Instruction: Generate impression based on findings.

Input: Left pelvic tenderness and mass. PELVIS:UTERUS, ADNEXA: Anteverted anteflexed uterus. The uterine morphology is unremarkable. The endometrium measures 15 mm in thickness, within normal limits for a premenopausal patient in the secretory phase. It is homogeneously hyperintense on T2-weighted imaging and has normal endometrial/inner myometrial interface. The inner myometrium/junctional zone measures approximately 4 mm, within normal limits. It is well-defined. Punctate cystic focus in the fundus is non-specific.1.3 x 1.1 cm left uterine body intramural fibroid demonstrating postcontrast enhancement.Tiny nabothian cysts. Otherwise the cervical stroma is unremarkable.The right ovary measures 2.6 x 1.4 x 1.5 cm, within normal limits and contains several physiologic follicles. There is minimal adjacent free fluid.The left ovary measures 2.8 x 2.4 x 3.7 cm. It contains a 2.5 x 1.9 x 2.3 cm focal lesion demonstrating low T1 weighted signal intensity, high T2-weighted signal intensity with thin-walled peripheral enhancement and a crenulated contour, likely representing a corpus luteal cyst. Possible small nodular enhancing component may be related to collapsed cyst walls. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free pelvic fluid, within physiologic limits.BONES, SOFT TISSUES: In the lower left rectus abdominis muscle there is a 3.3 x 1.4 x 3.0 cm (series 15 image 37 and series 10 image 42). The lesion demonstrates low T2 weighted signal intensity and scattered punctate T1-weighted hyperintensity. The lesion involves the anterior half of the muscle with ill-defined margins between itself and the muscle as well as spiculated margins suggestive of desmoplastic reaction. On subtraction imaging there is suggestion of mild internal septal enhancement. OTHER: No significant abnormality noted.

Output: 1. 2.5 cm left ovarian lesion with imaging characteristics most compatible with a corpus luteal cyst. Follow-up pelvic ultrasound in 2-3 weeks is recommended to document resolution. 2. 3.3 cm lesion involving the lower left rectus abdominis muscle. It's imaging characteristics may represent c-section scar endometriosis with associated desmoplastic reaction or less likely dermoid given the increased T1 signal.


Instruction: Generate impression based on findings.

Input: Essential (primary) hypertension [I10] / Headache [R51], Reason for Study: ^Reason: concern for possible stroke on CT, further eval needed History: HTN emergency, Headache Multifocal scattered diffusion restriction lesions on the right hemisphere involving right frontal, parietal, temporal and occipital lobes indicating acute ischemic infarct. There is no evidence of acute hemorrhagic lesion.Right side periventricular white matter extended toward the right side basal ganglia showed high signal intensity on FLAIR imaging indicating prior ischemic infarct related lesion. There are multiple scattered FLAIR/T2 high signal intensities on bilateral centrum semiovale and periventricular white matter indicating nonspecific but likely chronic ischemic infarct related lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening and opacification are seen especially on the left maxillary sinus and left anterior ethmoid sinus

Output: Multifocal acute ischemic infarct on the right hemisphere as described above.Underlying brain shows multifocal chronic ischemic changes.There is no evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Male, 32 years old, with neck and occipital pain. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are normal with no evidence of marrow edema. The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural lesions are suspected. Mild disc degeneration is seen at C5-6 and C6-7 with mild left foraminal narrowing at C6-7. No significant spinal canal compromise is noted. The paraspinal soft tissues are within normal limits.

Output: Mild degenerative findings without significant spinal canal or foraminal compromise.


Instruction: Generate impression based on findings.

Input: Clinical question: History of recent head and neck cancer, post surgery, pre-chemotherapy/RT. Signs and symptoms: Baseline chemo/RT CT of soft tissues of neck with contrast:70 cc of Omnipaque 350 was utilized for the above study.Images through the skull base, cavernous sinuses, paranasal sinuses and mastoid air cells are unremarkable. There is evidence of thrombosed right internal jugular vein that appears to extend into the right jugular bulb. This is a new finding since prior study. There is expansion of thrombosed right internal jugular from the skull base to approximately the level of the right carotid bifurcation.Examination demonstrates extensive postoperative changes of right neck with a large flap which extends from the right submandibular level inferiorly to the level of the right thyroid cartilage. There is evidence of partial right mandibulectomy. There is fixating screws and rod extending from anterior aspect of remaining right body of mandible posteriorly to the ramus of mandible.Postoperative changes in the including multiple surgical clips near right submandibular region are noted. This is also believed to be related to surgical changes of the lack placement.There is no definite differential mass or pathologic adenopathy by CT size criteria is identified. There is a small cyst within the right lobe of thyroid measuring approximately 10.5 mm times 7-mm on coronal reformatted image 39.Limited images of the apices of the lungs and mediastinum are negative. Please review dedicated report of CT of chest which visualizes both of these regions would better advantage.The osseous structures of the area of exam other than what was noted in the mandible are unremarkable. No evidence of cartilaginous erosion. The carotid system is intact.CT of brain with contrast:Examination demonstrates an enhancing mass measuring approximately 8 mm times 5 mm in transaxial dimension in the body of the left lateral ventricle. The mass is well demarcated and demonstrates uniform intense enhancement. No definitive calcification is detected. There is no associated edema of the adjacent brain parenchyma. Considering patient's history of malignancy metastatic lesion should be considered. Other differentials for this mass includes intraventricular meningioma, great plexus papilloma, ependymoma and other lesions. Follow up with a dedicated MRI may help in differentiating the etiology of this finding.There is no evidence of any additional area of abnormal enhancement. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Gray/white matter differentiation is well preserved.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are unremarkable.There is redemonstration of thrombosed and expanded right jugular vein in upper cervical with apparent extension into the right jugular bulb.

Output: 1.Extensive postoperative changes of the neck on the right with no detectable tumor or pathologic adenopathy.2.Well demarcated a small mass within the body of left lateral ventricle (5-mm times 8mm) as detailed. Differential includes metastatic lesion, meningioma, ependymoma and choroid plexus papilloma. Considering the history of malignancy metastatic disease should be considered and follow-up with an MRI is recommended.3.CT examination of brain and calvarium is otherwise unremarkable for malignancy.4.Thrombosed right jugular vein in upper cervical region and with apparent extension into the right jugular bulb.


Instruction: Generate impression based on findings.

Input: Patient with an NF-1 and large (20-cm) mass along left flank above pelvis. Please define the margins of the plexiform neurofibroma on his left flank/back. Multiple markers placed along the left back/flank denote the patient's mass. Deep to the markers, there is a heterogeneous, poorly-marginated infiltrative mass within the subcutaneous fat which extends deeper to involve the left quadratus lumborum muscle. The subcutaneous portion of the mass is approximately 16 x 4 x 10 cm (transverse x AP x craniocaudal), it's inferior margin situated at approximately the level of the iliac crest, and it's medial margin just left of midline. The superior margin of the subcutaneous component lies at approximately level of L3, but the intramuscular component extends more superiorly to the level of L1, yielding an overall craniocaudal dimension of approximately 16cm. On T1-weighted images the mass has components isointense to both fat and muscle. The majority of the mass is hyperintense to muscle on fat-saturated T2-weighted images. Smaller, better defined nodular components are noted in the mass which have low T1-weighted and high T2-weighted signal. There is a tubular flow void within the mass, indicating a prominent vessel, that courses toward the lumbar vascular plexus. This mass may represent a plexiform/diffuse neurofibroma although could possibly represent a venous malformation.Multiple smaller masses with predominantly high signal intensity on T2-weighted images, some of which have a target appearance, are seen in the subcutaneous tissue and musculature compatible with nerve sheath tumors. Another approximately 1.5-2 cm lesion below the level of the iliac bifurcation with high T2 weighted signal also likely represents a nerve sheath tumor or perhaps a lymph node. Additional neurofibromas are seen arising from the sacral nerve roots. There is also a subcentimeter round focus of signal abnormality within the right ilium along the sacroiliac joint which is nonspecific but may simply represent a cartilaginous rest.

Output: Findings compatible with neurofibromatosis as described above. The heterogeneous, infiltrative left flank mass, as described above, may either represent a plexiform/diffuse neurofibroma or perhaps a venous malformation and extends anteriorly to involve the quadratus lumborum. Other findings as above.


Instruction: Generate impression based on findings.

