer visualized.There is nonspecific T2/FLAIR hyperintensities in the subcortical and periventricular white matter and in the pons, representing chronic ischemic changes or posttreatment changes. These hyperintensities are unchanged since the previous study.There is no restricted diffusion. There is a punctate focus of susceptibility in the left parietal lobe, representing old blood product.There is mucosal thickening of the bilateral maxillary sinuses and the left sphenoid.Scattered foci of T1 hyperintensities are seen in the calvarium similar to prior. No destructive lesions within the calvarium are appreciated.

Output: Again seen is a small metastatic lesion in the right cerebellum that is unchanged in size and in pattern of enhancement since the previous study. The tiny focus in the left posterior temporal lobe seen in the previous study is less conspicuous with decreased enhancement. No new lesions.Patchy and confluent foci of FLAIR hyperintensity of bilateral hemispheric white matter and pons are compatible with small vessel ischemic disease and/or posttreatment-related changes. No significant intracranial edema, mass effect or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: 59 year old female with known recurrent right breast cancer post neoadjuvant chemotherapy. Personal history of bilateral breast cancer (right breast - DCIS/1997; left breast IDC/2011). There is an ill-defined hypoechoic mass at 10:00 position, measuring 24 x 13 mm, with mild blood flow. A marker clip is identified anterior to this mass. In the right retroareolar region (10:00 position), there is a dilated duct with internal solid lesion with mildly increased vascularity, measuring 15 x 4 mm, corresponding to today's MRI findings.In the right axilla, there are 2 abnormal lymph nodes, one (11 mm) with marker clip, and the other (14 mm) located superior and deep.

Output: Remaining right breast tumor and 2 abnormal morphology lymph nodes in the right axilla. BIRADS: 6 - Known cancer.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: hx of prostate cancer, in focal ablation trial, biopsy to follow . PELVIS:PROSTATE:Prostate Size: 4.5 x 6.0 x 3.5 cmPeripheral Zone: Right peripheral zone volume loss consistent with prior focal ablation therapy. Tiny foci of abnormal T2 hypointense foci which also demonstrate hyperenhancement, within the left peripheral zone (series 701, image 19). These are unchanged compared to prior studies.Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Capsular thickening in the region of prior ablation at the right base/mid gland.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 ablation changes in the prostate base/mid gland on the right.2.Tiny foci of signal abnormality within the left peripheral zone are unchanged compared to prior study.


Instruction: Generate impression based on findings.

Input: 61-year-old male with mass medial to the left knee with extreme pain medially to light touch. MENISCI: We see no findings to suggest an unstable meniscal tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss along the median eminence and medial facet of the patella with subchondral cysts and edema-like signal in the underlying bone.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendon are intact.ADDITIONAL

Output: Small nodular, enhancing mass in the subcutaneous fat medial to the proximal tibia is nonspecific, although we have seen glomus tumors of the knee present in a similar fashion; referral to orthopedic oncology is recommended.


Instruction: Generate impression based on findings.

Input: Meniscus tear status post ACL reconstruction 2003 with BTB. Medial joint line tenderness and progressive pain over several years. MENISCI: There is a horizontal tear through the posterior horn and body of the medial meniscus extending to the tibial articular surface with additional vertical component best appreciated on series 801, image 19. Postoperative findings of partial medial meniscectomy are present. Intermediate signal in the posterior horn of the lateral meniscus may indicate some intrasubstance degeneration though no discrete tear of the lateral meniscus is appreciated.ARTICULAR CARTILAGE AND BONE: There is grade II to III chondromalacia of the weightbearing portion of the medial femoral condyle, with a superimposed more focal area of increased signal suggestive of fraying (series 601, image 13). Low signal intensity in portions of the articular cartilage of the medial condyle may relate to microfracture changes. Otherwise cartilage of the lateral femoral condyle and patellofemoral compartment is intact. Tibial tunnel of the ACL graft reconstruction is noted. No significant bone marrow signal abnormality is present.LIGAMENTS: ACL graft reconstruction is present without evidence of complication. The posterior cruciate ligament, collateral ligaments, and popliteal ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Post surgical findings related to ACL graft reconstruction, medial meniscectomy, and microfracturing of the medial femoral condyle.2.Multidirectional tear of the medial meniscus, as above.


Instruction: Generate impression based on findings.

Input: Increased left-sided DTRs. CT of brain without enhancement:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system and all CSF cisterns remain within normal limits for patient's stated age of 77. The gray -- white matter differentiation is well preserved.Calvarium is intact.MRI is recommended if concern for stroke persists.Near complete opacification of right maxillary sinus consistent with chronic sinusitis. The rest of visualized paranasal sinuses are unremarkable.

Output: 1.Negative CT examination of brain. 2.Extensive chronic right maxillary sinus disease.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There is no evidence of abnormal diffusion or susceptibility. There are no structural abnormalities. There are no T2/FLAIR abnormalities. There is no abnormal enhancement. Ventricular size is normal. No midline shift. Basal cisterns are patent.MRA BRAIN:The cerebral internal carotid arteries are patent. The anterior, middle, and posterior cerebral arteries are patent. There is normal anterior communicating arteries. Both posterior communicating arteries are patent bilaterally. The basilar and the vertebral arteries are patent. There is no evidence of stenosis or aneurysm.MRA NECK:The bilateral common carotid arteries are normal. The cervical internal carotid arteries are normal. Cervical vertebral arteries are patent. There is no flow-limiting stenosis or aneurysm.

Output: 1. Unremarkable MRI of the brain. 2. Unremarkable MRA of the neck and the brain. There is no flow limiting stenoses, aneurysm, or evidence of vasculitis.


Instruction: Generate impression based on findings.

Input: Altered mental status and catatonia. History of developmental delay. Evaluate for acute changes. Brain parenchyma appears within normal limits. No focus of parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is within normal limitsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Sickle cell anemia and iron overload.EXAMINATION: MR Abdomen without contrast 4/29/15 Limited non infused MR of the liver in axial and coronal was performed for iron load measurement. The T2 star determination in the liver was made using 12 echoes of a m-FFE sequence in coronal and axial respectively, the average value is 10307.86 ms, with a standard deviation of 6325.55 ms.

Output: Liver iron load with a T star value of 10307.86 ms.


Instruction: Generate impression based on findings.

Input: Ms. Wesley is a 47-year-old female with known right breast cancer IDC with lobular features/DCIS and a metastatic right axillary lymph node. She presents today for I-SPY research MRI (#3). There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST: There has been interval decrease in size of biopsy-proven malignancy in the right retroareolar region now measuring 3.2 x 2.7 x 3.3 cm (AP x ML x SI), previously measuring 4.2 x 3.7 x 3.9 cm. Biopsy marker clip is located centrally within this malignancy. There continues to be persistent periareolar skin thickening. Multiple benign enhancing masses are unchanged. Biopsy-proven metastatic right axillary lymph node now measures 1.8 x 1.1 cm, previously measuring 2.5 x 1.7 cm. Biopsy marker clip is located centrally within this lymph node. No new abnormal enhancement is identified in the right breast. LEFT BREAST:No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region. Vascular port again present in the left medial chest wall.

