Instruction: Generate impression based on findings.

Input: Female 51 years old Reason: evaluate for History: hypoglycemia with hyperinsulinemia ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. Normal intrinsic T1 hyperintensity throughout the pancreas. No pancreatic mass. No pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes related to Roux-en-Y gastric bypass.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No specific cause is identified for patient's hypoglycemia/hyperinsulinemia.


Instruction: Generate impression based on findings.

Input: 38 year-old male with hypertension and headache. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensities within the subcortical white matter and periventricular distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Low back pain radiating to bilateral lower extremities, hip flexion weakness Five lumbar type vertebral bodies are presumed to be present with the most inferior well-defined disc space labeled L5-S1. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Multilevel degenerative changes are seen with disc desiccation and height loss at L5-S1 and to a lesser degree L4-L5 and L3-L4 levels. Edematous marrow signal changes are noted involving the endplates at the left L5-S1 level associated with disc height loss. The conus medullaris is normal in position.Individual levels as below:L1-L2: No spinal canal or neural foraminal stenosis.L2-L3: No spinal canal or neural foraminal stenosis.L3-L4: There is mild disc bulge, ligamentum flavum thickening, and facet arthropathy. There is no significant spinal canal stenosis. There is mild right neural foraminal narrowing. No significant left neural foraminal narrowing.L4-L5: There is disc bulge eccentric to the right, ligamentum flavum thickening, and moderate facet arthropathy as well as mild prominence of the dorsal epidural fat fat. There is resulting mild to moderate spinal canal stenosis. There is mild right neural foraminal stenosis. No significant left neural foraminal narrowing.L5-S1: Disc height loss with disc bulge and dorsal annular fissure. There is also ligamentum flavum thickening and moderate facet arthropathy. There is partial effacement of the bilateral recesses. There is mild central canal stenosis. There is moderate to severe left neural foraminal stenosis where there may be impingement of the exiting L5 nerve root. Right neural foramen is patent.

Output: Multilevel degenerative changes in the lumbar spine with up to mild to moderate L4-L5 and mild L5-S1 spinal canal stenosis. There is also moderate to severe left L5-S1 neural foraminal stenosis where there may be impingement of the exiting L5 nerve root. Additional levels as described above.


Instruction: Generate impression based on findings.

Input: seizures, No evidence of acute ischemic or hemorrhagic lesion on this scan.There are patchy high signal intensity lesions on bilateral periventricular white matters indicate non specific small vessel ischemic lesion. Underlying brain shows minimal to mild brain atrophy which could be a bit more prominent than age.The ventricles appear to be a bit prominent but no evidence of occlusive lesion.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Sphenoid sinus as well as bilateral maxillary sinuses show mucosal thickening and fluid level indicating sinusitis.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. The right Pcom artery is patent and Acom artery is patent but the left Pcom artery is not seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery origin appears to be narrowed about 50%. The right vertebral artery is hypoplastic. Bilateral common carotid, carotid bifurcations, internal/external carotid show tortuous course but do not show any significant luminal narrowing. There is no evidence of intracranial arterial luminal narrowing or arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial and extracranial craniocervical arterial luminal narrowing.3. No evidence of intracranial aneurysm.4. Non specific white matter changes with mild brain atrophy as described above.


Instruction: Generate impression based on findings.

Input: L3 compression fracture on outside hospital examination. Personal history of thyroid cancer. Evaluate fracture. There is approximately 25% loss of height of the L3 vertebral body appearing similar to prior. Vertebral body also demonstrates heterogeneous increased both T1 and T2 signal. No adjacent soft tissue edema. Mild increased internal STIR signal. Overall appearance is not significantly changed since 2009. Decreased T1 signal in the T11 vertebral body as well as a round focus of decreased T1 and T2 signal in the L2 vertebral body are nonspecific, but unchanged from prior examination in 2009. No specific evidence of metastatic disease on this noncontrast examination.Remainder of the vertebral body heights are maintained. Alignment is within normal limits. Intervertebral disc heights are maintained. The conus medullaris terminates at the L1-2 level.Level by level findings are as follows:T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: Trace diffuse disc bulge. No spinal canal or neural foraminal narrowing.L2-L3: Mild diffuse disc bulge. No significant spinal canal or neural foraminal narrowing.L3-L4: Moderate diffuse disc bulge. Trace spinal canal narrowing. No neural foraminal narrowing.L4-L5: Mild diffuse disc bulge. No spinal canal or neural foraminal narrowing.L5-S1: Mild disc bulge. Mild facet arthropathy. Prominence of the epidural fat. No significant spinal canal or neural foraminal stenosis.

Output: 1. No significant change in appearance of the L3 chronic compression fracture with approximately 25% loss of height compared to prior MRI from 2009.2. Mild degenerative changes as described without significant neural foraminal or spinal canal stenosis.3. No specific evidence of osseous metastatic disease on this noncontrast lumbar spine MRI. Osseous marrow signal abnormality involving the L3 vertebral body, T11, and L2 is not significantly changed since 2009.


Instruction: Generate impression based on findings.

Input: History of CFTR mutation with hypertriglyceridemia and severe pancreatitis now with worsening pain. Evaluate for pancreatic duct stricture and new fluid collection. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size measuring 19.4 cm in craniocaudal dimension. Loss of signal intensity on out of phase imaging compatible with diffuse fatty infiltration. No suspicious liver lesion. No significant intra or extrahepatic biliary ductal dilatation with the common bile duct measuring 7 mm. The patient is status post cholecystectomy.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. The pancreas is mildly atrophic. It demonstrates decreased intrinsic T1 weighted signal intensity and overall postcontrast enhancement. No evidence of parenchymal necrosis or hemorrhage. No significant parenchymal edema or peripancreatic fluid/fat stranding.Along the anterior pararenal fashion dorsal to the pancreatic tail is a 3.3 x 2.1 cm fluid collection along the lesser curvature of the stomach demonstrating thin wall enhancement compatible with a pseudocyst given the patient's history. There is minimal fluid surrounding the duodenal sweepNo evidence of arterial pseudoaneurysm or venous thrombosis.There is mild irregular narrowing, dilatation and mural contour of the main pancreatic duct (series 3 image 85 and 96) which is improved from the prior and is patent throughout, compatible with stigmata of chronic/prior pancreatitis. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild irregular dilatation, narrowing and mural contour of the main pancreatic duct, improved in caliber from the prior, compatible with stigmata of chronic/prior pancreatitis. 3.3 cm air and fluid collection anterior to the left adrenal gland abutting the lesser curvature of the stomach. This likely represents a pseudocyst when comparing to prior studies and much less likely a gastric diverticulum. It is mildly increased from the prior study.Fatty infiltration of liver.


Instruction: Generate impression based on findings.

Input: Multiple myeloma. History of lesions at T3, T6, T7, and T12 suspicious for myeloma. Bone marrow biopsy shows less than 10% plasma cells. There are T2 hyperintense enhancing lesions of variable sizes in the C6, T3, T6-10, T12, and L1 through L5 vertebrae. There is multilevel cervical and lumbar degenerative disease is associated with no significant spinal canal stenosis. Aside from multiple small intravertebral disc herniations, the vertebral body heights and alignment are intact. The spinal cord and cauda equina nerve roots are intact. The paravertebral soft tissues are unremarkable.

Output: 1.Multiple enhancing lesion within the vertebral column may represent multiple myeloma deposits, without evidence of pathological fracture. 2.Multilevel cervical and lumbar degenerative disease is associated with no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Brain tumor, follow-up. Again seen are postsurgical changes of right frontotemporal craniotomy for tumor resection. Again seen is masslike T2/flair hyperintensity in the right periatrial region extending across the corpus callosum into the left parietal lobe. T2/FLAIR hyperintensity involving the right basal ganglia and right frontal, temporal, and parietal white matter is not significantly changed. There are areas of thick enhancement along the medial aspect of the resection cavity, anterolateral to the resection cavity, as well as posteriorly abutting the tentorium compatible with treated tumor. There is mild apparent increase in enhancement involving the splenium and the left periatrial region on the post gadolinium spin echo sequence which is not seen on the SPGR and favored to be related to differences in contrast timing. There is also a new nodular enhancement in the right parietal white matter, axial post gad series 15 image 18 of 28.There is restricted diffusion within the tumor in the right periatrial region and splenium which was present previously but more prominent on the current study. No evidence of acute infarct. Unchanged additional areas of FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific.No new mass-effect, midline shift, or uncal herniation. No hydrocephalus.