Input: Achilles tendinitis TENDONS: No significant abnormality noted. Specifically, the Achilles tendon appears normal. LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is a small articular cartilage defect involving the posterior tibial plafond best appreciated on series 8 image 15/25. There are mild degenerative cystic changes present within the posterior talus as well. A small amount of marrow signal change is also evident in the base of the third metatarsal (series 1101 image 8) which is nonspecific in nature. There is no significant joint fluid. Note is made of an os peroneal (series 6 image 17).ADDITIONAL

Output: 1. Osteoarthritis of the tibiotalar joint with a small articular cartilage defect affecting the tibial plafond posteriorly.2. Normal appearance of the Achilles tendon.


Instruction: Generate impression based on findings.

Input: 40 year old female patient with right groin pain. Evaluate for right hip labral tear. ACETABULAR LABRUM: There is a focus of increased signal in the anterior superior labrum which probably represents an undersurface labral tear (image 4, series 1401).ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage appears intact.SOFT TISSUES: The right iliopsoas tendon appears intact and symmetric. ADDITIONAL

Output: Focus of increased signal in the anterior superior labrum which probably represents an undersurface labral tear.


Instruction: Generate impression based on findings.

Input: Clinical question: History of meningioma status post XRT. Signs and symptoms:As above. Pre-and post-enhanced pituitary MRI:Examination demonstrates a dural based extra-axial mass arising from the dorsal aspect of planum sphenoidale and the posterior and inferior extension into the sella. It measures a maximum of 22.8-mm in AP and 15-mm in cranial cephalad axis. The mass is larger on the right of the midline and results in slight elevation of the right frontal lobe and minimally of the left frontal. There is no evidence of signal abnormality of the adjacent parenchyma.The pituitary gland inferior to the tumor is identified and demonstrates subtle mass effect on the right from meningioma. Bilateral A1 segments of anterior or artery of elevated right mass. There is also last effect on the right cisternal portion optic nerve by the mass.Cavernous sinuses demonstrate normal signal intensity and pattern of enhancement and without evidence of tumor invasion. The proximal right supraclinoid internal carotid artery has extensive contact along its medial aspect with the meningioma however without evidence of encasement. Compared to prior exam there is no evidence of any change in the size, signal intensity, extent and uniform pattern of enhancement of tumor.

Output: 1.Stable size, signal intensity, extent and uniform pattern of enhancement of a meningioma arising from planum sphenoidale and with extension into the sella since prior exam.2.The mass arises slightly to the right of midline and with redemonstration of mass effect on the cisternal segment of right optic nerve and its contact with the supraclinoid right internal carotid artery without encasement.


Instruction: Generate impression based on findings.

Input: 42 year-old female with atrial fibrillation and multiple questionable TIAs. There is no evidence of intracranial hemorrhage, mass or edema. Previously described low density in right posterior parietal region is most likely due to encephalomalacia but has an unusual appearance. This well-defined area appears to exert local mass effect on the adjacent parenchyma and measures CSF density. Congenital malformations such as schizencephaly or arachnoid cyst cannot be ruled out. MRI may be considered as clinically warranted for further evaluation of this area.No acute change and no abnormal postcontrast enhancement.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No interval change.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: MRI: An area of T2 hyperintense, disorganized appearing tissue is redemonstrated within the cerebellar vermis measuring 22 x 25 mm. This lesion contains several foci of internal susceptibility corresponding to calcification on prior head CT, along with small foci of noncontiguous nodular enhancement. On some slices, there is the suggestion of a striated or "tigroid" appearance within the lesion best appreciated on thin slice T2 axial images. Mild bulging of the posterior wall of the fourth ventricle is seen without significant mass effect or hydrocephalus. The ventricles and sulci are unchanged.There are findings consistent with patient's known Chiari I malformation with inferior cerebellar tonsillar herniation and flattening. There is no acute infarct or midline shift. There are no separate areas of suspicious intracranial enhancement.MRS: Single voxel short and long TE spectroscopy of the cerebellar vermian lesion shows uniformly decreased myoinositol, choline, creatine and NAA peaks. Interrogation of normal-appearing cerebellar tissue demonstrates a normal spectroscopic pattern.

Output: Midline cerebellar vermian lesion with internal foci of calcification and scattered small foci of enhancement. There has been no significant interval change since prior imaging. Spectroscopic assessment of this lesion shows uniform reduction of all major detectable metabolites. This pattern is non specific but argues against an aggressive, highly proliferative process. The differential diagnosis would include non neoplastic or equivocally neoplastic processes such as dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease) or simply a developmental dysplasia of the cerebellum. Uniform reduction of MRS peaks has been reported in Lhermitte-Duclos. Low grade tumors such as ganglioglioma or pilocytic astrocytoma among others may also be considered, but the MRS features are not typical.


Instruction: Generate impression based on findings.

Input: Reason: shoulder mass History: pain. Limited evaluation of the left supraclavicular region given the location of the patient's palpable abnormality. A marker was placed over the left anterior superior medial supraclavicular region denoting the patient's palpable area of concern. No underlying abnormal soft tissue mass is identified. Small left supraclavicular lymph nodes are noted.

Output: No abnormal soft tissue mass is identified in the patient's palpable area of concern. However, note that palpable lipomas may sometimes be occult on MRI. Contrast reaction description:Supervising radiologist: Dr. WuMinor or major reaction: MinorContrast type:17 cc of gadolinium were administered. Signs and symptoms: Itchiness of eyes and neckTreatment given: ObservationDisposition at discharge from Radiology: stable with improvement of symptoms. Discharge instructions given: YesMode of communication of contrast reaction to the patient's referring clinician for entry into EPIC: Telephone (Dr. Shi)


Instruction: Generate impression based on findings.

Input: 44-year-old female status post PEA arrest, EEG with diffuse anoxic encephalopathy. Evaluate for anoxic encephalopathy; patient can't get MRI secondary to obesity. The CSF spaces and sulci appear more prominent than in prior examinations suggesting decreasing diffuse cerebral edema. For instance, the anterior horn of the left lateral ventricle measures 7-mm (series 3 image 17/32), previously measuring 4-mm in the 1/4/2012 exam (series 4 image 12/30) and 3-mm in 12/31/2011 exam (series 3 image 17/31). In the prior 7/29/2008 MRI brain, presumably at the patient's baseline, it measured 6 mm in diameter (series 4 image 9/21).There are scattered subtle parenchymal hypodensities that may be artifactual in etiology, but true pathological change is difficult to exclude.There is no evidence of intracranial hemorrhage or mass. There is no midline shift, or basal cistern effacement.The calvaria and skull base are radiographically normal. There is increased opacification of the bilateral sphenoid sinuses, greater on the right. The visualized paranasal sinuses are clear. There is interval increase in bilateral mastoid air cell opacification.There is a nasoenteric tube and endotracheal tube.

Output: 1. Increasing CSF spaces and sulci suggest decreasing diffuse cerebral edema.2. Increasing sphenoid sinus and mastoid air cells opacification, likely related to intubation status.3. Scattered subtle parenchymal hypodensities may be artifactual in etiology, but subtle encephalopathic changes cannot be completely excluded. Followup can be considered.


Instruction: Generate impression based on findings.

Input: History of liver transplant with recurrent hepatitis C presents with nausea and vomiting and elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 18 cm in craniocaudal dimension. It is normal in morphology.Marked signal loss on out of phase imaging compatible with diffuse fatty infiltration.No focal suspicious liver lesion.The hepatic artery is well seen and is opacified aside from susceptibility artifact from surgical clips. No flow limiting stenosis.There is moderate prominence of the common bile duct and central bile ducts with mild narrowing at the anastomosis.The portal vein and hepatic veins are patent.No suspicious liver lesion.SPLEEN: The spleen is normal in morphology and size measuring 10.6 cm in length without a focal lesion. Iron deposition of the spleen. PANCREAS: The pancreas is normal in morphology and signal intensity without a focal lesion. The main pancreatic duct is normal caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric mild perinephric fluid is nonspecific. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymph nodes. Mild atherosclerotic disease of the abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Surgical changes in the anterior abdominal wall. At least small right pleural effusion. Mild right basilar atelectasis. Mild bilateral gynecomastia. Nonspecific heterogeneous marrow signal intensity.OTHER: No significant abnormality noted.

Output: 1.Diffuse fatty infiltration of the liver. No suspicious liver lesion.2.Expected postoperative appearance of the vasculature which appears patent. Moderate prominence of the common bile duct and central bile ducts with mild narrowing at the anastomosis.3.Small right pleural effusion. Additional nonemergent findings as above.


Instruction: Generate impression based on findings.