Output: Continued reduction in size of known cancer in the right breast and metastatic right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 80-year-old male with gait and imbalance. Patient with parkinsonism, predominantly lower body; history of HLD; evaluate for vascular parkinsonism vs. NPH There is an area of hemosiderin stained encephalomalacia within the left inferior frontal lobe as well as additional scattered foci of hemosiderin deposition elsewhere, predominantly within the left frontal lobe. No acute intracranial hemorrhage or parenchymal edema is identified. No abnormal mass lesions are appreciated intracranially. No restricted diffusion is noted to suggest acute ischemia. The CSF spaces are appropriate for the patient's stated age with no evidence of significant deviation or mass effect. Vascular flow voids are intact with no definite evidence of vascular disease.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Hemosiderin staining encephalomalacia within the left inferior frontal lobe as well as additional scattered foci of hemosiderin deposition elsewhere predominantly within the left frontal lobe. Findings could represent sequela of remote traumatic injury. 2. No acute intracranial hemorrhage or ischemia is noted.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with low back pain in the setting of lung adenocarcinoma. Numerous patchy areas of T1 hypointense and STIR hyperintense marrow replacement are seen involving most of the visualized vertebral bodies with the possible exception of L1. The sacrum and iliac bones are also involved. Vertebral body heights are preserved. Within the limitations of a noncontrast examination, no evidence of significant epidural involvement is seen. Spinal alignment is anatomic.The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No specific epidural abnormalities are identified.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Disc bulging with a superimposed central superiorly directed extrusion. Severe spinal canal narrowing with effacement of CSF and crowding of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing.L5-S1: Facet hypertrophy and ligamentum flavum thickening. Mild disc bulging. No spinal canal stenosis. Moderate to severe right and moderate left foraminal narrowing.

Output: Numerous areas of marrow replacement are seen involving the lumbar spine, sacrum and iliac bones which are highly suspicious for metastatic foci. No compression deformities are noted. Within the limitations of a noncontrast examination, no evidence of significant epidural disease involvement is seen.Multilevel degenerative findings are also demonstrated, most significantly affecting the L3-4 level where there is a severe generalized spinal canal stenosis. Scattered variable foraminal narrowing is also present, most significantly affecting the right L5-S1 foramen.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with slurred speech and right facial droop on admission. Evaluate for stroke. Within the limits of motion degredation, the following observations are made. No restricted diffusion is seen. No edema or mass effect is seen. Mild T1 hyperintensity of the bilateral basal ganglia is unchanged. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: No evidence of acute ischemia or any other acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: An 85 year old female with glaucoma, asthma, depression and abnormal EKG (suspected of LVH strain). An echocardiography in 2013 showed normal systolic function with suspected apical hypertrophy. Referred to cardiac stress MRI to further evaluate ischemia and cardiomyopathy. MEDICATIONS: baclofen, alphagan, diltiazem, donezepil, ipatroprium, xalatan, levothyroxine, montelokast, omeprazole, sertraline, timolol, trospium Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 151 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 101 g/m2, and the LV mass is 179 g. There are no regional wall motion abnormalities present. The apex is severely hypertrophied with wall thickness measuring up to 22 mm; there is also extension of severe wall thickening into the basal and mid inferior, inferoseptal, and septal walls.First Pass PerfusionDuring hyperemia, a perfusion defect was present at the sub-endocardial level in the apical segments mainly in the septal and inferior walls.Viability/ Myocardial ScarThere was late gadolinium enhancement noted at the hypertrophied apex involving more than 50% in the anterior wall and less than 50% in the septum and lateral walls. The enhancement has an sub-endocardial and mid-myocardial pattern atypical for infarction. This finding in the context of a hypertrophied apex suggest fibrosis, inflammation, or infiltration. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 68 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is mildly dilated (42 X 41mm). There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (46mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is mild pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 67%).2. There is severe hypertrophy of the apex with cavity obliteration.3. Normal RV size and systolic function (RVEF 52%).4. During hyperemia, a perfusion defect was present at the sub-endocardial level in the apical segments mainly in the septal and inferior walls.5. There was late gadolinium enhancement noted at the hypertrophied apex involving more than 50% in the anterior wall and less than 50% in the septum and lateral walls. The enhancement has an sub-endocardial and mid-myocardial pattern atypical for infarction. This finding in the context of a hypertrophied apex suggest fibrosis, inflammation, or infiltration. 6. All these findings together are most probably compatible with apical hypertrophic cardiomyopathy. The perfusion defect is most probably secondary to the severe hypertrophy and not to coronary artery disease.7. The aortic root is mildly dilated.8. The pulmonary artery is moderately dilated.9. There is mild pericardial effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for mass/hydrocephalus/abnormality. Signs and symptoms: Enlarged head. Nonenhanced CT of brain:Significant pan ventriculomegaly with diffuse areas of periventricular low attenuation consistent with transependymal exudate. There is total effacement of cortical sulci and bulge of the brain parenchymal to the patent anterior fontanelle. There is no evidence of intracranial hemorrhage or midline shift. Further evaluation with MRI is recommended. There are no old studies available for comparison.Calvarium is intact however thin secondary to significant hydrocephalus.Visualized mastoid air cells, middle ear cavities, paranasal sinuses and orbits are unremarkable.

Output: Significant pan ventriculomegaly with transependymal exudate of periventricular white matter of bilateral cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: Former 30 3/7 week premature infant girl with history of cardiac arrests. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is deficient white matter myelination, which is mainly limited to the brainstem and portions of the cerebellum. In particular, there is no appreciable T1 hyperintensity of the posterior limbs of the internal capsules of peri-Rolandic regions. There is mild patchy symmetric T1 hyperintensity of the bilateral anterior thalami and globi pallidi. 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: Paucity of white matter myelination, which may be commensurate with corrected age for prematurity. Otherwise, no evidence of mass lesions, acute cerebral infarction, intracranial hemorrhage, hydrocephalus, or encephalomalacia.


Instruction: Generate impression based on findings.

Input: 43-year-old female with history of uterine AVM. PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged measuring 11 x 10 cm in maximal sagittal dimensions. There is a focus of mildly increased T2 signal abnormality within the left posterior uterus demonstrating arterial enhancement measuring 2.2 x 2.1 cm. The endometrial canal margins are indistinct and extend shallowly, but diffusely, into the myometrium compatible with adenomyosis. No abnormal flow voids are present to suggest large AVM.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a left Bartholin's gland cyst measuring 1.3 x 1.2 cm.

Output: 1. Markedly enlarged uterus.2. Probable small intramural uterine fibroid in the left posterior uterus. No evidence of uterine AVM, i.e., no flow voids seen.3. Diffuse uterine adenomyosis.


Instruction: Generate impression based on findings.

Input: Male, 8 years old. Swelling. Evaluate for osteo vs. subperiosteal abscess. Subcutaneous edema and inflammation circumferentially about the elbow, slightly more predominantly on the lateral aspect, compatible with cellulitis. Inflammation involves the distal brachialis muscle, indicating mild myositis. No discrete fluid collection is identified. Bone marrow signal is normal, and the cortical margins appear intact. No significant joint effusion is evident.

Output: Cellulitis about the elbow and mild myositis involving the brachialis muscle, without evidence of abscess or osteomyelitis. No significant joint effusion.


Instruction: Generate impression based on findings.

Input: New onset seizure 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.3D MRV brain with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: Normal brain MRA and MRV.


Instruction: Generate impression based on findings.

Input: New onset diplopia and memory loss, SLE patient. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. There is an unchanged small linear area of encephalomalacia in the right cerebellar hemisphere. There is unchanged apparent linear enhancement along the planum sphenoidale. The ventricles, sulci, and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is an unchanged enhancing focus in the right parietal bone. There is a small left sphenoid sinus rentention cyst.

Output: 1. CHronic lacunar infarct in the right cerebellar hemisphere, but no evidence of intracranial hemorrhage or acute infarct. 2. The unchanged apparent linear enhancement along the planum sphenoidale is likely related to artifact.3. Unchanged enhancing focus in the right parietal bone.


Instruction: Generate impression based on findings.

Input: 48-year-old with left breast invasive ductal carcinoma currently on neoadjuvant chemotherapy. No current complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Marked interval decrease in size of left upper outer quadrant mass corresponding to the site of the patient's previously biopsied known malignancy. A lock clip marks this location. There is small residual asymmetry medially in anterior to the clip better evaluated on today's MRI.No new masses, calcifications, or asymmetries in either breast.Small benign axillary lymph nodes bilaterally.  Targeted ultrasound of the left breast was then performed at the site of the patient's known malignancy. At the site of the previously identified lesion 8 cm from the nipple in the 2:00 radian there remains a irregularly marginated hypoechoic mass measuring 1.9 x 1.1 x 3.4 cm (previously 1.9 x 1.4 x 1.5 cm). Compared to prior, the appearance is less masslike. No significant internal vascularity is noted.