Output: 1. Compared to 11/26/2014, there is overall no significant change in extensive areas of masslike FLAIR hyperintensity and enhancement consistent with known high grade glial neoplasm. There is restricted diffusion involving the tumor within the periatrial region and splenium of the corpus callosum which was present on prior and compatible with Avastin effect. 2. Enhancement along the ventricular surface in the right periatrial region is again seen suspicious for subependymal tumor spread. 3. There is a new punctate focus of enhancement in the right parietal white matter which may represent treatment change and can be assessed on follow-up studies.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of HCV and cirrhosis. Evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: The liver has a cirrhotic morphology. There are several T2 hyperintense foci throughout the liver with the largest in the right hepatic lobe with no evidence of enhancement; findings compatible with cysts. No suspicious arterially enhancing focal lesion. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Again noted are multiple upper abdominal portacaval lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver without suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Evaluate brainstem lesion, compare with previous: vomiting, brainstem lesion on previous exam. There is no appreciable residual abnormal signal in the left pons. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues appear to be unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No appreciable residual brainstem lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: 7-year-old ex-34 week infant with ALTE requiring CPR at home. Nonenhanced head CT:There are questionable patchy areas of cortical low-attenuation in the bilateral posterior temporal and parietal lobes which considering patient's age may not be an abnormal finding however possibility of ischemic changes cannot be entirely ruled out. Please correlate with clinical exam and follow-up with an MRI study. There is no evidence of hemorrhage, mass effect, midline shift or hydrocephalus. There is no evidence of any crowding of the fontanelles. Mastoid air cells and middle ear cavities are pneumatized and unremarkable. Calvarium is intact.

Output: No definitive evidence of pathology. Questionable areas of low attenuation of the cortex and bilateral temporal and parietal lobes may be related to patient's premature brain however possibility of ischemic change cannot be entirely from out. Correlate with history and follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with a left parotid mass. An ill-defined lesion is evident within the left parotid gland occupying primarily the deep lobe and a small portion of the superficial lobe. The lesion measures at least 21 x 14 mm (image 30 series 701), and does seem to extend slightly through the stylomandibular canal.On T1-weighted images, the lesion is relatively isointense to skeletal muscle. On T2-weighted images, the lesion is very heterogeneous with portions which are hyperintense and other portions which are very hypointense potentially suggesting blood product. The lesion enhances in an ill-defined infiltrative manner with relative hypoenhancement centrally.Please note that microscopy coil images were attempted, but these were technically suboptimal. Spectroscopy of the lesion was also attempted as requested. The resulting spectrum (not shown) was dominated by a lipid peak which probably represents unavoidable inclusion of normal fatty tissue within the voxel. As such, the spectrum provided no additional diagnostic information. Likewise, relative cerebral blood volume mapping is noncontributory.There appear to be small cystic lesions elsewhere within the left parotid gland and within the right parotid gland of uncertain significance. The submandibular glands are unremarkable. The thyroid is only partially visualized.A mildly prominent left jugulodigastric lymph node is seen measuring 13 x 6 mm (image 19 series 701). No pathologic adenopathy is detected in the visualized neck by size criteria.The airway is patent and unremarkable. The osseous structures show normal signal intensity. On limited visualization of the intracranial compartment only minimal nonspecific periventricular T2 hyperintensity is seen.

Output: An infiltrative masslike lesion is identified within the left parotid gland occupying primarily the deep lobe with mild involvement of the superficial lobe. The lesion extends slightly through the stylomandibular canal.The signal characteristics of the lesion are quite heterogeneous, particularly on the T2-weighted images, where there are components which appear to contain blood product. This could reflect intrinsic lesional hemorrhage or the effect of prior biopsy.No definite pathologic adenopathy is seen in the neck, though there is a slightly prominent left jugulodigastric lymph node.The differential diagnosis for this parotid lesion would include a primary parotid tumor. Imaging is not capable of distinguishing between benign and malignant etiologies, but the ill-defined and infiltrative appearance of this lesion is worrisome.


Instruction: Generate impression based on findings.

Input: 88-year-old male with spiculated left upper lobe opacity on chest x-ray. LUNGS AND PLEURA: Emphysema. Adjacent to the aortic arch and right perihilar region is a spiculated mass with areas of cavitation measuring 2.7 x 4.7 cm call (image 32, series 5), consistent with a primary lung neoplasm. Adjacent region of right upper lobe septal thickening may present local lymphangitic spread, (image 43, series 5).Probable intrapulmonary lymph node coma (image 50, series 5).Hilar calcifications compatible with prior granulomatous disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Enhancing right adrenal mass measures 2.2 x 1.6 mm (image 12, series 3) is nonspecific but suspicious for metastatic disease. Further follow-up may be considered with PET/CT, dedicated adrenal CT or MRI as clinically indicated.Well-defined hypodense lesion within the midpole of the right kidney is incompletely evaluated but most likely represents a simple cyst.

Output: 1. Right parahilar mass consistent with primary neoplasm.2. Enhancing right adrenal mass suspicious for metastatic disease.Further follow-up may be considered with PET/CT, dedicated adrenal CT or MRI as clinically indicated.


Instruction: Generate impression based on findings.

Input: Several neurologic sequelae from MVA in 2002 presenting with right lower extremity weakness. The patient had been treated with halo, C1-2 wiring, ventriculoperitoneal shunt, syringoperitoneal shunt @ T12, suboccipital decompression with duraplasty, O-C2 fusion, T1-L1 fusion. Now POD #1 for re-exploration of posterior fossa, removal of hardware, placement of 4th ventricle shunt with connection to distal left ventriculoperitoneal shunt, distal revision of ventriculoperitoneal shunt, and craniotomy for Chiari malformation. Brain: There are postoperative findings related to occipital decompression and cranio-cervical fusion with surgical hardware that produces artifacts that obscures surrounding anatomy. There is fluid overlying the duraplasty at the craniectomy site that measures up to 20 mm in thickness. There inferior cerebellum appears low-lying, extending to the level of the inferior margin of the C1 arch and indents the posterior aspect of the medulla, where there is patchy high T2 signal. There is also marked crowding of the neo-foramen magnum with impeded CSF flow and a dysplastic inferior clivus. There is linear T2 hyperintensity in the inferomedial cerebellar hemispheres and right frontal lobe, which may represent postoperative encephalomalacia or gliosis along surgical tracks. There is a left transfrontal ventricular catheter that terminates in the region of the left foramen of Monro. There is also a fourth ventricular catheter. There is a small amount of pneumoventricle. The ventricular system does not appear to be dilated. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening. There are scattered areas of postoperative scalp swelling.Cervical Spine: There is partially imaged thoracic scoliosis and scoliosis rods and screws, which produces artifacts that obscures surrounding anatomy. There is focal fusion of the dens and the anterior arch of C1. There is syringohydromyelia that extends from the level of the dens to the imaged upper thoracic spine, which measures up to 10 mm. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to posterior fossa decompression, ventricular shunting, and craniocervical fusion, with suggestion of cerebellar slumping, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Extensive syringohydromyelia that extends from the level of the dens to the imaged upper thoracic spine, which measures up to 10 mm. Further evaluation of the rest of the spine may be useful.3. Partially imaged thoracic scoliosis and scoliosis rods and screws.


Instruction: Generate impression based on findings.

Input: 84-year-old female with constipation, unable to disimpact. Concern for mass or fecolith per ER. ABDOMEN: The exam is not sensitive detection of lesions in the solid organs due to the lack of intravenous contrast. Given that limitation, the following observations are made.LUNG BASES: Left mastectomy.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta no evidence of aneurysm.BOWEL, MESENTERY: Bilateral hypoattenuating foci in the kidneys likely cysts. Left lower pole lesion stable but does not have characteristics of simple cyst. See prior evaluation with ultrasound on MRI.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate amount of stool in the colon and in the rectum. There is distinct rectal wall thickening to about .8 cm as seen on series 4 image 129. Correlate for possible stercoral colitis limited to the rectum. There is mild stranding of the perirectal fat. Ischio rectal fossa fat is normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic disease.

Output: Possible proctitis. Moderate amount of stool in the rectum. Renal lesions likely cysts including one atypical lesion which is stable.