Input: Female 71 years old Reason: please assess dept of invasion of submucosal lesion History: submucosal lesion 10cm proximal to anal verge Overall image quality: ExcellentPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Segments of small bowel are noted in the hysterectomy bed. BLADDER: Partially distended urinary bladder without significant abnormality.LYMPH NODES: The patient has a large amount of pelvic fat. The mesorectal fascia is poorly defined.Nonspecific lymph node measuring 4 mm in short axis (series 601/42) at the 10:00 position approximately 2.4 cm from the rectum at this level.BOWEL, MESENTERY: Rectal Tumor:Size: 3.9 x 4.1 x 3.9 cm (image 601/46, series 801/33)Tumor appearance on T2-weighted images: T2 hyperintense. Peripherally enhancing. There is a large submucosal component of the tumor. The overlying mucosa is hyperenhancing (series 1303/453). The serosal surface around the tumor is poorly defined along its right lateral margin.Tumor location: (For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 8.3 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Approximately 5 cmCircumference of the rectum involved: Approximately 180 degrees.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): The patient is status post hysterectomy. No evidence of uterine or vaginal invasion.MRI T-stage: T3. There is disruption of the serosal surface surrounding the tumor consistent with perirectal fat invasion, however the exact extent of invasion is difficult to measure given the poorly defined serosal surface. Tumor Distance to Mesorectal Fascia: The mesorectal fascia is poorly defined.BONES, SOFT TISSUES: The tumor appears to abut the anterior sacral cortex at S3-4. No frank bone invasion.OTHER: Postsurgical changes from lumbar spinal fusion partially imaged.

Output: T2-hyperintense rectal mass consistent with patient's known mucinous carcinoma with suspected perirectal fat invasion.


Instruction: Generate impression based on findings.

Input: Right-sided weakness and aphasia. BRAIN MRI:Correlating with the hypoattenuation on the previous CT scan along the left precentral sulcus, there is diffusion restriction reflecting the recent/acute nature of the infarct. The infarct correlates with relatively well-circumscribed prominent T2-hyperintensity and minimal mass-effect that involves the respective parts of the middle and inferior frontal gyri. Multiple additional foci of diffusion restriction are present in the left frontal white-matter as well. There is no associated susceptibility effect to indicate hemorrhagic transformation.There are multiple near-CSF-intensity foci in the frontal and parietal white-matter that are associated with surrounding T2 FLAIR hyperintensity, compatible with chronic lacunar infarcts. Hyperintense T2/FLAIR signal extending along the posterior limbs of the internal capsules and cerebral peduncles may represent Wallerian degeneration and is more pronounced on the right.There is diffuse prominence of the ventricles and other CSF-containing spaces reflecting generalized brain volume loss. There is no midline shift or brain herniation.There are small retention cysts in the maxillary sinuses. There is minimal fluid in the right mastoid air cells posteriorly. These findings are nonspecific. There is no gross orbital abnormality or destructive skull lesion.CRANIAL MR ANGIOGRAPHY:There is generalized irregular/segmental attenuation of the intracranial arteries, which reflects diffuse atherosclerosis. The cavernous segments of the internal carotid arteries are mildly affected, right more than left, which correlates with calcification on the CT scan but there is no high-grade internal carotid artery stenosis. The most severe anterior circulation stenosis involves the proximal left A1 and the proximal left A2 segments. An anterior communicating artery is present. The middle cerebral arteries also show significant atherosclerotic involvement which results in marked attenuation of the flow-related signal in the distal right M2 segment at the trifurcation. The more peripheral middle cerebral artery branches show multifocal stenosis as well. Attenuation of flow-related signal in the anterior left middle cerebral artery branches correlates with the region of the above described acute left frontal infarct.The right vertebral artery terminates in the right posterior inferior cerebellar artery. The basilar artery is a continuation of the left vertebral artery. Left posterior cerebral artery shows fetal origin while the right one shows a fetal-type origin, which are normal variations. Diffuse atherosclerotic involvement of the posterior cerebral arteries is present as well.CERVICAL MR ANGIOGRAPHY:Mild attenuation of the proximal segment of the right common carotid artery is probably artifactual. The remainder of the common and cervical internal carotid arteries show relatively preserved contrast opacification without significant stenosis. There is poor visualization of the origin of the right vertebral artery, which is suspected to represent high-grade stenosis. The more distal right vertebral artery is patent. Right vertebral artery is nondominant. There is also mild multifocal irregularity involving the cervical vertebral artery segments.

Output: 1.Acute infarcts involving the left frontal lobe in the distribution of the left middle cerebral artery. No evidence of hemorrhagic transformation or significant intracranial mass effect.2.Changes of chronic microvascular ischemia and multiple chronic lacunar infarcts are present bilaterally in the frontoparietal lobes. Generalized brain volume loss is moderate.3.There is moderate multifocal irregularity involving the intracranial circulation related to atherosclerotic disease. There is relatively worse focal stenoses at the left A1, left A2, and distal right M1 segments. No large vessel occlusion. Asymmetric attenuation of flow-related signal in the anterior left middle cerebral artery branches correlates with a recent infarct. 4.Cervical MR angiography demonstrates no significant stenosis involving the common carotid or internal carotid arteries in the neck. There is mild multifocal irregularity of the vertebral arteries as well as suspected high-grade stenosis at the right vertebral artery ostium. Cervical vertebral artery segments are otherwise patent.


Instruction: Generate impression based on findings.

Input: (Idiopathic) normal pressure hydrocephalus. There are postoperative findings related to bifrontal craniotomy and three transfrontal ventriculostomy catheters. There is a right of midline frontal approach catheter with distal tip terminating in the prepontine cistern. There is a left frontal approach catheter with distal tip terminating in the third ventricle and additional left frontal approach catheter with distal tip terminating in the left lateral ventricle. There is encephalomalacia in the anterior right frontal lobe. There is prominence of the lateral and third ventricles and either a small cystic structure or adhesions present in the third ventricle. There is confluent T2 signal hyperintensity surrounding the margins of the lateral ventricles. There is also a chronic right thalamocapsular lacunar infarct. There is no midline shift. There is no evidence of acute ischemia or intracranial hemorrhage. There is no abnormal intracranial enhancement. There is thickening of the left frontal calvarium.

Output: 1. Mild prominence of the catheterized lateral and third ventricles with a small possible cystic structure or adhesions present in the third ventricle. Confluent white matter T2 hyperintensity surrounding the lateral ventricles is nonspecific.2. Encephalomalacia in the right anterior frontal lobe deep to the craniotomy site and chronic right thalamocapsular lacunar infarct.


Instruction: Generate impression based on findings.

Input: History of partially occluding portal vein thrombosis, re-evaluate for resolution. LIMITED ABDOMENLIVER:

Output: 1.Normal doppler examination of the portal venous system.2.Small amount of ascites.


Instruction: Generate impression based on findings.

Input: History of orthotopic liver transplant in 2013 for hepatocellular carcinoma. Evaluate for lesions, assess vessel patency, assess biliary system. ABDOMEN:LIVER, BILIARY TRACT: Stable postoperative changes from orthotopic liver transplant. There are expected foci of susceptibility related to surgical clips and changes in the porta hepatis and anterior abdominal wall. There are additional small foci of susceptibility within the biliary tree compatible with pneumobilia. There is stable trace intrahepatic biliary ductal dilatation.The main portal vein, left portal vein, and majority of the right portal vein are patent. The segment 8 branch of the portal vein is again poorly seen compatible with thrombosis. There is associated wedge-shaped early arterial enhancement throughout this segment compatible with vascular redistribution secondary to the thrombosis. The hepatic veins are widely patent. The hepatic artery anastomosis is obscured by susceptibility artifact, but the arteries are otherwise patent.The liver has normal signal and morphology. No focal suspicious enhancing lesion. SPLEEN: Borderline splenomegaly. No focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Note is made of multiple esophageal varices appearing similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable appearance of the liver status post transplant. There are persistent findings relating to thrombosis of the segment 8 branch of the portal vein. The remaining vasculature remains widely patent. Stable minimal intrahepatic biliary ductal dilatation. No suspicious enhancing lesions.2.Persistent findings of portal hypertension including splenomegaly and esophageal varice formation.


Instruction: Generate impression based on findings.

Input: There is an elongated non-enhancing T2 hyperintense lesion that measures up to 14 mm in length and 5 mm in width within the anterolateral left larynx, centered in the region of the laryngeal vestibule. There is associated surrounding mild edema and enhancement with mild narrowing of the airway. Otherwise, there is no evidence of soft tissue mass or significant cervical lymphadenopathy in the neck. There is nonspecific fluid in the bilateral mastoid air cells. The osseous structures are otherwise unremarkable. The airways are patent. There is mild prominence of the subarachnoid spaces anterior to the bilateral temporal lobes. The orbits are unremarkable.