Output: Marked interval decrease in size of the patient's known malignant left upper outer breast mass on mammogram. Altered configuration on ultrasound, where there appears to be a band like area than a focal mass. No new masses or new suspicious abnormalities in either breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate MPFL graft, cartilage MENISCI: There is mild increased signal intensity within the inner fibers of the posterior horn of the medial meniscus likely representing fraying of the free edge. There is also blunting of the free edge of the body of the medial meniscus with mild medial extrusion of the body that appears to progressed when compared with the prior study. The anterior horn appears intact, and I see no fluid-filled or otherwise unstable meniscal tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness fissuring of the articular cartilage of the medial facet of the patella that is new when compared with the prior study. There is adjacent superficial tearing of the articular cartilage that extends to the median eminence. The articular cartilage of the lateral facet appears relatively intact. There is thinning of the articular cartilage of the medial facet of the femoral trochlea that has progressed when compared with the prior study. The articular cartilage of the lateral facet appears relatively intact. There are rounded foci of signal abnormality within the subchondral bone of the weightbearing portion of the medial femoral condyle. I do not know whether these represent degenerative cysts or sites of prior microfracture. Edema extends superiorly from these rounded foci. The articular cartilage overlying these subchondral foci is thinned, with a near full-thickness defect noted just above the free edge of the posterior horn of the medial meniscus. There is also thinning of the articular cartilage of the medial tibial plateau which is new when compared with the prior study. There is mild heterogeneity of the signal of the articular cartilage of the lateral tibial plateau suggesting mild degeneration, particularly beneath the posterior horn of the lateral meniscus. There are small tricompartmental osteophytes.LIGAMENTS: The anterior cruciate ligament appears intact. The posterior cruciate ligament appears slightly elongated, perhaps due to old trauma, but otherwise intact. The superficial band of the medial collateral ligament appears intact. The lateral collateral ligament complex appears intact. There is a medial patellofemoral ligament graft, the posterior fibers of which contain intermediate signal intensity suggesting degeneration, but I see no full-thickness rupture. EXTENSOR MECHANISM: The patient has undergone a tibial tuberosity transfer. The distal patellar tendon appears thickened and is traversed by a linear focus of high signal intensity. I suspect this represent a combination of tendinosis and postsurgical changes, perhaps with focal insertional tearing. The proximal patellar tendon and the distal quadriceps tendon appear intact.ADDITIONAL

Output: 1.Surgical changes of MPFL graft, with intermediate signal intensity in the posterior fibers of the graft suggesting degeneration.2.Surgical changes of tibial tuberosity transfer with increased signal intensity in the distal patellar tendon suggesting tendinosis and perhaps focal insertional tearing.3. Overall progression of osteoarthritis/cartilage degeneration, particularly within the lateral patellofemoral joint, as described above.


Instruction: Generate impression based on findings.

Input: 3-month-old with a AT/RT status post resection, VP shunt, and chemotherapy. Increasing morning vomiting. Rule out shunt malfunction, hydrocephalus. The VP shunt catheter enters the skull through the right aspect of the occipital bone. The catheter tip terminates in the left frontal lobe. Position of the catheter is stable from previous studies. Ventricular size is stable from the prior study.In the posterior fossa there is a rounded area of hypoattenuation at the region of the patient's previous tumor resection. This is enlarged since the prior study and raises concern for a cystic lesion exerting mass effect upon the brainstem. Recommend contrast enhanced MRI for better evaluation of this finding.There is increased attenuation in the right transverse and sigmoid sinus consistent with the patient's known dural sinus thrombosis.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Enlarging, cystic lesion in posterior fossa at site of patient's previous tumor resection. Recommend contrast enhanced MRI for further evaluation. 2. Stable catheter position and ventricular size.3. Stable findings of right transverse and sigmoid sinus thrombosis.These findings were discussed with Dr. Anzoma at 5:40 p.m. 08/19/2008.


Instruction: Generate impression based on findings.

Input: 74 year old woman with history of hypertension, hyperlipidemia, referred for further evaluation of chest pain.MEDICATIONS: amlodipine, lasix, ASA, simvastatin, valsartan First Pass PerfusionDuring hyperemia, a perfusion defect was noted in the basal anteroseptum and the mid anterior and anteroseptum. No resting images could be acquired for comparison because of above described reaction. Left VentricleThe left ventricle visually appears normal in size with preserved systolic function. No late gadolinium imaging was performed due to patients severe allergic reaction requiring immediate stopping of procedure. Left AtriumThe left atrium appears mildly dilated.Right VentricleThe right ventricle visually appears normal in size with preserved systolic function.Right AtriumThe right atrium is grossly normal in size 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. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, a perfusion defect was noted in the basal anteroseptum and the mid anterior and anteroseptum. No resting images could be acquired for comparison because of above described reaction. 2. Normal LV size and systolic function. 3. Normal RV size and systolic function.4. Patient suffered severe allergic reaction to either Multihance or regadenoson.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: ? Rotator cuff tear History: pain ROTATOR CUFF: No significant abnormality noted. No muscle atrophy.SUPRASPINATUS OUTLET: Mild thickening and increased signal of the distal supraspinatus tendon representing mild tendinopathy.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis of the glenohumeral joint. Small subchondral cysts in the humeral head.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild supraspinatus tendinopathy with osteoarthritis as above.


Instruction: Generate impression based on findings.

Input: History of left renal inferior pole oncocytoma, status post left partial nephrectomy. Evaluate left upper pole lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing bilateral cysts. Several too small to characterize left renal T2-weighted hyperintensities, likely cysts. Postsurgical changes from a left inferior partial nephrectomy.The mildly T2 weighted hypointense lesion in the superior pole of the left kidney measures 1.5 x 1.2 x 1.7 cm (series 9/19), compared to 1.6 x 1.2 cm previously. There are mild associated exophytic cystic changes. There is significant intrinsic T1 weighted signal intensity. There is suspected mild post-contrast enhancement of the lesion. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable left upper pole renal hemorrhagic subtly enhancing neoplasm.


Instruction: Generate impression based on findings.

Input: 54-year-old female with history of mild intrahepatic biliary ductal dilatation observed on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Minimal intrahepatic biliary ductal dilatation. The common bile duct measures 7 mm. No filling defects are present. No suspicious hepatic lesions. Gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: There is atrophy of the pancreatic distal body and tail. There is no ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys.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: Minimal intra and extrahepatic biliary ductal dilation with no evidence of distal mass or filling defect; a benign distal stricture cannot be excluded.


Instruction: Generate impression based on findings.

Input: Redemonstrated are several foci of T2 hyperintensity within the white matter, both subcortical and periventricular, some of which are oriented perpendicular to the corpus callosum. There has been some subtle change of a few lesional sizes, however there are no new lesions dating back to the 2007 comparison. None demonstrate contrast enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Stable nonenhancing multiple sclerosis plaques as described in detail above.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:10/20/1944)Reason: eval for nerve impingement. Pt with lateral soft tissue like neck mass and now with radiating pain of neck, shoulder, arm History: R neck, shoulder, and arm painPROVIDER/ATTENDING NAME: DIANE B CHANEY DIANE B CHANEY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is mild loss of disc space height and the disc bulge at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild loss of disc space height and the disc bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild loss of disc space height and the disc bulge at this level.At C5-6 there is a broad-based right lateral recess disc protrusion present at this level which encroaches on the right-sided exiting nerve roots. There is narrowing of the spinal canal present with mild spinal stenosis.At C6-7 there is a diffuse disc bulge present at this level associated with endplate and uncovertebral osteophytes and some narrowing of the neural foramina bilaterally with encroachment of the left-sided exiting nerve roots. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is mild spinal stenosis at this level. There is endplate reactive change present at this level. This endplate reactive change has high signal on T1 and heterogeneous signal on T2 STIR..At C7-T1 there is no significant compromise to the spinal canal. There is mild disc bulge at this level associated with endplate and uncovertebral osteophytes and narrowing of the neural foramina bilaterally. There is some mild encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with narrowing of the spinal canal in the lower cervical spine. There is moderate encroachment of the right-sided exiting nerve roots at C5-6 as a result of a disc protrusion and some osteophytes. There are lesser degrees of neural foraminal encroachment in the lower cervical spine at other levels (detailed above) and mild degrees of spinal stenosis at C5-6 and C6-7.