Instruction: Generate impression based on findings.

Input: 51-year-old female with known bilateral breast cancer, left greater than right. Prior CT showing abnormal lesions in the liver and spleen. ABDOMEN:LIVER, BILIARY TRACT: The previously seen 1.0 x 0.8 cm posterior peripheral lesion in hepatic segment 6 demonstrates faint enhancement without washout and without delayed enhancement. Mild capsular retraction is noted at this lesion. Additional nonenhancing cysts identified. SPLEEN: 1.3 x 1.3 cm T2 hyperintense lesion in the spleen with enhancement compatible with a hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter simple cysts noted. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.1.0 cm posterior peripheral lesion in hepatic segment 6 with features most suggestive of a benign etiology, such as a sclerosed hemangioma. However, given the patient's history, follow-up cross sectional imaging is recommended to confirm stability.2.1.3 cm lesion in the spleen compatible with a hemangioma.


Instruction: Generate impression based on findings.

Input: Again seen is an Ommaya catheter with tip in the lateral aspect of the lateral ventricle. Again seen is a CSF signal intensity collection surrounding the catheter which is slightly larger measuring approximately 4.4 x 2.7 cm, previously 3.0 x 2.0 cm, but with near resolution of surrounding vasogenic edema. There is mild interval decrease in size of the ventricular system. Periventricular FLAIR hyperintensity which may have represented transependymal flow has also decreased.There is no discrete intracranial mass, midline shift, or herniation. Partially empty sella is again seen which can be normal variant but appears slightly less prominent than before.No abnormal mass within the orbits is appreciated. There is enhancement surrounding the optic nerve sheaths bilaterally, similar to prior. Distended optic nerve sheaths are again seen, perhaps slightly less prominent the interval. Previously seen bulging at the optic nerve head/papilledema also no longer appreciated. Evidence of left-sided intraocular lens replacement. No signal abnormality within the optic nerves. Left maxillary mucus retention cyst and minimal mucosal thickening in the ethmoid sinuses. There is heterogeneous low T1 marrow signal involving the calvarium including enhancement of the clivus which appears similar to multiple prior studies. No new osseous destruction; the finding may represent posttreatment change.CERVICAL SPINE

Output: 1. There is no evidence of progressive disease in the brain or spine. No new mass or new focus of abnormal parenchymal or meningeal enhancement. 2. There is mild decrease in size of the ventricular system compared to 9/1/2015 and decrease in periventricular FLAIR hyperintensity, findings which are favored to represent improvement in hydrocephalus with decreased transependymal CSF flow. Previously seen papilledema is also no longer evident and the partially empty sella also appears slightly less prominent; these findings are subtle but suggest improvement in intracranial hypotension and can be correlated with clinical findings. 3. CSF signal intensity fluid collection in the right frontal lobe surrounding the Ommaya catheter is slightly larger, but previously seen surrounding vasogenic edema has nearly resolved.4. There is no significant change in abnormal enhancement surrounding the optic nerve sheaths which is nonspecific and may be related to perineuritis, possibly from treatment-related change or possibly related to known leptomeningeal disease. No new nodular enhancement or mass in the orbits is appreciated to definitively suggest this represents lymphomatous involvement.5. Diffuse enhancement involving the cauda equina nerve roots remains unchanged across multiple prior studies and may represent treated leptomeningeal disease. No new nodular enhancement involving the cauda equina nerve roots or elsewhere in the spine to suggest worsening leptomeningeal disease. No epidural tumor.6. Enhancement involving the clivus as well as patchy enhancement involving the bilateral iliac bones are nonspecific but also remain unchanged across multiple prior studies.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with low back pain. Evaluate for fracture. Evidence of kyphoplasty is seen at T11, T12 and L1. Mild loss of vertebral body height is seen at L1. Moderate loss of vertebral body height is seen at T12 and T11. The T12 vertebral body is mildly retropulsed causing effacement of the ventral thecal sac.The remaining lumbar vertebra demonstrate relatively preserved height and morphology. Marrow signal characteristics are heterogeneous but benign. Spinal alignment is grossly anatomic.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.T12-L1: No significant disc degeneration is seen. No spinal canal stenosis is evident at the disc level. Just above, at the level of the T12 vertebral body, there is effacement of ventral thecal sac due to vertebral body retropulsion resulting in a moderate generalized canal stenosis. There is, however, no evidence of cord impingement.L1-2: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Mild spinal canal narrowing without nerve root crowding. Moderate to severe bilateral foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Moderate generalized spinal canal stenosis with slight nerve root crowding. Severe left foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Bulging disc asymmetric to the right. Mild spinal canal narrowing. Moderate left and mild right foraminal narrowing. L5-S1: Facet arthropathy. Mild bulging disc. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: 1.Evidence of kyphoplasty is seen at T11, T12 and L1. The L1 vertebral body shows minimal loss of height. T11 and T12 show more moderate vertebral body height loss. The remaining lumbar vertebrae are not significantly compressed.2.No aggressive or destructive osseous lesions are seen.3.Multilevel degenerative disease is seen. L3-4 is the most severely affected level where there is a moderate spinal canal stenosis. Multilevel foraminal narrowing ranging from mild to severe is also evident as discussed above.


Instruction: Generate impression based on findings.

Input: There is slight reversal normal upper cervical curvature which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses.

Output: Essentially negative noncontrast cervical spine MRI. Specifically, there are no MRI findings to explain the patient's spasticity.


Instruction: Generate impression based on findings.

Input: Preoperative planing for WHO II meningioma. There are postoperative findings related to prior biparietal craniotomy. There are tumors in the treatment bed, which demonstrate decreased enhancement, but have not significantly changed in size. There is persistent extensive vasogenic edema in the adjacent bilateral cerebral hemispheres. There is regional mass effect and mild midline shift to the right. There may also be enhancement in the brain parenchyma along the surgical margins, although this is incompletely characterized given the lack of precontrast images. There is obliteration of the posterior superior sagittal sinus. Skin fiducial markers are present.

Output: Postoperative findings related to prior biparietal craniotomy for prior partial resection of meningioma. There are residual tumors in the treatment bed, which demonstrate decreased enhancement, likely due to recent embolization. Nevertheless, there is persistent extensive vasogenic edema in the adjacent bilateral cerebral hemispheres.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with right lower extremity weakness. Five fully lumbar type vertebral bodies are present with a transitional S1. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is observed.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Mild facet arthropathy. Mild disc bulging. No significant spinal canal compromise. Mild left foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Mild narrowing of the spinal canal. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal compromise.

Output: Relatively mild degenerative findings are seen causing at most a mild spinal canal narrowing at L4-5 and scattered mild foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Newly diagnosed rectal cancer-rectal cancer staging. Li Fraumeni p53 mutation, bilateral breast carcinoma. Recent TAH/BSO. Colonoscopy proven invasive moderately differentiated rectal adenocarcinoma and rectosigmoid polyp with adenocarcinoma. Overall image quality: ExcellentPELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Multiple pathologic lymph nodes are present. The largest is at the 4:00 position measuring 1.6 x 1.3 cm approximately 2 mm from the left posterolateral mesorectal fascia (series 601/51).Lymph nodes outside the mesorectal fascia: There are non-specific mildly prominent left obturator and external iliac lymph nodes (series 601/57).Some pathologic morphology lymph nodes are noted superiorly in the presacral space. The largest measures 5 x 5 mm (series 601/69).BOWEL, MESENTERY: Rectal Tumor: Intermediate T2-weighted enhancing polypoid circumferential thickening of the mid to distal rectum. There is adjacent hypervascularity and suggestion of linear soft tissue extension (series 601/38), suspicious for extramural vascular invasion.Size: There is intermediate T2 weighted polypoid near circumferential thickening of the mid to distal rectum extending approximately 6.3 cm in craniocaudal dimension (series 801/33). The thickest region of wall thickening measures 2.1 cm (series 601/39).Tumor appearance on T2-weighted images: IntermediateTumor location: Middle-third to lower third of the rectum.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 1 to 2 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 0Circumference of the rectum involved: 100%Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): The tumor appears to invade the right aspect of the mid/superior vaginal cuff (series 601/43). At the lower vaginal cuff the rectovaginal fat plane is obscured, suspicious for tumoral invasion(series 601/32).There is soft tissue stranding extending beyond the expected serosal margin suspicious for perirectal fat invasion.MRI T-stage: T3c - Tumor invades >1cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: 8 mm (image 801/series 49).More proximally there is a short segment of the rectosigmoid which appears fixed/collapsed (series 601/63) throughout the exam and demonstrates circumferential hyperenhancement (series 1303/528) and restricted diffusion (series 902/456). This region appears to be discontinuous from the mid/distal rectal lesion. Diverticulosis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Polypoid circumferential lesion involving the mid to distal rectum with perirectal lymphadenopathy, mesorectal fat extension and suspicion of extramural vascular invasion. The mass invades the vaginal cuff as described above.2. Mesorectal lymphadenopathy. 3. Multiple additional prominent pelvic lymph nodes as described above. 4. Abnormal appearing short-segment of the rectosigmoid is discontinuous from the rectal lesion; this may correspond to the site of rectosigmoid adenocarcinoma biopsied during colonoscopy.