Output: A cystic lesion in the left anterolateral larynx measures up to 14 mm and is associated with mild airway narrowing. The imaging characteristics are nonspecific and the evaluation is somewhat limited without an available preoperative comparison study. Nevertheless, differential considerations include residual congenital saccular laryngeal cyst and perhaps less likely a branchial apparatus anomaly or lymphatic malformation. Apparent mild surrounding inflammatory changes may be reactive or postoperative in nature, although superimposed infection cannot entirely excluded.


Instruction: Generate impression based on findings.

Input: Suspicious lesion on outside MRI. History of hepatitis B. ABDOMEN:LIVER, BILIARY TRACT: Unremarkable liver morphology. Numerous siderotic nodules.Peripheral decreased T1 weighted signal focus in the right hepatic dome (series 17/19) is unchanged and demonstrates loss of signal on out of phase imaging without arterial enhancement or other suspicious imaging features, possibly focal fat. The peripheral lesion in the inferior aspect of the right lobe of the liver with linear margins and very low T1-weighted signal intensity demonstrates interval increase in size. It demonstrates significant loss of signal on in phase imaging. There is no definite arterial enhancement of this focus, but rather possible traversing vessel enhancement. Overall this region of signal abnormality is increased from the 7/9/2015 outside MRI and measures up to 2.6 cm. Superomedially to this lesion is a more nodular discrete lesion measuring 1.2 cm (series 11/24) demonstrating mild T2 weighted hyperintensity compared to 1.3 cm previously (series 1001/34). The lesion has restricted diffusion. There may be mild enhancement on portal venous phase imaging but no definite arterial enhancement, washout or capsule formation.Cholelithiasis without cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Tortuous thoracic aorta.OTHER: No significant abnormality noted.

Output: Focus of signal abnormality of the inferior aspect of right hepatic lobe likely represents a region of increasing focal iron deposition in association with a discrete stable 1.3 cm lesion demonstrating subtle portal venous phase enhancement, T2 weighted hyperintensity and restricted diffusion without arterial enhancement, washout or capsule formation. The liver morphology is unremarkable. Overall the findings do not meet AASLD imaging criteria for HCC. At least short-interval (3-month) follow-up CT or MRI is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: 1 year post op intradural schwannoma sitting on S1 nerve root. Assess for recurrence. Signs and symptoms: One year follow-up. Pre and post enhanced lumbar MRI1:Examination demonstrates interval improvement of postoperative changes of right laminectomy at L4 level. There is no detectable residual or recurrence of schwannoma. This is a similar observation as prior exam.There is normal anatomical alignment of the vertebral column. Moderate degenerative disc disease at L5-S1 level and mild disc desiccation at L4-L5 is present. There is no evidence of central spinal stenosis at any level.There is no evidence of neural foraminal compromise at any level.There is interval improvement of a midline annular fissure at L4-L5 and with expected residual enhancement. Incidental note is made of small foci of T2 hypointensity in the uterus consistent with a fibroid.

Output: 1.No evidence of residual or recurrence of schwannoma.2.Interval improvement of postoperative changes of right L4 laminectomy.3.No spinal stenosis or neural foraminal compromise at any level.4.Interval improvement of midline annular fissure at L4-L5 with expected residual enhancement.5.Incidental note is made of small fibroids of the uterus.


Instruction: Generate impression based on findings.

Input: Radiculopathy, thoracic regionClinical question: thoracic disk herniation?Signs and Symptoms: has hx thoracic diskectomy in 1996 now with recurrent moderate-severe thoracic pain after lifting a heavy tray There is a T2 and T1 hyperintense lesion within the anterior aspect of the T5 vertebral body. It is well-circumscribed. On a CT of the chest from 8/21/2007. Have bone spicules within it. Most likely this represents a vertebral body hemangioma.Patient status post left-sided hemilaminotomy at T8-9. There are some degenerative changes present thoracic spine associated with some narrowing of the right neural foramen at T10-T11 where there is encroachment of the right-sided exiting nerve roots. There is T2 signal hyperintensity along the right-sided posterior elements at T9 and T10. There is facet hypertrophy present on the right-sided T9 and T10. There are minor disc bulges at other levels.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.

Output: The patient status post left-sided hemilaminotomy at T8-9. There are some degenerative changes present at T9-10 and T10-T11 with associated findings suggestive of more subacute inflammation and associated with encroachment of right-sided exiting nerve roots at T10-T11 associated facet hypertrophy.


Instruction: Generate impression based on findings.

Input: Male 71 years old prostate cancer. Evaluate for brachytherapy consideration. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.5 x 4.1 cmPeripheral Zone: There is a T2 and ADC hypointense intense lesion on the right extending from the apex to the base measuring 16 x 8 mm (series 701, image 12) with possible anterior extracapsular extension. This cannot be separated from an adjacent transitional zone nodule that measures 17 x 16 mm (series 701, image 12). This transitional zone lesion may be part of the more anterior lesion and cancer is favored however, we cannot exclude the possibility of this representing a BPH nodule. Similar small foci of T2 hypointensity are seen on the left suspicious for additional sites of cancer.Central Gland: Benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: Possible anterior extracapsular extension related to the right anterior peripheral zone lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits.OTHER: No significant abnormality noted.

Output: Multiple lesions suspicious for prostate adenocarcinoma. The anterior lesion has possible extracapsular extension.


Instruction: Generate impression based on findings.

Input: 9 year male with headaches and vomiting and previously documented mega cisterna magna. Compared to previous. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. The small CSF signal intensity structure along the dorsal midline posterior fossa with no restricted diffusion or enhancement is unchanged since the prior exam. There is again mild scalloping of the adjacent calvarial table. There is no midline shift or herniation. The major cerebral flow voids are intact. There is no abnormal intracranial enhancement. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No acute intracranial abnormality. Stable mega cisterna magna.


Instruction: Generate impression based on findings.

Input: 58 year old with suspicious lesion on mammogram and ultrasound in the right breast at 12:30 position. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a regional non-mass enhancing lesion with architectural distortions at posterior upper inner right breast (12:30 position), measuring 26 x 24 x 28 mm (AP x LR x CC). This enhancing lesion corresponds to the suspicious lesion seen on mammogram and ultrasound.There is an additional enhancing mass, measuring 7 x 10 x 13 mm, at anterior 12 o'clock position in the right breast. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.Port-A-cath is present at right upper chest wall.

Output: 1. Suspicious regional non-mass enhancing lesion with architectural distortions at posterior upper inner right breast (12:30 position), corresponding to the suspicious lesion seen on mammogram and ultrasound. Ultrasound guided biopsy of this lesion was performed later today.2. An enhancing mass at anterior 12 o'clock position in the right breast. MR directed ultrasound of this lesion was performed later today and sonographic correlate was detected. Ultrasound guided biopsy of this lesion was performed later today.3. No MR evidence of malignancy in the left breast.4. No abnormal lymph nodes in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: There is no abnormal enhancement, acute infarct, mass effect, or cerebral edema. There is a small linear T2 hyperintense prominent perivascular space in the left frontal lobe. The white matter signal intensity is within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild ethmoid sinus mucosal thickening. The skull and extracranial soft tissues are unremarkable.

Output: Unremarkable exam.


Instruction: Generate impression based on findings.

Input: 4-year-old female with right chest wall swelling and lymphatic malformation. Evaluate structure and extent of the malformation. Well encapsulated right chest wall mass with intermediate T1 and high T2 signal demonstrating minimal delayed enhancement measures 5.2 x 4.9 x 2.3 cm (coronal series 401, image 20; axial series 501 image 20), previously measuring 5.7 x 2.5 x 3.8 cm. This mass is a slightly different orientation than on prior exam and measurements are made in a slightly different orientation. The mass is now more rounded in the axial plane and previously appeared more triangular. The difference in orientation may be secondary to positioning during imaging or possibly differential growth. Again seen are T2 hypoattenuating serpentine signal voids within the mass. No restricted diffusion to suggest abscess. No additional lesions are identified. No abnormal signal seen within the adjacent osseous structures.

Output: Well encapsulated right chest wall heterogenous mass with minimal delayed enhancement likely representing a lymphangioma is in a slightly different orientation than on prior exam.


Instruction: Generate impression based on findings.