Instruction: Generate impression based on findings.

Input: Reason: trigeminal neuralgia; referred for radiosurgery; please obtain for treatment planning purposes History: trigeminal neuralgia The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the SWI images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.This is a limited examination for the purpose of treatment planning for trigeminal neuralgia. No obvious intracranial mass lesion is appreciated.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: rule out Right RTC tear or arthropathy History: pain and decreased ROM at right shoulder; heard popping sensation 6 mos ago when reaching out ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is an os acromiale. The acromioclavicular joint is slightly widened with a small amount of fluid within the joint which may reflect prior surgery or trauma, but we see no edema within the distal clavicle or os currently. There is no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is full-thickness loss of cartilage along the anterior superior glenoid as well as small osteophytes indicating osteoarthritis. There is also heterogeneity of the articular cartilage along the posteromedial aspect of the humeral head. There are small defects along the surface of the humeral head with underlying edema which may be degenerative in etiology. Fluid separates the anterior superior labrum from the underlying glenoid in the location of the aforementioned absent articular cartilage which may represent a tear or simply a prominent sublabral sulcus, exaggerated by the lack of articular cartilage.BICEPS TENDON: There is a lobulated collection of fluid within the bicipital groove surrounding the biceps tendon suggesting a tenosynovitis. The intra-articular portion of the tendon of the long head of the biceps appears normal.ADDITIONAL

Output: 1. Normal appearing rotator cuff.2. Os acromiale with slight widening of the acromioclavicular joint which may reflect old surgery or prior trauma.3. Osteoarthritis of the glenohumeral joint.4. Biceps tenosynovitis.


Instruction: Generate impression based on findings.

Input: Low back pain with radiation into left thigh, also history of metastatic breast cancer, possible spinal stenosis, on tamoxifen. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. There is mild heterogeneity of the bone marrow which is nonspecific. Endplate marrow signal changes are noted at L4-L5 and L5-S1 which are on a degenerative basis. No suspicious focal lesions are appreciated. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge with mild right foraminal disk protrusion. Minimal narrowing of the inferior aspect of the right neural foramen. Otherwise, no significant spinal canal or left neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is disk desiccation with loss of height with mild diffuse disk bulge. There is also ligamentum flavum thickening and mild facet arthropathy which result in minimal narrowing of the spinal canal. There is mild to moderate left neural foraminal narrowing. No right neural foraminal stenosis.L5-S1: There is disk desiccation with loss of height and mild bulge. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal narrowing. There is mild multilevel facet arthropathy. Paraspinous soft tissues are within normal limits. Small bilateral renal cysts.

Output: 1. No compression fractures or suspicious lesions within the lumbar spine to suggest metastatic disease. Postcontrast study would be more sensitive for small lesions and can be considered if clinically indicated.2. Mild multilevel degenerative changes as detailed above. There is minimal narrowing of the spinal canal at L4-L5, otherwise no significant spinal canal stenosis at any level.3. There is mild to moderate left neural foraminal stenosis at L4-L5 related to disk bulge and facet arthropathy. There is contact of the exiting left L4 nerve root.


Instruction: Generate impression based on findings.

Input: Male 37 years old Reason: H/o post transplant Hodgkin Lymphoma in remission. Last contrast neg CT showed a small hypoattenuating area of unclear etiology. Please eval History: None ABDOMEN:LIVER, BILIARY TRACT: There is a well demarcated 2.4 x 1.9 cm mildly T2 hyperintense/mildly T1 hypointense lesion within the posterior right hepatic lobe. Evaluation for enhancement is limited due to delay in arterial phase of imaging. The lesion appears isointense to hepatic parenchyma on more delayed phases of contrast without definite washout. There is a subtle suggestion of a central T2 hyperintense scar (series 6, image 15). This does not have the appearance of focal fat.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Atrophic left native kidney. Right fossa transplant graft is partially imaged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple enhancing lesions within the vertebral bodies and left posterior rib (series 3, image 21) are incompletely evaluated on this study and are nonspecific.

Output: 1.2.4 cm lesion within the posterior right hepatic lobe is nonspecific. This may represent malignancy in the context of this post transplant patient with lymphoma. FNH could have a similar appearance however and the patient will be recalled for dynamic postcontrast imaging including hepatobiliary phase for further evaluation.2.Multiple enhancing lesions within the bones are incompletely evaluated on this study and are nonspecific.


Instruction: Generate impression based on findings.

Input: 64-year-old male with elevated alkaline phosphatase, mild transaminase elevation ABDOMEN:LIVER, BILIARY TRACT: Normal liver contour. Peripherally calcified lesion measuring 2.1 x 1.7 cm in the dome of the right lobe of the liver, segment eight is unchanged from exam dated 4/26/2014. Mild intrahepatic biliary ductal dilatation. Common bile duct measures 6 mm. Distended gallbladder and cholelithiasis without evidence of cholecystitis. There are two small apparent filling defects in the distal common bile duct (series 8, image 82; series 9, image 4). SPLEEN: Trace fluid around the spleen. PANCREAS: Thinning of the pancreatic parenchyma at the proximal body may reflect focal atrophy versus normal variant. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst it is unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction. T2 hyperintense lesion adjacent to a loop of small bowel may represent a fluid filled diverticulum versus enteric duplication cyst. No evidence of complication. BONES, SOFT TISSUES: Compression deformity of the T12 vertebral body with greater than 50% loss of height anteriorly. Grade 1 anterolisthesis of L4 on L5. Mild superior endplate compression deformity of the L5 vertebral body.OTHER: No significant abnormality noted.

Output: 1.Mild intrahepatic biliary ductal dilation. Two small apparent filling defects in the distal common bile duct are inconclusive although tiny nonobstructing stones not entirely extruded. No CBD dilation. 2.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Female, 44 years old. Hx of cervical cancer, with subacute right lower extremity weakness and radiculopathy. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. Within the limits of noncontrast imaging, no suspicious lesions are identified within the lumbar spine. The conus medullaris on sagittal imaging is grossly intact. There are minimal degenerative changes of the lumbar spine, including mild disc bulge at L1-2, with no significant compromise to the spinal canal or neuroforamina.An expansile infiltrative mass centered on the right iliac bone is partially visualized with mild extension into the lateral sacrum and iliacus muscle. There is presumed involvement of the peripheral lumbosacral plexus/nerves to explain the patient's symptoms but is not assessed on this lumbar spine study. This mass appears new from prior CT imaging dated 10/2015. No other mass lesions are identified. Diffuse T1 hyperintensity in the pelvis may be related to prior radiation therapy. Atrophic right kidney.

Output: 1.Expansile mass centered on the right iliac bone is partially visualized and highly suspicious for osseous metastasis. Contrast-enhanced MR imaging of the pelvis may be obtained to assess for the full extent of this lesion. There may be involvement of the peripheral lumbosacral plexus/nerves to explain the patient's symptoms but is not assessed on this lumbar spine study. 2.No suspicious lesions identified within the lumbar spine. No compromise of lumbar spinal canal or neuroforamina.


Instruction: Generate impression based on findings.

Input: 19 year old male with shoulder pain, possible posterior labral tear ROTATOR CUFF: The muscles and tendons of the rotator cuff appear normal.SUPRASPINATUS OUTLET: The AC joint is within normal limits. There is no fluid in the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. The labrum appears intact. The bone marrow signal is within normal limits.BICEPS TENDON: The long head biceps tendon is intact and normally situated within the bicipital groove.