Instruction: Generate impression based on findings.

Input: Left wrist pain LIGAMENTS: No significant abnormality noted. The intra-articular contrast remains in the mid carpal space. No communication is seen with the radiocarpal space, indicating that the intrinsic scapholunate and intrinsic lunate- triquetral ligaments are intactTRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Negative MR arthrogram of the left wrist


Instruction: Generate impression based on findings.

Input: Reason: 14 y/o with autism macrocephaly optic nerve hypoplasia primary generalized epilepsy. CT head normal 2003 o other neuroimaging done. Please evaluate for other developmental anomalies History: 14 y/o with autism macrocephaly optic nerve hypoplasia primary generalized epilepsy. CT head normal 2003 no other neuroimaging done. Please evaluate for other developmental anomalies. There is a nonenhancing lesion in the suprasellar cistern measuring 1.8 x 1.7 cm in axial dimension and 1.6 cm in craniocaudal dimension which follows CSF on all sequences, likely representing an arachnoid cyst. The anterior pituitary gland is small and may be slightly compressed downward within the sella. Pituitary infundibulum is diminutive and incompletely visualized in its course. There is evidence of posterior pituitary ectopia appearing as an enhancing lesion with intrinsic T1 shortening, best seen on T1 axial orbit images, located in the midline at the median eminence of the hypothalamus. The optic chiasm is displaced superiorly and appears diminutive. The bilateral optic nerves also appear small. There are 3 punctate subcortical T2 hyperintensities, the largest in the right parietal subcortical white matter without associated diffusion restriction. No evidence of acute infarct. Septum pellucidum is present. No hydrocephalus. Remainder of the midline structures are intact including a normal-appearing corpus callosum. There is no midline shift or herniation. The globes are normal in appearance. The paranasal sinuses are unremarkable.

Output: 1.Evidence of posterior pituitary ectopia which is located at the median eminence of the hypothalamus. Pituitary stalk is severely diminutive and poorly visualized. Anterior pituitary is small. There is also hypoplasia involving the bilateral optic nerves and chiasm. Septum pellucidum is present. Constellation of findings are within the spectrum of septic optic dysplasia. 2.Likely an arachnoid cyst involving the suprasellar cistern measuring approximately 1.8 x 1.7 x 1.6 cm with mild mass effect on the optic chiasm superiorly and the anterior pituitary inferiorly.3.A few punctate scattered subcortical T2/flair hyperintensities which are are nonspecific and may be related to prior inflammation/infection, ischemia, or less likely demyelination.


Instruction: Generate impression based on findings.

Input: Status post left knee arthroscopy with continued pain, evaluate for patellofemoral chondromalacia or medial meniscus tear MENISCI: There is increased signal intensity within the superior fibers of the posterior horn of the medial meniscus at/near its root, which is new from the prior study. While this finding is compatible with a tear, it is conceivable that this could represent postoperative changes from prior meniscal repair or debridement. The remaining medial meniscus is unremarkable. The lateral meniscus is normal.ARTICULAR CARTILAGE AND BONE: There is a small focus of increased signal intensity seen only on the fat-suppressed proton density axial sequence traversing the articular cartilage of the median eminence of the patella which may represent a small non-fluid-filled cleft. This location is similar to that of the fissure described on the prior study. There is abnormal signal intensity within the subchondral marrow of the lateral aspect of the medial femoral condyle likely representing the site of microfracture. Increased signal intensity in the overlying articular cartilage may represent a residual cartilage defect. The lateral compartment is unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Small focus of signal abnormality in the patellar cartilage as described above may represent a non-fluid filled cleft.2.Signal abnormality in the medial femoral condyle likely due to microfracture. Increased signal intensity in the overlying cartilage may represent a residual cartilage defect.3.Abnormal signal in the posterior horn of the medial meniscus near its root is compatible with a tear, but could also represent postoperative changes.


Instruction: Generate impression based on findings.

Input: Clinical question: Cognitive impairment, rule out vascular issues, NPH, urinary incontinence. Signs and symptoms: As above. Nonenhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrate small foci of flair hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres, right thalamus and bilateral basal ganglia which considering patient's stated age of 83 most likely representing chronic nonhemorrhagic small vessel ischemic strokes a mild degree. The cortical sulci remain within normal size and morphology for age. There is slight prominence of the supratentorial ventricular system which has remained stable since prior exam from 2014 however slightly more pronounced when compared with prior MRI from 2013. In proper clinical setting possibility of NPH should be considered.The fourth ventricle remains within normal size.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Chronic nonhemorrhagic small vessel ischemic strokes of mild-to-moderate degree with mild interval progression since prior MRI exam 2 - 25 - 2014.3.Slight prominence of supratentorial ventricular system is stable since prior exam from 2014 MRI however with interval progression since MRI from 2013. In proper clinical setting the possibility of NPH should be considered.


Instruction: Generate impression based on findings.

Input: Ms. Tennant is a 37-year-old female with biopsy-proven DCIS and ADH of the left breast. She presents today for MR evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. There is a moderate amount of background parenchymal enhancement noted bilaterally, which limits the sensitivity of MRI.In the left upper outer breast, susceptibility artifact from biopsy marker clip is identified, at site of biopsy-proven DCIS. Seen immediately inferior to the biopsy clip artifact is linear nonmass enhancement, measuring approximately 2.2 cm in AP dimension. Note that the MR detected area of linear enhancement (2.2 cm-AP dimension) measures less than the mammographically detected area of calcifications (4.0 cm-AP dimension). There is no abnormal enhancement seen at the site of biopsy-proven ADH in the left lateral breast.No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Moderate amount of background parenchymal enhancement, which limits the sensitivity of MRI.(2) 2.2 cm linear nonmass enhancement corresponding to the site of biopsy-proven DCIS in the left breast. Note that the MR detected area of enhancement (2.2 cm-AP dimension) measures less than the mammographically detected area of calcifications (4.0 cm-AP dimension).(3) No abnormal MR enhancement at the site of biopsy-proven ADH in the left breast.(4) No MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with metastatic melanoma to the left sacrum. Evaluate for extent of disease. A 3 x 3 x 2 cm enhancing mass is evident within the left sacral ala. The lesion encroaches slightly upon the left S1 neural foramen. A majority of the lesion is intraosseous, though there is a small extraosseous component tracking inferiorly and anteriorly along the S1 nerve root as it exits the foramen.No definite evidence of any additional metastatic lesion is seen. There are scattered areas of marrow inhomogeneity, for example anteriorly within the L4 vertebral body. However, these areas do not enhance and as there is no correlating bony destruction on the prior CT myelogram, they are favored to be benign. Vertebral body heights are maintained. Spinal alignment is anatomic.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No pathologic spinal cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Prominently lateral disc bulging. No spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Mild facet arthropathy. Mild disc bulging. No spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a superimposed central protrusion. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Advanced facet arthropathy. No spinal canal or foraminal stenosis.

Output: A metastatic lesion is evident within the left sacral ala. The lesion encroaches mildly upon the left S1 neural foramen. The lesion is predominantly intraosseous, though there is a small extraosseous component which tracks inferiorly and anteriorly along the exiting S1 nerve root.


Instruction: Generate impression based on findings.