Input: 62 years Female (DOB:2/5/1954)Reason: evaluate for left MCA vs. internal capsule stroke History: right weakness and difficulty understanding speechPROVIDER/ATTENDING NAME: GREGG M HELLAND GREGG M HELLAND MRI of the brainThere is a focus of diffusion restriction present along the left medial pons.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right sphenoid sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.MRA brain:The right vertebral artery is very small distal to the origin of the right posterior inferior cerebellar artery. Left vertebral artery is also small and there is a 60% stenosis along the distal left vertebral artery. There is a approximately 66% stenosis of the basilar artery just above the level of the right anterior inferior cerebellar artery origin. There are bilateral fetal posterior cerebral artery artery origins. The P1 segments are hypoplastic.There is 70% stenosis at the origin of the inferior division of the left middle cerebral artery.There is 60% stenosis at the origin of the right anterior cerebral artery.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is very small. There is extracranial origin of the right posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The thyroid gland has a heterogeneous appearance

Output: 1.There is an acute lacunar infarct present along the medial aspect of the left half of the pons.2.There is 60% stenosis of the left vertebral artery near its junction to the basilar artery. 3.There is 70% stenosis along the mid basilar artery just above the level of the right anterior inferior cerebellar artery origin. There is fetal origin of the posterior cerebral arteries bilaterally associated with hypoplastic P1 segments4.There is 70% stenosis at the origin of the inferior division of the left middle cerebral artery.5.There is 60% stenosis at the origin of the right anterior cerebral artery.6.No evidence for extracranial cerebrovascular occlusive disease.7.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 58-year-old male with right facial droop and right upper extremity weakness. Evaluation is slightly limited by patient motion artifact. There is a focus of restricted diffusion in the left putamen/globus pallidus/posterior limb of the internal capsule with associated increased T2 FLAIR signal compatible with acute infarction, but without associated susceptibility artifact suggest hemorrhagic conversion. Patchy and punctate areas of periventricular and subcortical white matter T2 hyperintensity are nonspecific, but suggests chronic small vessel ischemic disease. Patchy areas of susceptibility artifact in the bilateral basal ganglia consistent with chronic hemosiderin staining. There is no midline shift or herniation. There is mild prominence of the CSF spaces suggestive of global parenchymal volume loss. Right maxillary mucosal thickening and mucus retention cyst. The orbits, skull and scalp soft tissues are unremarkable.

Output: 1.Acute lacunar infarct of the left basal ganglia/posterior internal capsule, without evidence of hemorrhagic conversion.2.Scattered punctate foci of FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific, but suggest chronic small vessel ischemic disease.These findings were relayed to Dr. Xiao via telephone at 18:50 on 10/23/2015.


Instruction: Generate impression based on findings.

Input: 37-year-old woman personal history of BRCA2 mutation presents for screening bilateral breast MRI preparation for bilateral mastectomy. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Breast cancer with brain metastases, compare to last MRI. Signs and symptoms: Post 2 cycles of chemotherapy. Pre and post enhanced brain MRI is performed.No diffusion-weighted abnormalities.Examination redemonstrates multiple supratentorial metastatic lesions with evidence of interval progression of disease.Example left frontal necrotic rim-enhancing metastatic tumor measures at 20 x 20 mm compared to prior study measurement of approximately 10 mm. A right inferior temporal metastatic tumor measuring at 12 mm compared to prior study measurement of 4 mm. A left parietal periventricular metastatic lesion measuring 13 x 16 mm compared to prior study measurement of 8 x 10 mm. A right frontal superficial necrotic enhancing tumor measures at 19 x 17 mm compared to prior study measurement of 10 x 8 mm.There is also evidence of interval increased surrounding vasogenic edema of the metastatic lesions however without mass effect on the ventricular system or deviation of midline.There is no detectable leptomeningeal enhancement.Ventricular system remain within normal size and with maintained midline.Calvarium demonstrate normal signal intensity and without evidence of metastases.

Output: 1.Interval progression of metastatic disease with increased size of all supratentorial metastatic lesions as detailed/measured above.2.Interval subtle increased surrounding vasogenic edema however with regional mass effect and no midline shift.


Instruction: Generate impression based on findings.

Input: Radiculopathy, lumbar region [M54.16], Reason for Study: ^Reason: lumbar radiculopathy History: lower back pain with radiation down right leg For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: There is broad based disc protrusion toward right side lateral recess with extension to the proximal part of the neuroforamen.

Output: L5S1 disc herniation toward right lateral recess which extends to the right side proximal neuroforamen.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: eval lesion seen on CT History: dizziness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cysts on the left maxillary sinus.Brain MRA3D time in a MRI of the axial diffusion of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Normal brain MRI.2. Normal brain MRA3. Normal Neck MRA


Instruction: Generate impression based on findings.

Input: Neck pain Magnetic resonance imaging was done of both the right and left tibia and fibula without intravenous contrast. Examination of the images reveals very minimal increased signal on the STIR images in the mid diaphysis of the right and left tibia. This probably represents residual stress reaction. When compared to the previous exam of November 2015 the amount of abnormal signal has markedly decreased. No evidence is seen fractures.

Output: Markedly decreased stress reaction when compared to the previous exam of November 2015


Instruction: Generate impression based on findings.

Input: Altered mental status. Many of the images are degraded by patient motion. There is no evidence of gross intracranial hemorrhage, mass, or acute infarct. There is mild periventricular cerebral white matter T2 hyperintensity. There is coaptation of the frontal horn of the right lateral ventricle, but no ventriculomegaly. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Probable mild chronic small vessel ischemic white matter disease, but no evidence of gross acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 30 year old woman with complex congenital disease s/p repair as follows: hypoplastic RV and tricuspid and pulmonary artery atresia with Glen shunt, ASD and previous Blalock-Taussig shunt placement transferred here for hemoptysis, now referred for cardiac MRI to better delineate her anatomy. Overall AnatomyHypoplastic right ventricle s/p Glenn shunt. The interatrial septum has been resected with effectively a large ASD present. There is tricuspid valve atresia with hypoplastic right ventricle. The left ventricle is dominant and is the systemic ventricle.Systemic Venous Return (Fontan)A Glenn shunt connects the SVC to a small caliber right pulmonary artery. There are no obstructions or stenoses in either the SVC or IVC. Systemic Ventricle (i.e. Left Ventricle)The left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 120 ml/m2 (normal range: 65+/-11), the LVEDV is 185 ml (normal range 109+/-23), the LV end systolic volume index is 72 ml/m2 (normal range 18+/-5), the LVESV is 111 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 81 g (normal range 114+/-24). Wall motion is dyssynchronous consistent with the patient's history of congenital heart disease and previous cardiac surgery.Pulmonary Venous ReturnThere are four pulmonary veins which drain into the common atrium. There are no obvious obstructions of the pulmonary veins.Right VentricleThe right ventricle is hypoplastic.Common AtriumThe interatrial septum has been resected resulting in a common atrium. Aortic ValveThe aortic valve is trileaflet. The valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Tricuspid ValveThe tricuspid valve is atretic.AortaThe aorta is located anterior. There is a left sided aortic arch with no left subclavian noted. There is no thoracic aortic aneurysm or thoracic aortic dissection. The maximum diameter of the aorta is 30mm. The sinus of Valsalva measures 36mm. Left and Right Pulmonary ArteryThe main pulmonary artery is not seen. The left pulmonary artery is not seen. The right pulmonary artery is small in caliber and measures 12 mm. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge intraabdominal mass with associated liver metastases. Left lower lobe lung changes consistent with bronchiectasis. There is peripheral enhancement of the lung fields on MRA consistent with extensive chest wall collateralization. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Hypoplastic RV with tricuspid and pulmonary artery atresia. 2. Severely dilated LV (systemic ventricle) with moderately reduced EF of 40%. Wall motion is dyssynchronous. 3. Glen shunt intact (SVC to RPA). 4. Extensive chest wall collateralization. 5. Large intraabdominal mass with liver metastases.


Instruction: Generate impression based on findings.

Input: TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is a very small focus of abnormal signal seen in medial talar dome that most likely represents a small osteochondral defect. The overlying cartilage appears intact. ADDITIONAL

Output: Very small osteochondral lesion with overlying intact cartilage


Instruction: Generate impression based on findings.