Output: Normal shoulder without specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Female 65 years old Reason: liver lesion History: as above LUNG BASES: Bibasal atelectasis.ABDOMEN:LIVER, BILIARY TRACT: There is signal dropout within the liver suggestive of hepatic steatosis.There is a 3.1 x 2.4 cm lobulated T1 hyperintense/T2 hypointense lesion within segment 7 which has thin enhancing internal septations and minimal mural nodularity in the lateral wall. The central T1 hyperintense signal likely reflects proteinaceous material/hemorrhage.A nonenhancing T2 hyperintense lesion measuring 1.7 cm in the left hepatic lobe has the appearance of a simple cyst.Multiple additional T2 hyperintense lesions are too small to characterize.SPLEEN: Mild splenomegaly measuring 13.3 cm.PANCREAS: A 1.3 x 1.2 cm lesion projects off the dorsal aspect of the pancreatic body (series 801, image 25). This follows pancreatic parenchymal signal on all sequences and although the location is somewhat atypical this likely represents contour irregularity. Immediately medial to this there is a 0.7 cm, T2 hyperintense lesion, likely representing a side branch IPMN (series 801, image 25).ADRENAL GLANDS: A 2.7-cm nodule arising from the left adrenal gland demonstrates signal dropout on out of phase images and is suggestive of an adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Lobulated, 3.1 cm, T1 hyperintense lesion within segment 7 with thin enhancing internal septations and small enhancing mural nodule. This is most compatible with a biliary cystadenoma. Biliary hamartoma or complex hepatic cyst could have a similar appearance. 2. Probable contour irregularity of the dorsal aspect of the pancreatic body. Given the somewhat atypical location follow up MRI is recommended to ensure stability.3. subcentimeter IPMN adjacent to above-described lesion.4. Left adrenal adenoma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosusClinical question: evaluating for underlying cause of change in pattern of headaches.Signs and Symptoms: Pt with migraines since elementary school, has had increased frequency of migraines over past 6 months, now 8 per month. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for intracranial mass lesion. MRI of the brain is within normal limits.2.Mucosal thickening in the paranasal sinuses is most likely inflammatory in nature but is a common finding. Please correlate with clinical symptoms for potential sinusitis.


Instruction: Generate impression based on findings.

Input: Lower back and groin pain. Evaluate for lumbar spine compression/DJD/metastasis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. No suspicious osseous lesions. No abnormal epidural or leptomeningeal enhancement. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation and a central disc protrusion. No spinal canal or neural foraminal stenosis.L4-L5: There is disc desiccation and a central disc protrusion. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. No evidence of metastatic disease in the lumbar spine.2. Mild degenerative changes with small disc protrusions at L3-L4 and L4-L5. There is no significant associated spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 10-year-old male with a LL and known cervical hydromyelia, with neuropathy, and confusion. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The cerebellar tonsils are in an appropriate position. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: Redemonstrated is a long-segment nonenhancing thoracic syrinx that measures up to 3 mm in maximal width, unchanged in appearance. As before it extends from approximately C5/6 through T12. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.No MRI evident intracranial abnormality. 2.Redemonstrated is a stable long-segment thoracic syrinx that measures up to 3 mm in maximal width, without associated enhancement.


Instruction: Generate impression based on findings.

Input: Known pancreatic tail cyst. Evaluate for growth or changes. ABDOMEN:LIVER, BILIARY TRACT: Left lobe hepatic cyst measuring 1.2 cm. Multiple other nonspecific subcentimeter T2 hyperintense lesions, likely cysts. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a multilobulated cystic nonenhancing lesion of the pancreatic tail, measuring 2.9 x 2.0 cm (series 8, image 14) which may represent ductal or parenchymal pancreatic lesion. It is stable to slightly increased in size from that seen on prior CT, remeasured at 2.6 x 2.0 cm. Atrophy of the pancreatic tail is noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multilobulated nonenhancing cystic lesion of the pancreatic tail is stable to slightly increased from previous exam and may represent a mucinous cystic neoplasm.


Instruction: Generate impression based on findings.

Input: Female; 52 years old. Reason: 52F with colon cancer with suspicious liver lesion. rule out metastatic disease prior to OR date on 4/22/15 History: colon cancer with OSH CT report indicating suspicious liver lesion. please rule out metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: 1 cm simple cyst is seen in the anterior aspect of the left lobe of the liver in segment 3. No suspicious hepatic lesions. Mild diffuse hepatic steatosis. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesions.2.Mild diffuse hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: left facial droop and altered mental status. Clinical question: Stroke? Non-enhanced CT brain:There is evidence of a large right temporal craniotomy with diffuse area of encephalomalacia in the right anterior and mid temporal. There is ex vacuo dilatation of right temporal horn and trigone of right lateral ventricle.Encephalomalacia of the right occipital lobe of unknown etiology. This finding could represent an old stroke or cytotoxic views the treated metastatic lesion. Clinical information on MRI of brain head was performed after this CT indicated patient's history of metastatic lung cancer.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium demonstrate changes of right frontal temporal craniotomy and is otherwise unremarkable. Visualized mastoid air cells and middle ear cavities and paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Encephalomalacia of in the right temporal lobe under a craniotomy flap are present postoperative change.3.Right occipital encephalomalacia of unknown etiology. Please see above comments.4.Calvarium demonstrate right sided craniotomy and he is otherwise intact.5.Visualized paranasal sinuses, mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: Spinal stenosis, lumbar region, without neurogenic claudication Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a minor disc bulge at this level. This has not changed substantially since the previous examAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate to marked bilateral facet hypertrophy present at this level which was also present on the prior exam and has not changed substantially. The patient is status post posterior elements surgery at this level with laminotomy defects. There is some disc desiccation present at this level. Overall there is mild spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present associated with a mild disc bulge and some mild ligamentum flavum hypertrophyAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a parapelvic cyst present in the left kidney which was also present on the prior exam but is somewhat larger on the current exam.

Output: No compromise to lumbar spinal canal or neural foramina. The patient is status post lumbar spine surgery at L4-5.


Instruction: Generate impression based on findings.

Input: History of HCV cirrhosis. Presents for hepatocellular carcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: The liver contour is mildly lobular. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with left-sided back pain and left lower extremity radiculopathy. T1 hypointensity and heterogeneous T2 hyperintensity are seen affecting the superior aspect of the L4 vertebral body. These findings correlate with sclerosis and cystic changes demonstrated on prior CT from 2013. Only slight loss of vertebral body height is seen at this level which may reflect endplate degeneration and/or Schmorl's node formation. The remaining vertebral bodies are free of significant marrow signal abnormality and demonstrate preservation of height. Spinal alignment is anatomic. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.A large left renal cystic lesion is partially visualized.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Mild disc bulging. No spinal canal or foraminal stenosis. L3-4: Moderate facet arthropathy and ligamentum flavum thickening. Bulging disc. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Advanced facet arthropathy. Ligamentum flavum thickening. Disc bulging with perhaps a small superimposed right paracentral/foraminal protrusion. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. L5-S1: Moderate facet arthropathy. Ligamentum flavum thickening. Bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Findings are seen compatible with sclerosis and endplate degeneration or Schmorl's node formation at L4. Accounting for differences in technique, this abnormality does not appear to have changed significantly when compared to a prior CT examination from 2013.2.No other definite acute vertebral body abnormalities are seen.3.Multilevel disc and posterior element degeneration are seen. At most, the spinal canal is mildly narrowed. Moderate right foraminal narrowing is seen at L4-5.


Instruction: Generate impression based on findings.