Input: 47 year old with personal history of left mastectomy in 2003 for IDC with reconstruction. Patient received radiation, chemotherapy, and hormonal therapy. Patient had right breast reduction in 2005. No new breast complaints. History of breast carcinoma in maternal grandmother and maternal great-grandmother. Minimal parenchymal enhancement is noted in the right breast. The patient is status post left mastectomy and autologous reconstruction. No suspicious enhancement is seen in either the right breast or left reconstruction. Stable benign enhancing mass in the right lower outer quadrant compatible with a benign intramammary lymph node. There is a focal area of enhancement in the skin at the 8:00 position of the right breast that measures 8 x 4 mm, not seen on prior examinations.No abnormal axillary lymph nodes are identified in either axillary region.High T2 liver lesions are again noted, likely cysts or hemangiomas.

Output: 1.No MRI evidence for malignancy within right breast.2.Focal area of skin enhancement in the 8:00 position of the right breast could represent a focal skin lesion. Recommend correlation with physical exam (which will be performed by Donna Christian) followed by a targeted ultrasound as needed.Findings were discussed with Donna Christian (pager 6871) via telephone by Dr. Kulkarni at 3:44 PM on 12/16/2015.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: Back pain, urinary incontinence, and poor rectal tone The vertebral bodies in the cervical, thoracic, and lumbar spine are grossly maintained. Alignment is grossly maintained. Advanced degenerative changes are seen in cervical spine with disc osteophyte complexes at C3-C4, C4-C5, C5-C6, and C6-C7, which in association with ligamentum flavum thickening result in moderate to severe spinal canal stenosis. There is abnormal T2 signal suspected at the C4-C5 level which may represent myelomalacia and can be better assessed on dedicated cervical spine imaging.Small disc bulge is seen in the thoracic spine at the T6-T7 level. Moderate endplate marrow signal changes and mild endplate irregularity at the T6-T7 level.Degenerative changes are seen in the lumbar spine with prominence of the dorsal epidural fat. There is up to moderate spinal canal stenosis suspected at the L2-L3, L3-L4, and L4-L5 levels related to prominence of the dorsal epidural fat with superimposed degenerative changes.

Output: Examination is obtained per screening cord compression protocol. There is moderate to severe spinal canal stenosis in the cervical spine on a degenerative basis with suspected cord signal abnormality, which may be related to myelomalacia, at the C4-C5 level. Up to moderate multilevel spinal canal narrowing in the lumbar spine is also noted.Further dedicated imaging of the cervical and lumbar spine was obtained. Please refer to separate report.


Instruction: Generate impression based on findings.

Input: There is a linear flow void extending from the left superior frontal sulcus towards the anterior aspect of the left lateral ventricle where there is heterogeneous ovoid 9 x 7 mm area with susceptibility effect and heterogeneous predominantly T2 hyperintense, T1 isointense signal. There is no surrounding vasogenic edema or significant mass effect. There is no acute infarct, midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The skull and extracranial soft tissues are unremarkable.

Output: Findings most likely representing a 9 x 7 mm cavernoma adjacent to the frontal horn of the left lateral ventricle with associated developmental venous anomaly. Recommend comparison with prior outside examination when available.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:7/31/1964)Reason: assess for stenosis History: left face and arm weaknessPROVIDER/ATTENDING NAME: KEME H CARTER RICHARD KRAIG MRI of the brainThere is a small focus of diffusion restriction present along the posterior limb of the right internal capsule.There is a mild to moderate degree of periventricular and subcortical white matter signal hyperintensities on T2 and FLAIR MRI imaging. Additionally there are T2 and FLAIR hyperintense lesions present in the right internal capsule, basal ganglia and external capsules as well as the brainstem.On susceptibility imaging there are punctate foci of signal hypointensity present in the basal ganglia and thalami as well as the lower brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. There is a stenosis present along the left posterior cerebral artery along the left perimesencephalic cistern at the posterior aspect of the left P2 segment.The anterior communicating artery appears to be fenestrated. The posterior communicating arteries are not readily identified. The left vertebral artery is larger than the right vertebral artery.There is some mild degree dilatation of imaging due to some patient motion.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 right vertebral artery is smaller than the left vertebral artery

Output: 1.There is an acute lacunar infarct present along the right internal capsule at the posterior limb.2.There is a stenosis present along the left P2 segment.3.There are microhemorrhages present within the basal ganglia and brainstem which are in a pattern suggestive of hypertension.4.There are punctate lesions present in the basal ganglia and brainstem which probably represent old infarcts.5.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 6.Please note that the aneurysms less than 3 mm in size may be overlooked in exam like this with mild motion artifact.


Instruction: Generate impression based on findings.

Input: Mechanical symptoms, medial knee pain. Evaluate for meniscus and loose body. MENISCI: The inner aspect of the body of the medial meniscus is not visualized. There is irregularity and blunting of the posterior horn of the medial meniscus compatible with a complex tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is near full thickness loss of the articular cartilage of the weight-bearing portion of the medial femoral condyle and thinning of the articular cartilage more anteriorly. Additionally there is full thickness loss of the articular cartilage of the anterior lateral femoral condyle with subchondral edema, appearing similar to the prior study. Focal areas of near full thickness to full-thickness loss are also noted within the posterior lateral femoral condyle articular cartilage. There is thinning and heterogeneity of the lateral facet articular cartilage of the patella indicating degeneration with minimal subchondral edema. Partial thickness fissuring is also noted about the median eminence. There is thinning of the lateral femoral trochlea articular cartilage.Medial compartment osteophytes are noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus. 2. Chondromalacia as described above.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with frequent headaches on the left side of the head on and off for three weeks. Patient on clinical trial with MPDL/BEV for recurrent high grade serous fallopian tube carcinoma. No evidence of edema or mass effect is seen. No pathologic intracranial enhancement is observed. Scattered nonspecific foci of T2 hyperintensity are seen within the cerebral hemispheres without significant interval change. There are no findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. Ventricular size and morphology are within normal limits.

Output: 1.No evidence of intracranial metastases.2.No acute intracranial findings.3.Stable scattered nonspecific foci of T2 hyperintensity may reflect chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB:1/1/1962)Reason: s/p fall, evaluation for vertebral compression fracture. History: pain significantly worse than 10 days agoPROVIDER/ATTENDING NAME: SAMANTHA C ISRAEL SAMANTHA C ISRAEL Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact.Since the prior examination bone cement has been placed within the right sacral alla were there is a known insufficiency fracture..There is redemonstration of burst fracture at L2 with retropulsion of fragments into the spinal canal and mild narrowing of the spinal canal. The appearance has not changed since the prior exam. There is T2 and FLAIR signal hyperintensity within the L2 vertebral body.There is redemonstration of a small lesion within the L3 vertebral body which is stable.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level. There is mild ligamentum flavum hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a subacute compression fracture present at L2 with 50% loss of vertebral body height which is unchanged since prior exam.2.Since prior exam patient has undergone right sacral alla sacroplasty for an insufficiency fracture of the right sacral alla. There are edematous changes present within the right sacral ala which were also present on the prior exam.3.An L3 1cm lesion is stable.4.There are mild degenerative changes present in the lower lumbar spine mainly related to some facet hypertrophy.


Instruction: Generate impression based on findings.

Input: 66-year-old male with metastatic lung cancer to the liver ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. T2 hyperintense lesion in segment 8 of the liver measuring 11 x 11 mm with discontinuous nodular enhancement is likely a hemangioma. Lesion in the liver dome/superiormost aspect of caudate lobe with isointense T2 signal, hyperintense T1 signal measuring 1.8 x 2.1 cm with avid enhancement compatible with metastasis. Additional enhancing segment six lesion measuring 15 x 16 mm (series 11, image 46) likely represents metastasis. Additional focus in the left dome of the liver may be artifact (series 11, image 111). 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: T2 hyperintense focus in the T10 vertebral body, favored to be a hemangioma but nonspecific.Curvilinear T2 hypointensity at the femoral heads bilaterally may reflect avascular necrosis, incompletely evaluated.T1 isointense, T2 hyperintense, nonenhancing lesion in the posterior left iliac wing is indeterminate.OTHER: Lung findings are not well assessed on MR.

Output: 1.Enhancing lesions with subsequent washout seen in the caudate lobe and segment 6, consistent with metastatic disease.2.Segment 8 lesion has imaging characteristics of a hemangioma.


Instruction: Generate impression based on findings.