Input: Advanced degenerative changes are partially visualized in the cervical spine on localizer images. Thoracic vertebral column alignment is within normal limits. There is minimal anterior wedging of the T7, T8 and T9 vertebral bodies. The vertebral body heights are otherwise preserved. There is multilevel degenerative endplate bone marrow signal alteration and multilevel disc desiccation and loss of disc height throughout the upper and mid thoracic spine with vacuum disc phenomenon at multiple levels. Minimal disc-osteophyte complexes are present throughout the thoracic spine, but there is no significant spinal canal stenosis. The thoracic spinal cord displays normal signal and morphology. There is a large heterogeneous right thyroid lobe mass. There are bilateral pleural effusions and atelectasis are noted. The atrophic right kidney is partially imaged, but contains multiple probable renal cysts. There is a large staghorn calculus left renal collecting system.

Output: 1. Multilevel degenerative disc-osteophyte complexes without spinal canal compromise, but no specific findings to suggest discitis-osteomyelitis or epidural abscess.2. Large heterogeneous right thyroid lobe mass. 3. Large staghorn calculus left renal collecting system


Instruction: Generate impression based on findings.

Input: 29 years Male (DOB:8/9/1986)Reason: Assess for L5 disk herniation History: L5 R sided radiculopathyPROVIDER/ATTENDING NAME: SHERWIN S HO SHERWIN S HO Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with severe headaches. Scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres and to a lesser extent the pons. A very small focus of encephalomalacia seen in the left cerebellum. No restricted diffusion is noted. No evidence of edema or mass effect is detected. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection are seen. The ventricles are normal in size and morphology. A small mucous retention cyst is evident in the left maxillary sinus.

Output: 1.Findings are seen compatible with chronic microvascular ischemic disease and perhaps a small chronic infarct of the left cerebellum.2.No definite acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: Recent right cerebellopontine angle tumor intracapsular debulking. There are recent postoperative findings related to right suboccipital and translabyrinthine craniectomy with fat graft obliteration for intracapsular debulking of a right cerebellopontine angle tumor. There is residual tumor within the cerebellopontine angle cisterns that measures up to 4 cm. There is also a small amount of tumor within the skeletonized right internal auditory canal. There are scattered areas of susceptibility effect within the residual tumor, which likely correspond to blood products, particularly along the surgical margins. There is associated mass effect upon the adjacent brainstem and right cerebellar hemisphere, with leftward displacement of the vertebrobasilar system, as well as partial effacement of the fourth ventricle, but no dilatation of the third and lateral ventricles. There is a small area of restricted diffuse and high T2 signal in the lateral right cerebellar hemisphere, which represents acute ischemia. The supratentorial brain is unremarkable. There is persistent swelling and subgaleal fluid, which may represent leakage of cerebrospinal fluid and/or seroma.

Output: Recent postoperative findings related to intracapsular debulking of a right cerebellopontine angle tumor, with residual tumor measuring up to 4 cm and associated mass effect upon the adjacent brainstem and right cerebellar hemisphere, as well as partial effacement of the fourth ventricle, but no dilatation of the third and lateral ventricles. A small amount of hemorrhage is present within the residual tumor, which extends into the skeletonized right internal auditory canal.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:10/29/1975)Reason: 3T scanner, CCM Protocol, qsm/permeability if possible; no contrast per patient's request History: please evaluate for changes and lesion burden - compare to prior outside images uploaded to EpicPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 9 x 8 mm lesion located in the inferior aspect of the left brachium pontis which has not changed since the prior exam. It is got a rim of signal loss and heterogeneous T2 signal centrally. There is associated susceptibility effect.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 in the maxillary sinuses and mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient was unable to complete the examination. As a result this is a limited exam.There is redemonstration and no change of a cerebral cavernous malformation located in left middle cerebellar peduncle.


Instruction: Generate impression based on findings.

Input: 68 year old male with AMS, hemiplegia. Evaluate for CVA. Many of the standard sequences are motion degraded and therefore fast MRI sequences were obtained. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Again seen is encephalomalacia centered in the right basal ganglia and right subinsular region. There is resultant ex vacuo dilatation of the right lateral ventricle. There is also a chronic lacunar infarct in the left frontal corona radiata. Additional nonspecific periventricular and subcortical white matter T2/FLAIR hyperintensity is visualized. The ventricles and extra-axial spaces are prominent compatible with global volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1.Moderately degraded study due to patient motion. No evidence of acute infarct or intracranial mass effect. 2.Moderate chronic small vessel ischemic disease and global volume loss. 3.Encephalomalacia centered in the right basal ganglia and right subinsular region.


Instruction: Generate impression based on findings.

Input: Facial numbness, dizziness, hearing loss: chronic right sided weakness, abnormal VNG testing with left peripheral nystagmus, and right hearing loss. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense lesions. A vein courses along the superior aspect of the left trigeminal nerve. Otherwise, there is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. However, there is a partially-empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary sinus. Brain MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms.Internal Auditory Canals MRI: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct and sac, and semicircular canals, appear unremarkable. There is a mild effusion within the right mastoid air cells. The left mastoid air cells are unremarkable.

Output: 1. Mild scattered cerebral white matter T2 hyperintense lesions and nonspecific, but may be related to chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive lesions 3. No evidence of retrocochlear or inner ear lesions.4. Mild right mastoid air cell effusion.5. A partially-empty sella is nonspecific, but may represent a manifestation of pseudotumor cerebri, especially in the setting of obesity. 6. A vein courses along the superior aspect of the left trigeminal nerve, which can be an anatomic variant.


Instruction: Generate impression based on findings.

Input: Right lower extremity radiculopathy Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is grossly within normal limits although there is exaggerated kyphosis at the L1-L2 level and minimal anterolisthesis of L5 on S1. Bone marrow signal is benign. Conus is at the lower limits of normal at the inferior L2 level. There appears to be fatty infiltration along the filum terminale from the mid to lower L3 level to the L5-S1 levels, slightly to the left of the midline (which is unusual) and measuring up to 2 mm in diameter. Unlikely this represents a vessel given the thickness of it.There is disc desiccation throughout the lumbar spine with mild loss of disc height, relatively worse at the L1-L2 level. Additional details regarding multilevel degenerative changes, as described below:L1-L2: Mild disc bulge with small right paracentral disc protrusion. No spinal canal or neural foraminal stenosis.L2-L3: There is a central disc extrusion with mild caudal migration. There is very mild spinal canal narrowing involving the anterior thecal sac without compression of the cauda equina nerve roots. Neural foramina are also patent. Mild facet arthropathy.L3-L4: Minimal disc bulge as well as mild to moderate bilateral facet arthropathy. There is mild narrowing of the lumbar spinal canal which is predominantly on a developmental basis. Neural foramina are patent.L4-L5: Moderate bilateral facet arthropathy with small synovial cyst posterior to the left facet joint. Minimal disc bulge. There is minimal narrowing of the spinal canal. Neural foramina are patent.L5-S1: Minimal disc bulge and moderate to severe bilateral facet arthropathy. There is partial effacement of the lateral recesses, right greater than left. No significant central spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. Left neural foramen is patent.Paraspinous soft tissues are within normal limits. Partially imaged sacroiliac joints demonstrate degenerative changes with suggestion of sclerosis along the iliac aspects of the joints, as seen on recent radiographs.

Output: 1. Multilevel degenerative changes in the lumbar spine. There is partial effacement of the right lateral recess and mild to moderate right-sided neural foraminal stenosis at the L5-S1 level which may be contributing to patient's right lower extremity radiculopathy. 2. Advanced facet arthropathy at L5-S1 and to a slightly lesser degree at the L4-L5 level. There is minimal L5 on S1 anterolisthesis. Please see above for additional details including L2-L3 disc extrusion.3. There appears to be fatty infiltration of the filum terminale which is noted to be slightly left of the midline. The conus terminates at the inferior L2 level which while is at the lower limits of normal, would suggest correlation with clinical signs of cord tethering to exclude this possibility.


Instruction: Generate impression based on findings.