Input: 70 year-old female with metastatic breast cancer presenting with drowsiness and decreased concentration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is redemonstration of abnormal low T1 signal abnormality with consequent enhancement in the medial right parietal bone which is largely unchanged (measuring 57 mm in both the axial and coronal plane). There is no underlying suspicious dural or parenchymal enhancement.Major flow-voids are preserved.Sella and orbits are grossly within normal limits. A small amount of fluid is visualized bilaterally within the maxillary sinuses. The remaining paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Unchanged abnormal right parietal bone marrow signal is consistent with metastasis.2. There is no evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: H/o breast cancer. Examination demonstrates a focal hypodensity lateral to the left insular fissure, corresponding a metastatic lesion on the previous MRI. The brain is otherwise normal in attenuation and morphology. There is no intracranial hemorrhage, mass effect, edema, midline shift or abnormal extra-axial fluid collection.There is a focal area of lytic change in the left frontal bone. The visualized paranasal sinuses are well cells are normally pneumatized.

Output: 1. Left temporal metastatic lesion. An infused exam is suggested for further evaluation. 2. Metastatic lesion in the left frontal bone.


Instruction: Generate impression based on findings.

Input: Headache after concussion; seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, without evidence of hippocampal sclerosis, heterotopia, or gross cortical malformation. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No gross evidence of traumatic brain injury or potential seizure foci.


Instruction: Generate impression based on findings.

Input: 38-year-old female with stage I adenocarcinoma of the cervix status post abdominal trachelectomy PELVIS:UTERUS, ADNEXA: Bilateral hemorrhagic and physiologic ovarian cysts. Interval decrease in size of 4.0 cm follicle in the left ovary. Status post trachelectomy without evidence of a focal enhancing mass. Small amount of fluid within the endometrial canal.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy is evident. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No enhancing mass or pelvic lymphadenopathy to suggest recurrence.


Instruction: Generate impression based on findings.

Input: Cervical Spine: There is no significant change in appearance of the craniocervical junction including 7 mm inferior displacement of cerebellar tonsils through a foramen magnum, retroverted odontoid, and postoperative changes. CSF space posterior to the cerebellar tonsils is preserved. Partially imaged brain also demonstrates dysplastic corpus callosum with abnormal T2 hyperintensity better assessed on prior dedicated brain MRI. Ventriculostomy catheter is partially imaged. Lateral ventricles are not well assessed but appear decompressed. There is preserved biphasic flow ventrally at the foramen magnum with diminished flow dorsally at the foramen magnum and upper cervical canal, similar to prior CSF flow study from 9/28/2012.The cervical spinal cord has normal signal characteristics and overall morphology aside from trace prominence of the central canal at the C2 level which is not appreciably changed since 4/26/2014.As before, there is straightening of the normal cervical lordosis which may be positional. The cervical vertebral bodies are appropriate in overall alignment and height. No spinal canal or neural foraminal stenosis at any level. Thoracic Spine: The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is no evidence of syrinx. Lumbar Spine: There are postoperative changes related to myelomeningocele repair and cord untethering. Laminectomy changes are again seen from L3 to S1 level, although there is likely also a component of preceding congenital posterior element dysplasia. The lumbar spine is normal in overall alignment and height. There is partial lumbarization of S1 vertebral body. The conus medullaris/distal neural tissue is low lying and terminates at L3 and abuts the posterior dura as before. Prone images demonstrate no appreciable ventral motion. Distal nerve root clumping also not significantly changed. There is no significant compromise to spinal canal or neural foramina. Small focus of fluid is again seen posterior to the left L3-L4 facet joint measuring 9 x 11 mm in the AP and transverse dimensions and is slightly increased in size. There is moderate degree of facet arthropathy at the L4-L5 level similar to prior to a milder degree more superiorly and inferiorly.

Output: 1.Unchanged appearance of the decompressed craniocervical junction including 7 mm inferior displacement of the cerebellar tonsils as well as diminished biphasic flow dorsally at the foramen magnum and upper cervical canal.2.Stable mild prominence of the central canal at C2. Otherwise, no cord signal abnormality to suggest new or enlarging syrinx. 3.Postsurgical changes in the lumbar spine related to prior myelomeningocele repair and cord untethering again seen. Unchanged appearance of the conus/ distal neural tissue which abuts the dorsal dural margin. No appreciable ventral motion is seen on the prone sequences which is unchanged. Cord re-tethering cannot be excluded and suggest correlation with clinical findings. Distal cauda equina nerve roots also abut the dorsal and lateral dural margins which may indicate arachnoiditis but also unchanged.4.Facet arthropathy in the lower lumbar spine is again seen. There is a small focus of fluid, presumed synovial cyst, posterior to the left L3-L4 facet joint which is slightly larger since 4/26/2014.


Instruction: Generate impression based on findings.

Input: 43 years, Female, Reason: eval s/p ablation for epilepsy History: epilepsy. Compared to 9/9/2015, there is been decrease in enhancement related to ablation of the right amygdala/hippocampus. There is also mild T2/FLAIR hyperintensity within this region which may represent gliosis. Mild volume loss in the right medial temporal lobe is also noted when compared to prior MRI dating back to 4/30/2014 with slight increase in size of the right temporal horn. Changes of prior left-sided electrode placement involving the left medial temporal lobe also noted. Unchanged mild nonspecific patchy T2 hyperintensity in the frontoparietal periventricular white matter. No evidence of acute ischemia, intracranial hemorrhage, new mass or mass effect. No hydrocephalus. Multiple burr holes in the bilateral occipital and right temporal calvarium again seen.

Output: Interval decrease in enhancement in the right medial temporal lobe consistent with evolution of posttreatment changes of prior laser ablation.


Instruction: Generate impression based on findings.

Input: Clinical question: 43-year-old male with history of scoliosis, pes cavus, family history of RA with 4 months seen near back pain without improvement with physical therapy. Concern for radiculopathy on exam. Evaluate for degenerative disk disease and stenosis. Signs and symptoms: Lumbar/thoracic back pain, positive straight leg raise. Non-enhanced thoracic MRI:There are no coronal images available for evaluation of scoliosis.There is normal anatomical alignment the vertebral column and with normal signal intensity. There is no evidence of any appreciable significant degenerative disease of the spine. There is no evidence of spinal canal compromise or stenosis at any level.There is no evidence of neural foraminal compromise at any level.There is normal signal intensity and caliber of thoracic cord.Nonenhanced MRI:There are no coronal images available for assessment of scoliosis.There is normal anatomical development of the vertebral column and with normal signal intensity. There is normal anatomical alignment of the common however with straightening of lumbar lordosis.Mild degenerative disk disease at L5 -- S1 and a shallow broad-based bulging disk is noted. There is however no evidence of neural foraminal or spinal canal compromise or stenosis at any level. No detectable perispinal soft tissue abnormalities.There is normal termination of the cord at L1 level.The signal intensity of the conus and cauda equina is unremarkable.

Output: 1.Nonenhanced MRI of thoracic spine is unremarkable.2.Nonenhanced MRI of lumbar spine demonstrate mild degenerative disk disease at L5 -- S1 and unremarkable otherwise. No evidence of tethered cord. No evidence of spinal canal or neural foraminal compromise or stenosis at any level.


Instruction: Generate impression based on findings.

Input: 16-year-old with history of osteochondritis dissecans status post fixation. Postsurgical changes of an osteochondral lesion fixation involving a large irregularity, measuring approximately 1.5 cm, along the articular surface of the medial femoral condyle which remains in a similar position and alignment. A large knee joint effusion is noted.

Output: Postsurgical changes of an osteochondral lesion fixation.


Instruction: Generate impression based on findings.