Input: Per EPIC, history of chronic hepatitis B, HCC metastatic to lung (s/p sorafenib, currently on phase III study of cabozantinib 4/3-) presenting with encephalopathy. Evaluate for lesion, RPLE. Image quality is somewhat degraded by motion artifact. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There is high T1 signal in the bilateral basal ganglia, particularly the globus pallidi, and thalami, as well as the cerebral peduncles. There are no enhancing intracranial lesions. There are scattered punctate foci of increased T2 signal within the periventricular and subcortical white matter, which are non-specific, but likely represent chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the bilateral ethmoid and sphenoid sinuses.

Output: 1. Findings compatible with chronic hepatic encephalopathy.2. No evidence of intracranial metastasis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. McKinney is a 55-year-old female in high-risk screening protocol MRI program. Family history of breast cancer in mother, two maternal aunts, and ovarian cancer in maternal cousin. Personal history of benign right breast biopsy in 1982. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Few scattered foci of enhancement are seen in both breasts, none of which appear more suspicious than the rest. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: Characterize new cystic mass anterior left shoulder History: Sudden appearance of left shoulder mass a month ago. ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is a full-thickness tear of the posterior fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 1.5 cm in AP dimension. There is extension of the tear to involve the anterior fibers of the infraspinatus. There is increased signal abnormality within the muscle belly of the supraspinatus suggesting that this tear may be acute in etiology. The supraspinatus muscle appears intact. The infraspinatus muscle appears intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small glenohumeral joint effusion which extends into the subacromial subdeltoid bursa confirming a full-thickness tear. There is an additional focus of signal abnormality within the anterior fibers of the deltoid musculature measuring approximately 1.2 x 0.8 x 3.7 cm with apparent increased signal abnormality on T1 and T2-weighted images and peripheral enhancement on postcontrast sequences. This collection is immediately adjacent to a skin marker which presumably corresponds to the patient's palpable area of concern. Additionally, there is another focus of signal abnormality more posteriorly within the deltoid musculature measuring 2.0 x 1.9 x 5.1 cm which also demonstrates increased signal abnormality on T1 and T2-weighted images and peripheral enhancement on postcontrast sequences. There are foci of low signal intensity debris within these collections as well as within the glenohumeral joint and subacromial subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small glenohumeral joint effusion which demonstrates enhancement on postcontrast sequences indicating a synovitis. The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal intensity within the anterior and superior glenoid labrum likely representing a combination of degeneration and degenerative tearing. There is focal near full-thickness articular cartilage degeneration along the superior aspect of the articular cartilage of the humeral head.BICEPS TENDON: There is thickening and intermediate signal intensity within the tendon of the long head of the biceps indicating moderate tendinosis. The biceps anchor is not well visualized which may represent a complete rupture of the tendon with retraction.ADDITIONAL

Output: 1. Multiple lobulated foci of signal abnormality within the deltoid musculature which demonstrate peripheral enhancement on postcontrast sequences. There is associated increased signal abnormality on T1-weighted images within these collections. This may represent subacute blood products/hematoma, however, melanoma and alveolar soft part sarcoma remain as differential considerations.2. Glenohumeral joint effusion with findings indicating a synovitis and subacromial subdeltoid bursitis.3. Full-thickness rotator cuff tear and tendinosis as described above.4. Probable complete rupture of the tendon of the long head biceps.5. Osteoarthritis of the shoulder and other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Day is a 68 year old female with a personal history of left breast lumpectomy in 2005 for IDC treated with radiation, chemotherapy, and Arimidex. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal background parenchymal enhancement is noted bilaterally.Stable lumpectomy changes are present in the left breast. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: history of meningioma resection, follow up. No evidence of acute ischemic or hemorrhagic lesion.Left tentorial edge meningioma is redemonstrated, and its size, configuration and MR characteristics do not show any interval change since prior exam.Re demonstration of the left middle cranial fossa post-operative changes including left temporal lobe inferior and middle temporal gyri encephalomalacia, no change since prior exam.The ventricles, sulci and cisterns are unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No change of left tentorial meningioma since prior exam.2. No change of postoperative changes of left middle cranial fossa including left temporal lobe.3. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 64 years, Male, Reason: Liver protocol, triple phase, follow up of liver nodules History: hep C cirrhosis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic liver morphology. Peripheral hyperattenuation on arterial phase images, e.g., within segment 6, likely represents perfusion abnormality.Segment 7 lesion with intrinsic T1 shortening, no appreciable enhancement and washout on delayed phases is unchanged. This likely represents a dysplastic nodule and corresponds to the two identified lesions previously alluded to on the prior exam. A small adjacent foci of enhancement only seen on arterial phase images likely represents a perfusional abnormality.Additional lesions (10/38, 10/38, 10/65) which are high signal on T1 and do not enhance within segments 4A, 8 and 4B likely represent dysplastic nodules and are unchanged from the prior exam.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Multiple nonenhancing lesions have signal characteristics suggestive of dysplastic nodules, these lesions do not meet strict criteria for HCC currently, are not significantly changed from the prior exam. Continued follow up is recommended.


Instruction: Generate impression based on findings.

Input: Susceptibility artifact from left parietal approach ventriculocisternal catheter limits evaluation of the adjacent parenchyma on the diffusion sequence. There is no evidence of restricted diffusion to suggest acute ischemia. Interval normalization of the T2 hyperintensity previously seen within the left bilateral occipital lobes with suggestion of development of volume loss. There is also small foci of T2 hyperintensity and volume loss involving the bilateral thalami. These changes are compatible with evolution of previously seen ischemic injury.Bilateral transparietal catheters and disconnected left frontal catheter are again seen. Evidence of prior right frontal ventriculostomy also noted. There is mild interval enlargement of the lateral and third ventricles compared to prior MRI dated 12/2/2014 and minimally larger compared to outside CT dated 1/21/2015 with for example the third ventricle measuring 11 mm in diameter, compared to 7 mm on prior CT from 1/21/2015. Colpocephaly and thinning involving of the corpus callosum, particularly involving the mid callosal body again seen. Tiny foci of susceptibility are again noted along the margins of the ventricular system compatible with chronic blood products. Aqueductal stenosis again noted.No abnormal parenchymal or meningeal enhancement is seen. No evidence of abscess or empyema. Small focus of fluid intensity is seen at the right frontal burr hole site. Major flow-voids are demonstrated in the major intracranial vascular structures. There is significant interval improvement opacification of the mastoid air cells and paranasal sinuses compared to prior MR.

Output: 1. Susceptibility artifact from left transparietal catheter limits evaluation of the surrounding parenchyma. There is no evidence of acute ischemia in the visualized brain. No findings to suggest abscess or empyema. If there is suspicion for meningitis, consider lumbar puncture for more sensitive evaluation.2. Compared to prior MR from 12/2/2014, evolution of previously seen ischemic injury involving the occipital cortex and bilateral thalami seen.3. There is minimal interval enlargement of the ventricular system compared to most recent outside CT from 1/21/2015 and much more evident enlargement comparing to prior MRI from 12/2/2014. Third ventriculostomy appears grossly patent but better assessed on prior MRI from 12/2/2014 with high resolution 3D T2 and CSF flow sequence


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of IPMN. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: A few scattered subcentimeter hepatic cysts are unchanged. No suspicious enhancing hepatic lesions. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is been no significant interval change in several small cystic lesions seen throughout the pancreas, most consistent with small intraductal papillary mucinous neoplasms. The largest of these in the pancreatic head measures 1.2 x 1.0 cm (series 3, image 25), previously measuring 1.2 x 1.1 cm. There is no discrete enhancement of these lesions. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable nonspecific focal enhancement in the L1 vertebral body which may be degenerative in etiology. OTHER: No significant abnormality noted.

Output: 1.Stable pancreatic cystic lesions most consistent with branch type intraductal papillary mucinous neoplasms.2.Stable nonspecific focal enhancement in L1 vertebral body which may be degenerative in etiology.


Instruction: Generate impression based on findings.

Input: Neck pain and recent trauma. There appears to be intermediate T1 and T2 signal epidural material in the right aspect of the partly imaged upper thoracic spine. There is absence of the usual cervical lordosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Apparent intermediate T1 and T2 signal material in the right epidural space of the partly imaged upper thoracic spine may be volume averaging artifact, although hemorrhage cannot be entirely excluded in the setting of trauma. A dedicated thoracic spine MRI may be useful for further evaluation if clinically warranted. Otherwise, no evidence of cervical spine ligamentous injury or spinal cord lesions. Findings discussed with Dr. Hobbs at 2:20pm on 4/18/15.