Input: 68-year-old female with a history of pancreatic tail lesion. ABDOMEN:LIVER, BILIARY TRACT: No evidence of intra-or extra biliary ductal dilation. Note is made of multiple dependent gallstones.SPLEEN: No significant abnormality noted.PANCREAS: Note is made of a focus of fluid signal intensity in the head of the pancreas measuring approximately 5 mm in diameter, appearing similar to the prior study. Differential considerations include a branch type IPMN and cyst. The inherent T1 signal of the pancreas is preserved without evidence of focal signal abnormality in the pancreatic tail, as clinically questioned.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of a focus of fluid signal intensity within the left kidney, consistent with a simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Note is made of bilateral saline breast implants, incompletely visualized.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in 5-mm focus of fluid signal intensity in the head of the pancreas. Differential considerations include a branch type IPMN and cyst.2.The inherent T1 signal of the pancreas is preserved without evidence of focal signal abnormality in the pancreatic tail, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Continued worsening back pain, status post kyphoplasty. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights in the lumbar spine are grossly maintained aside from mild compression deformity involving the superior endplate of L1 which is similar to 4/1/2016 and also evident on CT lumbar spine from 10/6/2015. Schmorl's nodes which are evident throughout the lumbar spine are not appreciably changed since 4/1/2016. Mild bone marrow edema is seen involving the L1 to L3 vertebral bodies which is not significantly changed since 4//2016 and may be related to degenerative change, surgery, and/or Schmorl's nodes. Mild deformity of the superior L5 endplate is also unchanged and may reflect graft subsidence but unchanged since at least 10/6/2015. There is severe lumbar levoscoliosis with apex at the L3-L4 level as seen before with mild right lateral translation of L2 on L3 and left lateral translation of L4 and L5. Partially imaged T10 chronic compression fracture is noted.Individual levels as described below:L1/2: Degenerative disc disease, vacuum disc phenomena, and eccentric left disc bulge including involvement of left neural foramen. Mild right and moderate left neural foraminal stenosis. No central canal stenosis.L2/3: Interbody spacer is present. There is mild disc bulge and facet arthropathy. There is no significant central canal stenosis. There is moderate right and mild left neural foraminal stenosis. L3/4: Interbody spacers present. There is mild disc bulge and facet arthropathy, particularly on the right. Moderate right neural foraminal stenosis. No left neural foraminal or spinal canal stenosis.L4/5: Interbody spacer is present. There is mild disc bulge, and moderate bilateral facet arthropathy. There is no significant central canal stenosis. There is moderate right and mild-to-moderate left neural foraminal stenosis. L5/S1: Minimal degenerative disc disease. No neural foraminal or spinal canal stenosis.

Output: 1. No findings to suggest an acute compression fracture.2. Mild L1 compression fracture demonstrates no significant associated edema and not significantly changed since CT from 10/6/2015.3. Multiple Schmorl's nodes throughout the lumbar spine are not significantly changed. 4. Severe levoscoliosis of the lumbar spine again seen. No significant spinal canal stenosis at any level. Multilevel neural foraminal narrowing as described above.


Instruction: Generate impression based on findings.

Input: 22 years Male (DOB:10/14/1993)Reason: h/o demyelination, infantile spasms History: altered mental statusPROVIDER/ATTENDING NAME: NEIL H HYMAN NEIL H HYMAN There is T2 and FLAIR ill-defined signal hyperintensity surrounding the trigone and occipital horn of the right lateral ventricle. Air is associated FLAIR leptomeningeal signal hyperintensity along the surface of the right temporal lobe extending to the right inferior parietal lobule.. There is no associated contrast enhancement. These findings have not changed substantially when compared to the previous exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are vague signal changes present involving predominantly right temporal lobe white matter and and to a lesser degree gray matter especially adjacent and lateral to the temporal horn and trigone of the right lateral ventricle. Some patchy signal changes are also present in the right temporal lobe gray matter. These are nonspecific findings. These findings are stable compared to the previous exam.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing colitis. Evaluate for lesion or dominant stricture. ABDOMEN:LIVER, BILIARY TRACT: Mild irregular narrowing of the central biliary tree and confluence of the right bile duct compatible with primary sclerosing cholangitis without a new dominant stricture or enhancing mass lesion. The appearance is similar to the prior study.The previously identified lobular lesion in the inferior right lobe of the liver is best seen on postcontrast imaging measuring approximately 1.6 cm (series 13/32), essentially unchanged. The lesion remains isointense on portal venous and delayed/equilibrium phase imaging and retains contrast on hepatobiliary phase imaging, compatible with focal nodular hyperplasia.Scattered small cysts.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.Benign lesion in the right lobe of liver is unchanged and is compatible with focal nodular hyperplasia.2.Mild biliary irregularity appearing similar to the prior compatible with primary sclerosing cholangitis without a dominant stricture or focal lesion.


Instruction: Generate impression based on findings.

Input: Ovarian cancer, status post chemotherapy and radiation therapy: possible brain lesion base on PET/CT. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: Epilepsy 2 protocol. 1 mm thin cuts. Signs and symptoms: Seizure since age 20. Nonenhanced brain MRI:Unremarkable diffusion weighted series.On axial and coronal T2 and FLAIR images there is mild prominence of the right anterior temporal horn of lateral ventricle and suggestion of mild decreased volume of right hippocampal gyrus compared to the left however without detectable signal abnormality. This finding is best appreciated on coronal T2 and T2 FLAIR on images 14 through 18).The anatomical development, morphology and signal intensity of brain otherwise remains within normal. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of all major intracranial arterial branches are identified and unremarkable.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Subtle prominence of temporal horn of right lateral ventricle anteriorly and mild decreased volume of the right hippocampal gyrus however without detectable signal abnormality as detailed above.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemia, etiology of seizures. Signs and symptoms: As above. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates a slight generalized prominence of cortical sulci which may be at the upper limits of normal for stated age. Ventricular system remains within normal size and with maintained midline.Images through posterior fossa demonstrates significant cerebellar diaphragm and volume loss in particular along its superior aspect as was noted on prior head CT. As finding is not associated with any detectable signal abnormality. There is resultant mild ex vacuo dilatation of the fourth ventricle.Findings could be result of seizure treatment however less likely possibility of neurodegenerative disease cannot be entirely excluded.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses demonstrate no abnormality.Unremarkable orbits, calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells.Nonenhanced cervical spine MRI:Examination of cervical spine is severely limited due to significant motion artifact which makes precise assessment not possible.The signal intensity of the vertebral column demonstrate no definitive abnormality. There is straightening of cervical lordosis and suggestion of at least partial fusion at C6-C7. The caliber and the signal intensity of the cord remains grossly within normal. Foramen magnum is unremarkable. Degenerative changes at C3-C4 results in mild central spinal stenosis. No evidence of a spinal canal compromise or stenosis at any other level. Suboptimal quality of exam precludes precise assessment for the neural foramina. There is no detectable. Spinal soft tissue abnormalities.Nonenhanced thoracic MRI:This examination is also suboptimal due to excessive motion artifact. Multiple MRI sequences were repeated however without significant improvement.Within this limitation there is no detectable signal abnormality or vertebral column and alignment of the spine remains beginning normal. There is no convincing evidence of spinal canal compromise or stenosis. Grossly unremarkable signal intensity and caliber of thoracic cord.Grossly unremarkable paraspinal soft tissues.Lumbosacral spine examination also is limited due to motion artifact. No gross signal abnormality of the vertebral column other than mild changes secondary to degenerative disease. No evidence of a spinal canal compromise or stenosis at any level.No definitive evidence of very poorly visualized conus or the cauda equina.No gross abnormality of the paraspinal soft tissues.

Output: 1.Nonenhanced brain MRI demonstrate no acute intracranial process. Cerebellar and vermian parenchymal volume loss without detectable associated signal abnormality of the parenchyma. Mild generalized prominence of supratentorial cortical sulci likely within normal range for patient's stated age and unremarkable exam otherwise.2.Suboptimal MRI of spine secondary to extensive motion artifact as detailed. Within this severe limitation examination demonstrate degenerative changes of cervical spine with resultant mild central spinal stenosis only at C3-C4 level. No spinal stenosis at any other level. No convincing evidence of cord caliber or signal abnormality. Grossly unremarkable signal intensity and the alignment of the vertebral column. No convincing evidence of paraspinal soft tissue abnormalities.


Instruction: Generate impression based on findings.

Input: Status post trauma, no neurologic activity. Normal gray-white matter differentiation. There are no changes to suggest diffuse axonal injury however MRI would be more sensitive in detecting changes of DAI. No coup or contra-coup lesion demonstrated.There is no evidence of acute intracranial hemorrhage, mass, midline shift or edema. No intra or extra-axial collection. There is a 5 mm thick left scalp hematoma overlying the left parietal-temporal region.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. No fracture or diastases demonstrated.Mucosal thickening is seen in maxillary antrum with a fluid level on the right and in the sphenoid sinuses. Nonspecific soft tissue opacification seen in the right ethmoid cells. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: *Normal unenhanced brain CT.*No acute intracranial abnormality. However MRI would be more sensitive in detecting changes of DAI.


Instruction: Generate impression based on findings.