Input: 57-year-old male with chronic low back pain. There is minimal retrolisthesis of L2 on L3, otherwise alignment is within normal limits. Bone marrow signal is benign. There is patchy T1 and T2 hyperintensity such as within the left half of the L1 vertebral body, which may represent a vertebral body hemangioma. There is mild to moderate degenerative disc space narrowing most severely affecting L2-3 and L3-4. The distal spinal cord and nerve roots appear unremarkable. Additional level specific findings are as follows:T12-L1: Minimal degenerative disc disease without central canal or neural foraminal compromise.L1-L2: Mild degenerative disc disease without significant central canal or neural foraminal stenosis.L2-L3: Mild-moderate degenerative disc disease with minimal disc bulge. No significant central canal or neural foraminal stenosis.L3-L4: Mild degenerative disc disease without significant central canal or neural foraminal stenosisL4-L5: No significant degenerative disc disease or central canal stenosis. Mild left neural foraminal stenosis and facet degenerative changes.L5-S1: No significant degenerative disc disease, central canal, or neural foraminal stenosis mild facet degenerative changes.

Output: Mild to moderate multilevel lumbar degenerative disc disease. No significant central canal or neural foraminal stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple myeloma There is no abnormal marrow signal to suggest active myelomatous involvement. There is no abnormal enhancement following gadolinium administration.There is mild diffuse fatty atrophy of the pelvic musculature, particularly of the gluteal groups. There is mild osteoarthritis of the hips.

Output: No evidence of active myelomatous involvement.


Instruction: Generate impression based on findings.

Input: 31-year-old female with right knee locking. MENISCI: There is marked attenuation of the medial meniscus, particularly of the body and posterior horn. This may be due to extensive partial meniscectomy, but if there is no history of prior surgery then this represents extensive tearing of the medial meniscus. We see no fluid signal entering the remainder of the medial meniscus to confirm a tear if there has been prior meniscectomy. A small focus of intermediate signal intensity along superior aspect of the remainder of the posterior horn of the medial meniscus may represent scar tissue or additional degenerated meniscal tissue. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defect. The bone marrow signal is within normal limits..LIGAMENTS: The ACL is intact. Fibers of the PCL can be traced from the femur to the tibia, but the PCL appears attenuated, likely from prior tear. The LCL and MCL are intact.EXTENSOR MECHANISM: The quadriceps and patella tendons are intact. Subjectively the femoral trochlea appears shallow, suggesting dysplasia with slight lateral translocation of the patella relative to the center of the trochlea. The medial retinacular structures appear normal. Mild thickening of the iliotibial band may reflect prior surgical scarring.ADDITIONAL

Output: 1. Medial meniscal abnormalities as described above, either reflecting prior meniscectomy or extensive tearing; please correlate with surgical history.2. Thinning of the PCL, which may reflect prior injury.3. Findings suggestive of mild femoral trochlear dysplasia with mild lateral translation of the patella.


Instruction: Generate impression based on findings.

Input: Male 65 years old Reason: Evaluate for possible prostate tumor History: elevated PSA , previous negative biopsies. PELVIS:PROSTATE:Prostate Size: 5.2 x 2.9 x 3.9 cmPeripheral Zone: The peripheral zone demonstrates diffusely abnormal T2 hypointense signal, left greater than right with hyperenhancement. The findings are suspicious for diffuse prostatitis. There is a subcentimeter focus of abnormal T2 hypointense signal which is dark on the ADC map in the right posterior paracentral peripheral zone at the base. This measures 0.4 x 0.4 cm (series 601, image 20) and is suspicious for a focus of prostatic adenocarcinoma.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No 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.Subcentimeter focus of signal abnormality in the right posterior peripheral zone at the base which is suspicious for a focus of prostatic carcinoma. This is on a background of diffuse prostatitis.


Instruction: Generate impression based on findings.

Input: 68-year-old female with altered mental status There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality


Instruction: Generate impression based on findings.

Input: History of hepatitis C and cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No specific stigmata of portal hypertension. No intrahepatic or extrahepatic biliary ductal dilatation.The vessels are patent.Scattered punctate foci of arterial enhancement without washout with associated mild T2 hyperintensity measuring less than 5 mm are likely perfusional anomalies. No definite corresponding lesion to that seen on the ultrasound is identified.No suspicious lytic arterial enhancing lesion or washout on portal venous, equilibrium or delayed phase imaging. No discrete suspicious lesion on T2-weighted for diffusion-weighted imagingNormally distended gallbladder with small gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology without a suspicious lesion or specific stigmata of portal hypertension. No definite corresponding lesion to that seen on ultrasound. Continued surveillance imaging is recommended.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: There is T1 and T2 linear hypointensity within the left precentral gyrus and precentral sulcus most compatible with chronic blood products as well as a small focus of T2 hyperintensity within the adjacent left superior frontal gyrus most compatible with gliosis. There is no evidence of acute infarct. There are a few scattered punctate foci of T2 hyperintensity within the supratentorial white matter that are most compatible with chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a prominent cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is minimal fluid within left mastoid air cells.

Output: 1.Findings most compatible with chronic blood products and minimal adjacent gliosis centered within the left pre-central and superior frontal gyri given the history of prior hemorrhage. 2.Minimal nonspecific fluid within left mastoid air cells.


Instruction: Generate impression based on findings.

Input: 40 year-old female with HIV/AIDS and cervical cancer, status post radiotherapy. Presents with rectal bleeding. Evaluate for mass or inflammatory change. ABDOMEN:LUNG BASES: Small pleural-based nodules at the lung bases may be due to atelectasis or scar. No acute infiltrates or effusions.LIVER, BILIARY TRACT: Dilated gallbladder with cholelithiasis. Mild gallbladder wall thickening, possibly secondary to chronic cholecystitis. There is a benign hemangioma in the inferior right hepatic lobe, unchanged from the MRI examination.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is moderate left hydronephrosis and hydroureter with obstruction by infiltrative mass near the left ureterovesical junction, most likely a metastasis. The hydronephrosis is new since the MRI examination of 1/28/08.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse colorectal wall thickening, probably due to post-radiotherapy change. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: The uterus demonstrates heterogeneous contrast enhancement with loss of the normal fascial planes between the uterus and bladder most likely due to direct tumor invasion. The interface between the rectum and uterus/cervix is indistinct, probably due to post radiotherapy change. New 1 cm right sided intrauterine mass near the fundus at axial image 94/144 of series 3. BLADDER: Diffuse bladder wall thickening. Left sided 4 cm diameter intraluminal mass is stable since 1/28/08. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse rectosigmoid wall thickening, probably due to post-radiotherapy change. BONES, SOFT TISSUES: Of sclerosis at the pubic symphysis is most likely due to radiation osteonecrosis.OTHER: No significant abnormality noted

Output: Post-radiotherapy changes to pubic symphysis and rectosigmoid. Cervical mass invades bladder. New left hydronephrosis and hydroureter due to bladder mass and infiltrative changes at the UVJ.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, pregnant at 30 weeks gestation with two-day history of blurred vision and headache. Exam is consistent with a partial right third nerve palsy. A mass is present in the right middle cranial fossa with a broad base of attachment along the greater sphenoid wing measuring 42 x 28 mm transaxial and 37 mm craniocaudal. There is a thin cleft of CSF signal separating this lesion from the adjacent temporal lobe indicating extra-axial origin. The lesion itself demonstrates T1 isointensity and mild T2 hyperintensity relative to white matter, with mild diffusion restriction. The adjacent greater sphenoid wing and anterior clinoid process seem to be mildly thickened.This lesion induces significant regional and generalized mass effect with compression of the adjacent temporal lobe, leftward uncal herniation, and compression and leftward deviation of the mid brain. Edema is present within the right temporal lobe tracking superiorly into the right parietal lobe and the basal ganglia. There is a moderate generalized midline shift of the anterior brain structures, while posteriorly, the falx seems pushed towards the right. This may reflect competing mass effect between the tumor on the right, and the entrapped enlarged left lateral ventricle. The right lateral ventricle is partly effaced. The fourth ventricle is normal.Dedicated MRA images demonstrate tumor related mass effect upon the right MCA system with vessels displaced superiorly and draping over the large tumor. Nevertheless, the MCA vessels demonstrate normal caliber with no evidence of significant stenosis or occlusion. Along the posterior margin of the tumor, there is a serpiginous prominent venous structure which may reflect venous engorgement due to mass effect or increased drainage from the adjacent lesion. Elsewhere, assessment of the intracanal vasculature is within normal limits. No definite evidence of any intracranial aneurysm is detected within the limitations of technique.