Instruction: Generate impression based on findings.

Input: 78 years, Female, left upper lobe lung mass, adenocarcinoma. Evaluate for brain metastasis.. No evidence of intracranial metastatic disease. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is prominent dural calcification along the left anterior frontal parietal convexity which is nonspecific. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is global parenchymal and loss, with particularly prominent volume loss involving the anterior and medial temporal lobes. No hydrocephalus. Major flow-voids are preserved.There is a partially empty sella which can be a normal variant at this age group. There is mild patchy opacification of the paranasal sinuses with small fluid levels in the bilateral maxillary sinuses, which can be seen with acute sinusitis in the appropriate clinical setting. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Prominent volume loss involving the anterior and medial temporal lobes which may be related to a neurodegenerative process and can be correlated with clinical findings.


Instruction: Generate impression based on findings.

Input: There are postoperative changes from previous right frontal craniotomy. There are scattered foci of susceptibility along the margins of the right frontal lobe region resection cavity as well as along the ventricular margins which appears unchanged, and likely due to chronic hemosiderin deposition. The enhancement that was noted in the previous study along the posterolateral margin of the resection cavity is less conspicuous. There is persistent enhancement in the anterolateral margin of the resection cavity. The enhancing nodular tissue along the superior posterior margin of the right frontal lobe resection cavity is unchanged.There is a nonenhancing T2/FLAIR hyperintense mass in the cerebellum, along the right posterior-lateral margin of the fourth ventricle, which exerts partial effacement of the 4th ventricle. This is unchanged from the most recent exam and the minimally progressed since 5/7/2015.There is nodular enhancement of the right frontal horn abutting the mildly thickened anteromedial ependymal surface is decreased in size since the previous study, decreased from 17 x 16 mm to 13 x 9 mm.The T2/FLAIR hyperintensity along the left centrum semiovale and the left corona radiata is less well defined than on the previous study.The ventricles and sulci are within normal limits other than ex vacuo dilatation of the right anterior body of the lateral ventricle. The cisterns remain patent. There is no midline shift. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Interval decrease in size of the right frontal horn mass abutting the medial ependymal surface.2. The right paramedian cerebellar lesion that exerts partial effacement of the fourth ventricle is unchanged from the most recent study and minimally progressed since 5/7/2015.3. The enhancing nodular tissue along the superior posterior margin of the right frontal lobe resection cavity is unchanged.


Instruction: Generate impression based on findings.

Input: 46 years, Male, chronic headaches. Patient had MRI scheduled today but syncopal episode brought him to the emergency department. No intracranial mass or mass-effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Some of these foci are less conspicuous compared to prior likely due to differences in technique. Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Mastoid air cells are clear. Scattered paranasal sinus opacification is again seen including mild mucosal thickening involving the bilateral maxillary sinuses, right greater than left, as well as mild ethmoid and sphenoid sinus opacification. Evidence of prior endoscopic sinus surgery again seen. Sinus opacification is improved since 6/14/2016 CT. Bone marrow signal and extracranial soft tissues are otherwise grossly unremarkable.

Output: 1. No evidence of intracranial mass or mass effect. No evidence of infarct or hemorrhage.2. Mild nonspecific scattered foci of T2/FLAIR hyperintensity which are nonspecific but may represent mild chronic small vessel ischemic disease.3. Scattered paranasal sinus opacification which appears overall improved since maxillofacial CT dated 6/14/2016.


Instruction: Generate impression based on findings.

Input: 60 year-old female with history of medial joint line tenderness. Evaluation of the proximal tibia is limited due to metal susceptibility artifact from intramedullary rod which is incompletely imaged on this study.MENISCI: There is attenuation of the body and posterior horn of the medial meniscus. In particular, there is very little meniscal tissue identified near the root. In the absence of prior meniscectomy, this represents a radial root tear with additional attritional tearing of the remaining posterior horn and body. Alternatively, these findings may be due to prior meniscectomy. There is linear signal abnormality within the posterior horn of the medial meniscus which extends to the articular surface. In absence of prior surgery, this represent a tear, although this also could simply represent residual degenerative signal from prior partial meniscectomy.ARTICULAR CARTILAGE AND BONE: There are severe degenerative changes of the articular cartilage of the medial tibial-femoral compartment with areas that are devoid of cartilage. There are small foci of signal abnormality in the underlying bone, likely degenerative in etiology. There are a few small foci of signal abnormality within the medial femoral condyle which could conceivably represent tiny regions of avascular necrosis, but this is equivocal. There is near full thickness articular cartilage degeneration of the lateral femoral condyle above the posterior horn of the lateral meniscus. There is also severe osteoarthritis of the patellofemoral joint with areas along the medial facet of the patella which are devoid of cartilage. There are tricompartmental osteophytes.LIGAMENTS: The fibers of the ACL are indistinct. The distal fibers of what may be the ACL extend to a focus of signal abnormality within the anterior aspect of the joint that we believe corresponds to an ossicle seen on recent radiographs. This constellation of findings may represent a chronic ACL avulsion injury from the tibial plateau. The PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: The quadriceps tendon is intact. There is thickening of the medial aspect of the patellar tendon which may reflect tendinosis or scarring from prior surgery.ADDITIONAL

Output: 1.Severe osteoarthritic changes as described above.2.Small foci of signal abnormality within the medial femoral condyle may conceivably represent tiny foci of avascular necrosis, but this is equivocal.3.Postoperative changes as above.4.Medial meniscal abnormalities as described above which may reflect prior partial meniscectomy, but we cannot exclude the possibility of a tear.5.Possible chronic avulsion injury of the ACL off the tibial plateau.6.Thickening of the patellar tendon which may be postoperative or degenerative in etiology.


Instruction: Generate impression based on findings.

Input: Patient is status post left lumpectomy and axillary lymph node dissection in 2001 for breast cancer, status post chemotherapy and radiation therapy. BRCA 1 mutation. Breast MRI for surveillance. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are stable postsurgical changes in the left breast including volume loss, scarring and skin thickening. There is postsurgical scarring in the left axilla. No abnormal enhancement is seen in either breast. Stable enhancing focus seen in right breast 9:00 position. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: 70 with TBI, here with fevers, AMS. Has unstageable sacral wound w/eschar. Requesting MRI of sacrum to evaluate for abscess or osteo History: fevers with large sacral wound Intravenous contrast was not able to be administered due to a malfunctioning IV.There is diffuse nonspecific subcutaneous edema most pronounced along the anterior and lateral aspects of the pelvis. There is also increased signal abnormality within the gluteal musculature, right greater than left. There is increased signal abnormality within the iliacus and paraspinal muscles bilaterally which is nonspecific. There is also increased signal abnormality within the imaged musculature of the left hip with some of this inflammatory change/edema becoming confluent within the vastus lateralis musculature. Superimposed infection cannot be excluded. There is minimal soft tissue irregularity along the posterior aspect of the sacrum consistent with the stated history of ulceration. There is extension of this ulceration to the level of the left gluteal musculature. There is associated subcutaneous inflammatory change as well as inflammatory change within the left gluteus maximus musculature. There is a loculated focus of fluid signal intensity within the medial aspect of the left gluteus maximus muscle, measuring approximately 2.0 x 2.0 cm in transverse dimensions, as well as a fluid collection within the presacral space which may represent early abscess formation versus confluent inflammatory change/phlegmon.A Foley catheter is in place. Note is made of a 2.1 cm focus of fluid signal intensity along the right posterolateral aspect of the urethra which may represent a urethral diverticulum. There is a small amount of fluid identified within both hips which is not necessarily of any current clinical significance.

Output: Soft tissue ulceration along the posterior aspect of the sacrum with inflammatory change in the subcutaneous and surrounding soft tissues including a 2.0 cm loculated fluid collection in the left gluteus maximus muscle as well as a presacral fluid collection which may represent early abscess formation versus confluent inflammatory change/phlegmon, although these findings are incompletely characterized on this noncontrast examination. Diffuse nonspecific subcutaneous and soft tissue edema/inflammatory change about the pelvis. No evidence of osteomyelitis. Other findings as described.


Instruction: Generate impression based on findings.