Input: 43 year old female with knee pain. Evaluate for meniscus tear, chondromalacia. MENISCI: The posterior horn of the medial meniscus appears smaller in size relative to the anterior horn with blunting of the contour anteriorly compatible with a tear. The anterior horn of the medial meniscus appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the articular cartilage of the patella with focal intermediate signal cleft along the medial and lateral facet with underlying subchondral bone marrow edema. There is a focal area of full-thickness articular cartilage defect overlying the medial femoral condyle with underlying subchondral bone marrow edema. There is focal subchondral bone marrow edema of the lateral tibial plateau. LIGAMENTS: The cruciate and collateral ligaments appear normal.EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: 1. Tear of the posterior horn and medial meniscus. 2. Generalized thinning of the articular cartilage of the patella with focal areas of articular cartilage defects as described above. Additional area of articular cartilage degeneration affects the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: assess for polyradiculopathySigns and Symptoms: H/O inflammatory polyradiculopathy, recent onset of incontinence Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is redemonstration of mild thickening of the nerve roots of the cauda equina associated with some subtle contrast enhancement.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is redemonstration of some mild thickening of the nerve roots of the cauda equina. This is nonspecific, however, it could be seen with hereditary motor sensory neuropathy, Guillain-Barre syndrome, other infections and a moderate knee and processes as well as other entities such as sarcoidosis and arachnoiditis. It was also present on the prior exam and does not appear to have changed significantly.


Instruction: Generate impression based on findings.

Input: Pituitary tumor, evaluate for recurrence: yearly follow up. The pituitary lesion is no longer apparent. The pituitary gland is not expanded. The infundibulum is deviated slightly to the left, but is intact. The optic apparatus and cavernous sinuses are intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is a small retention cyst in the right maxillary sinus. There is persistent nonspecific prominence of the adenoids.

Output: No residual pituitary lesion is apparent.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The conus terminates at L1-L2. The paravertebral soft tissues are unremarkable. There is a grossly unchanged 1 cm hyperintense lesion within the spinal cord at the T11 level that is only partially imaged on axial sequence. There is multilevel disc desiccation, loss of disc height, Schmorl's node formation, endplate degenerative change that is most prominent at the L1-L4 levels with prominent dorsal epidural fat.L1-L2: There is an unchanged disc bulge eccentric to the right as well as mild bilateral facet arthropathy and ligamentum flavum thickening with mild spinal canal and mild right neural foraminal stenosis similar to prior. L2-L3: There is a moderate disc bulge as well as bilateral facet arthropathy and ligamentum flavum thickening. These findings result in unchanged mild to moderate spinal canal stenosis and mild bilateral foraminal stenosis. There is prominence of the epidural fat.L3-L4: There is a moderate disc bulge with a superimposed central disc extrusion as well as mild bilateral facet arthropathy and ligamentum flavum thickening that results in unchanged moderate to severe spinal canal stenosis, moderate left, and mild right neural foramen stenosis. There is prominence of the epidural fat.L4-L5: There is a moderate disc bulge with a superimposed central disc protursion as well as mild bilateral facet arthropathy and ligamentum flavum thickening. These findings result in unchanged moderate spinal canal stenosis and mild bilateral neural foramen stenosis. There is prominence of the epidural fat.L5-S1: There is a mild disc bulge as well as a superimposed left paracentral disc extrusion and inferior migration with mild facet arthropathy and ligamentum flavum thickening bilaterally. These findings result in unchanged mild spinal canal stenosis as well as narrowing of the left lateral recess without significant neural foraminal stenosis. There is prominence of the epidural fat. No significant foraminal stenosis.

Output: 1.Unchanged T2 hyperintense spinal cord lesion at the T11 level likely represents a demyelinating lesion given the patient's brain imaging findings.2.Unchanged lumbar degenerative changes compared to 5/30/2014 as detailed above with varying degrees of spinal canal stenosis (worst at L3-4) related to disc herniations and epidural lipomatosis. There is also mild foraminal stenosis as detailed above.


Instruction: Generate impression based on findings.

Input: There has been interval evolution of postoperative findings related to left frontal lobe surgery for resection of recurrent left frontal lobe mass. The cavity now contains multiple septations and susceptibility effect. There is persistent confluent T2 hyperintensity surrounding the posterolateral aspect of the resection cavity and extending into the anterolateral aspect of the left lateral ventricle and the corpus callosum. There is also linear enhancement along the margins of the resection cavity, which is more extensive than previously. However, there is no associated grossly elevated perfusion in this region. There is dural enhancement anterior to the resection cavity, which crosses the midline to the right anteromedial dura. There are nonspecific punctate foci of susceptibility effect in the right parietal region. The ventricles and the basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is no evidence of acute infarct.

Output: Interval evolution of postoperative findings related recurrent glioblastoma from the left frontal lobe, in which the resection cavity contains blood products in apparently septated compartments and nonspecific enhancement surrounding the resection cavity. Otherwise, no evidence of glioblastoma progression.


Instruction: Generate impression based on findings.

Input: Dizziness attributed to BPPV and right sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There are scattered foci of nonspecific cerebral white matter T2 hyperintensity bilaterally.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Reason: Left medial sided knee pain, hx lateral tibial plateau fx, evaluate for cause of pain History: above ARTICULAR CARTILAGE AND BONE: There is a comminuted intra-articular fracture of the proximal tibia. The fracture predominantly involves the lateral tibial plateau with downward sloping of the plateau posteriorly, resulting in approximately 1 cm of depression relative to the level of the medial tibial plateau. The fracture also extends in a sagittal plane into the anterior portion of the medial tibial condyle, but we see no depression or displacement of the medial condyle. There is signal abnormality within the articular cartilage overlying the posterior half of the lateral tibial plateau likely representing a combination of degeneration and tearing. The articular cartilage of the lateral femoral condyle appears relatively intact. We see no fluid-filled defects of the articular cartilage of the medial tibial plateau. Although the articular cartilage of the medial femoral condyle appears intact, there is subchondral edema within the weightbearing portion of the medial femoral condyle, which is associated with plaque-like low signal intensity along the subchondral bone plate. This is nonspecific and could reflect pre-existing degenerative changes, a healing impaction/stress fracture, or mild osteonecrosis. Other than mild superficial fraying of the articular cartilage along the medial facet of the patella, the patellofemoral articular cartilage appears normal.MENISCI: There is poorly defined increased signal intensity along the inferior aspect of the posterior horn of the medial meniscus indicating an undersurface tear involving both the central and peripheral portions of the meniscus. In addition, the body of the medial meniscus appears attenuated which may represent additional fraying or tearing. There is a 5 mm poorly defined low signal intensity focus along the medial aspect of the medial tibial plateau beneath the periphery of the body of the medial meniscus which may represent a small extruded meniscal fragment. The anterior horn appears intact. The anterior horn and body of the lateral meniscus appear intact. The majority of the posterior horn appears intact, although there is increased signal intensity within the root of the posterior horn extending to the superior margin of the meniscus which could represent partial-thickness tearing. The popliteomeniscal fascicles are also indistinct with intermediate signal intensity immediately posterior to the posterior horn of the lateral meniscus which may represent scar tissue.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The distal patellar tendon is slightly thickened with intrasubstance foci of high signal intensity likely reflecting tendinosis and perhaps interstitial tearing.ADDITIONAL

Output: 1. Comminuted intra-articular fracture of the proximal tibia with depression of the posterior aspect of the lateral tibial plateau and extension of the fracture into the medial tibial condyle as described above.2. Subchondral edema of the medial femoral condyle is nonspecific, but could reflect pre-existing degenerative changes, healing impaction/stress fracture, or mild spontaneous osteonecrosis.3. Medial meniscus tear as described above with possible displacement of a small flap of meniscal tissue into the medial gutter.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: Abnormal linear signal within and attenuation of the posterior horn of the medial meniscus, compatible with a horizontal cleavage tear. No significant abnormality noted in the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Tricompartmental joint space narrowing with small osteophytes. Diffuse marked cartilage loss in all three compartments of the knee, with areas of partial thickness cartilage defects at the bilateral femoral condyles and full thickness loss at the lateral facet of the patella. Bone marrow signal is within normal limits. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Horizontal cleavage tear of the posterior horn of the medial meniscus.2. Marked tricompartmental cartilage loss, as described above.3. Large knee joint effusion with loose bodies.


Instruction: Generate impression based on findings.

Input: Lumbago [724.2], Reason for Study: ^Reason: cord compression History: fecal incontinence x 4 days, back pain x 4 days The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.The conus medullaris terminates at the L1-L2 level.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.