Output: A large extra-axial mass is present within the right middle cranial fossa with a broad base of attachment to the greater sphenoid wing. There are findings to suggest hyperostosis of the sphenoid and anterior clinoid process. Even without the benefit of IV contrast, the imaging findings are most suggestive of a large meningioma.This lesion induces significant regional and generalized mass effect with substantial edema tracking through the temporal lobe. There is right uncal herniation, a moderate midline shift to the left, effacement of the right lateral ventricle and entrapment/dilatation of the left lateral ventricle.MRA images demonstrate displacement of the right MCA vessels from their normal course but preservation of vessel patency. No evidence of significant vascular stenosis or occlusion is seen. No aneurysms are detected within the limitations of technique.


Instruction: Generate impression based on findings.

Input: 62-year-old male with a history of multiple myeloma with 3 weeks of cough, hemoptysis. Bronchoscopy showed adenocarcinoma of the lungs. Rule-out brain metastases. There are areas of white matter hypodensity in the right frontal lobe. Given the history of a neoplastic primary, metastatic involvement cannot be ruled out. An MRI with contrast is recommended for further evaluation. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is partial opacification of the dependent portions of the left maxillary sinus, improved compared to the prior examination. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Patchy areas of hypodensity in the right frontal white matter. Given the history of neoplasm, an MRI is recommended for further evaluation to rule out metastatic foci as clinically indicated.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with CCM3 mutation, known acoustic neuroma, yearly follow-up examination. Innumerable susceptibility inducing lesions are redemonstrated scattered throughout both cerebral hemispheres, the brainstem and cerebellum. Since the prior examination, at least three new foci are identified, two in the left centrum semiovale and one in the left aspect of the pons. There may also be several additional new punctate foci but accurate comparison is limited by the small size of these lesions.Of those lesions identifiable on T1-weighted imaging, none shows any evidence of increasing T1 hyperintensity to suggest interval bleeding. In addition, none of these lesions induces any significant local mass effect.An extra-axial enhancing lesion based along the left aspect of the anterior interhemispheric falx is unchanged over multiple prior exams. No new enhancing lesions are appreciated. No significant generalized mass effect is seen. No abnormal extra-axial collections are detected. The ventricles remain normal in size and morphology.On thin section T2-weighted imaging of the IACs, a small nodule of soft tissue thickening is redemonstrated within the right IAC. This lesion no longer enhances as it did and may even be somewhat smaller when compared to earlier examinations. No new IAC or CP angle lesions are identified. The visualized cisternal cranial nerves are otherwise unremarkable.

Output: 1.Innumerable lesions are redemonstrated compatible with multiple cavernous malformations. Although there is evidence for at least three new lesions, the bulk of the disease is unchanged and there are no findings to suggest significant interval bleeding.2.A presumed parafalcine meningioma shows no evidence of interval growth.3.A presumed right vestibular schwannoma shows no evidence of interval growth.


Instruction: Generate impression based on findings.

Input: 24-year-old female with medial joint pain. Evaluate MCL and chondromalacia of medial joint. MENISCI: The medial lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities identified. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

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


Instruction: Generate impression based on findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 3.1 x 4.7 x 3.8 cm (AP x TR x CC).Peripheral Zone: Several foci of T2 signal abnormality involving the mid gland peripheral zone, left greater than right, not significantly changed.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Several foci of peripheral zone signal abnormality involving the mid gland peripheral zone, left greater than right, not significantly changed and without evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Abnormal movements. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of gross intracranial structural abnormalities. In particular, the basal ganglia appear to be unremarkable.


Instruction: Generate impression based on findings.

Input: Marked family history of breast cancer along with pancreatic and ovarian cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, especially in an asymmetric fashion in the right superior breast around 12:00 position. Given that this is a baseline study, 6 month follow up MRI is recommended to confirm stability of the nodular parenchymal enhancement in the right superior breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Subcentimeter high signal intensity lesion in the left lobe of liver on T2 W sequence most likely represents a benign cyst or a hemangioma.

Output: No MRI evidence for malignancy. Nodular asymmetric parenhcymal enhancement in the right breast 12:00 position. Given that this is a baseline study, 6 month follow up MRI is recommended to confirm stability of the nodular parenchymal enhancement in the right breast. Findings conveyed to Susan Glick pager 7730 who will convey the results to the patient. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Male, 85 years old, history of pituitary lesion, assess for progression in size. Again seen is an enhancing mass involving the sella measuring approximately 12 x 13 x 15 mm in the AP, transverse, and craniocaudal dimensions, which is not appreciably changed allowing for slight differences in scan planes. There is mild suprasellar extension without any mass effect on the optic nerves or chiasm. The mass extends to abut the right cavernous sinus without evidence of cavernous sinus invasion. The pituitary stalk deviates toward the left as before. Small amount of enhancing tissue in the left aspect of the sella is presumed to reflect normal pituitary tissue. Limited evaluation of the brain demonstrate scattered foci of T2/FLAIR hyperintensity in the white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. There is evidence of volume loss, commensurate with patient's advanced age. Noted is extra-axial enhancing lesion along the left frontal convexity measuring approximately 4-5 mm in thickness and 2 cm in the craniocaudal extent. This lesion is stable to minimally larger when compared to prior study from 1/31/2014, but inadequately compared in the absence of dedicated brain sequences on the current or prior study. There is minimal local mass effect on the left middle frontal gyrus. No midline shift or evidence of herniation. Small left maxillary mucus retention cyst incidentally noted.

Output: 1. Compared to 1/31/2014, there is no significant change in enhancing sellar mass compatible with a macroadenoma. As seen before, there is minimal suprasellar extension without mass effect on the optic nerves or chiasm.2. Extra-axial enhancing lesion along the left frontal convexity likely represents a small meningioma and appears stable to minimally larger when compared to prior study from 1/31/2014. There is minimal local mass effect on the adjacent left middle frontal gyrus. If clinically indicated, dedicated MRI brain may be obtained for further assessment.


Instruction: Generate impression based on findings.

Input: Evaluate for new cervical spinal stenosis in patient with increasing arm numbness and weakness History: neck pain, arm weakness, and numbness. There are postoperative findings related to anterior fusion of C4 through C6. There is adjacent level degenerative spondylosis with small disc-osteophyte complexes at C3-4 and C6-7 that result in moderate bilateral neural foraminal narrowing at C3-4 and severe bilateral neural foraminal narrowing at C6-7, as well as mild spinal canal narrowing at these levels. There is no significant neural foraminal or spinal canal stenosis at the other cervical spine levels. There is no spondylolisthesis. The spinal cord signal and morphology is normal. Aside from the surgical alterations, the vertebral bone marrow appears unremarkable. The imaged intracranial structures and paraspinal soft tissues are grossly unremarkable.

Output: Postoperative findings related to anterior fusion of C4 through C6 with adjacent level degenerative spondylosis with small disc-osteophyte complexes at C3-4 and C6-7 that result in moderate bilateral neural foraminal narrowing at C3-4 and severe bilateral neural foraminal narrowing at C6-7, as well as mild spinal canal narrowing at these levels.


Instruction: Generate impression based on findings.

Input: Stage IVa lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of gross intracranial metastases.


Instruction: Generate impression based on findings.

Input: Headaches. Postoperative changes of a left temporal craniotomy for clipping of the aneurysm again is identified and remains is stable. Small area of lucency in the subcortical white matter of left parietal is noted. This finding was not present on the prior study. Also new since prior exam is an additional foci of low density in the subcortical white matter of the operculum of the left frontal lobe. These areas are concerning for small vessel strokes. Further evaluation with an MRI is recommended. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus is present.

Output: Suspected areas of loss of cortical lucency concerning for small vessel disease which was not noted on the prior study. Further evaluation with an MRI is recommended.