Input: Reason: fibroids, considering UFE History: heavy periods PELVIS:UTERUS, ADNEXA: The uterus measures 10.0 x 9.3 x 11.7 cm.There are innumerable intramural and subserosal fibroids within the uterus. No submucosal fibroids. Most of these lesions are only faintly enhancing. There is no avid enhancement within any particular lesion. For reference, a large subserosal fibroid at the fundus measures 3.3 x 4.2 cm (5/21). An intramural fibroid measures 2.5 x 2.9 cm (5/12).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Innumerable subcentimeter foci in the subcutaneous tissues which are hypointense on T2 and isointense on T1 may be related to subcutaneous injections.OTHER: No significant abnormality noted.

Output: Innumerable subserosal and intramural fibroids within the uterus, measuring up to 4.2 cm, which demonstrate minimal enhancement. None of these lesions are avidly enhancing.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma with single brain lesion; please evaluate for radiosurgery planning. There is a presumably enhancing hemorrhagic lesion in the right medial occipital lobe lesion that measures up to 15 mm. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Preoperative planning MRI shows a right medial occipital lobe lesion that measures up to 15 mm, which is compatible with a metastasis.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: for stereotaxis for OR History: AMS, Weakness There are multiple fiducial markers on scalp.Due to significant patient motion artifact, the quality of exam has been degraded. The left parietal lobe mass was again demonstrated, however, since there was no contrast infused, previously shown peripheral enhancing rim was not seen on the scan.The left lateral ventricle appears to be compressed due to mass effects of the lesion.

Output: 1. Limited exam due to patient's motion artifacts and non contrast infused exam.2. No change of the size and T2 characteristics of the left parietal lobe lesion.


Instruction: Generate impression based on findings.

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

Output: 1. Concavity of the superior aspect of the pituitary may indicate pseudotumor cerebri, but is otherwise nonspecific.2. No intracranial hemorrhage, mass, or mass effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left supraclavicular lymph node metastasis. There is persistent left level 4 lymphadenopathy, which measures 13 x 14 mm in axial cross-section. There is also a prominent left supraclavicular lymph node, which measures 7 x 11 mm in axial cross-section. The other cervical lymph nodes and other neck soft tissues are unremarkable. There is mild multilevel degenerative cervical spondylosis. The images portions of the intracranial structures and orbits are unremarkable.

Output: Persistent left level 4 and supraclavicular lymphadenopathy with corresponding hypermetabolism on PET are compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:3/7/1960)Reason: Evaluate for ischemia History: slurred speech, R sided weaknessPROVIDER/ATTENDING NAME: KAMALDEEP S HEYER TAO XIE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is T2 and FLAIR signal hyperintensity present within the cortex and subcortical periventricular white matter of the left frontal lobe and more less a watershed distribution. There is associated ex vacuo effect along the left lateral ventricle.There is focal signal loss present along the left posterior limb of internal capsule on susceptibility weighted imaging. There is associated volume loss along the left cerebral peduncle which is compatible with a layering degeneration.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Encephalomalacia along the watershed distribution on the left frontal lobe is suspected to be related to prior ischemic event.2.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: There is moderate tumor on sorafenib PELVIS: The ill-defined infiltrating mass in the left hemipelvis is increased in size. The infiltrative character makes is difficult to accurate measure, though is at least 9.4 x 7.7 cm (series 601, image 17), previously 6.6 x 5.5 cm. The mass encases the left external iliac artery. The mass invades and occludes the left external iliac vein, with numerous collateral vessels identified. Anteriorly, the mass further invades and enlarges the left rectus muscle and adductor brevis. Laterally, the mass invades the left pelvic side wall, iliacus muscle, psoas muscle, and abuts the left acetabular cortex. Posteriorly, the mass extends into obturator internus muscle. Medially, the mass likely involves the left lateral bladder wall and adjacent loops of small intestine. The rectum appears uninvolved. UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is mildly increased left thigh soft tissue edema, reflecting venous congestion of the aforementioned left external iliac vein occlusion.

Output: 1. Increase in size and extent of the left pelvic desmoid tumor.2. Occlusion of the left external iliac vein, with venous collateral formation.


Instruction: Generate impression based on findings.

Input: 62-year-old male with PNET metastatic to the liver. Please evaluate for interval change since the prior MRI. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Numerous arterially enhancing hepatic metastases are slightly decreased to not significantly changed compared to the previous examination. Reference segment 5 lesion measures 2.1 x 1.8 cm (series 1001, image 282). The reference segment 6 lesion measures 2.0 x 1.9 cm (series 1001, image 212), previously measuring 2.2 x 1.9. SPLEEN: No significant abnormality noted.PANCREAS: Ill-defined pancreatic head lesion measures 2.1 x 1.4 cm (series 1001, image 187), previously measuring 2.2 x 1.7 cm. No pancreatic ductal dilatation.ADRENAL GLANDS: Unchanged mild nonspecific thickening of the left adrenal gland.KIDNEYS, URETERS: Left renal cysts and left renal atrophy is again noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged peripancreatic node is again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable to slightly decreased numerous hepatic metastatic lesions. 2.Stable to slightly decreased pancreatic head lesion.


Instruction: Generate impression based on findings.

Input: Ms. Stolzer is a 50 year old female with a personal history of left breast mastectomy in 2010 for IDC/DCIS treated with hormonal therapy. Personal history of benign right breast biopsy in 2010 for PASH and benign left chest wall lymph node biopsy in 2011. Family history of breast cancer in mother. Patient is status post left breast mastectomy. There is heterogeneous amount of fibroglandular tissue in the right breast.No new abnormal enhancement is seen in either breast. Stable enhancing masses in the left breast 3:00 and 7:00 positions, the latter of which has previously been biopsied with final pathology of benign lymph node.No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: 80 years, Female, follow-up meningioma, surveillance. There are postsurgical changes of right frontal craniotomy presumably related to resection of meningioma. There is extensive encephalomalacia in the right anterior and inferior frontal lobes which remains unchanged. Small foci of susceptibility in this region may be related to chronic blood products and/or mineralization. There is a small focal area of thickened, dural based enhancement along the right anterior frontal convexity, measuring up to 4 mm in thickness, which remains unchanged since prior study from 7/16/2011 and compatible with postsurgical change (although minimal residual meningioma is not entirely excluded and can be correlated with extent of surgical resection). No new or enlarging lesions.Otherwise no intracranial mass or mass effect. Minimal scattered nonspecific foci of T2/FLAIR hyperintensity in the white matter are compatible with chronic small vessel ischemic changes. There is global parenchymal volume loss commensurate with patient's advanced age. No evidence of intracranial mass effect, midline shift, or herniation. There is ex vacuo dilatation of the right frontal horn. No hydrocephalus. Remainder of the calvarium and extracranial soft tissues are grossly unremarkable. Bilateral lens implants.

Output: 1. Stable postsurgical changes of right frontal meningioma resection. No definite evidence of residual or recurrent meningioma. Please see comment above.2. Known right MCA aneurysm better assessed on recent MRA study.


Instruction: Generate impression based on findings.

Input: Diagnosis: Fever, unspecifiedClinical question: evaluate for signs of brain abscessSigns and Symptoms: h/o recurrent brain abscess, s/p craniotomy, now with fever and headache The patient is status post right craniotomy and right temporal lobe surgery for removal of a ring enhancing lesion. There is no residual enhancing lesion appreciated. There are adjacent T2/FLAIR hyperintense signal changes present in the immediately adjacent brain tissue which have decreased since the prior exam. Previously noted scalp soft tissue swelling has regressed since the prior exam but has not resolved. There is a 9 x 17 mm coronal dimension fluid collection at the resection site which follows CSF on all pulse sequences. There is a thin rim of adjacent enhancement associated with this fluid collection.The patient is status post right mastoidectomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam a right temporal lobe ring enhancing lesion has been removed. There is a small fluid collection present at the surgical site.2.Status post right mastoidectomy and temporal bone surgery.


Instruction: Generate impression based on findings.

Input: Preoperative planning for deep brain stimulator. There is no evidence of intracranial hemorrhage or mass. The brain parenchyma and pituitary gland appear grossly unremarkable. The ventricles and sulci are diffusely prominent due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unremarkable brain MRI for deep brain stimulator surgical planning.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: recurrent seizures 5/015 previous 2011 History: recurrent seizures 5/015 previous 2011 No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Scratch thatThere is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: 40 year old 5 month pregnant female with history of heroine use and cocaine use with two days of left-sided weakness/numbness. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormalities.