Instruction: Generate impression based on findings.

Input: 21 year old female with a history of ewing sarcoma treated with adriamycin as a child. Referred for cardiovascular MRI to evaluate for function and scar. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 92 ml/m2 (normal range: 65+/-11), the LVEDV is 144 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 68 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload (T2-star is 36ms).Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 147 ml (normal range 110+/-24), the RV end systolic volume index is 46 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. There is a trace pericardial effusion. Extracardiac FindingsThere is significant iron overload of the liver (T2-star = 5ms). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mildly dilated left ventricle with normal systolic function (LVEF 56%). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Normal right ventricular size with normal systolic function (RVEF 51%).3. Evidence of hepatic iron overload, which was previously present but not noted.4. When compared to the study from 1/21/2013, no significant change. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 43 years old. Severe headache. There is no evidence of acute infarct, intracranial hemorrhage, mass effect or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. There are no areas of abnormal signal or abnormal parenchymal/leptomeningeal enhancement. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is scattered mild opacification of the mastoid air cells, right greater than left. There are small left maxillary sinus mucous retention cysts, as well as minimal right maxillary sinus mucosal thickening. The other imaged paranasal sinuses and the orbits are unremarkable.

Output: Normal brain MRI without focal abnormality to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 37 years Female (DOB:10/6/1978)Reason: please do dr javed MS protocol on 3T, compare to prior outside MRI ( in PAX) History: numbness, migraine, vertigoPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of several punctate subcortical and periventricular white matter lesions which are bright on FLAIR MRI. There is no associated contrast enhancing lesion within the brain parenchyma.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The cerebellar tonsils are low lying extending 4 mm below the level of the foramen magnum.

Output: 1.There are several periventricular and subcortical white matter lesions present not significantly changed since the prior exam. This does not number is too small/early to the imaging criteria for demyelination. No abnormal enhancing lesions are appreciated within the brain parenchyma to suggest acute plaque.2.Low-lying cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:3/23/1960)Reason: L MCA syndrome History: R hemianopsia, L gaze, R face/arm/leg weakness, aphasia NIH SSS = 22PROVIDER/ATTENDING NAME: DAVID A HARTER AGNIESZKA A ARDELTFLUOROSCOPY TIME: 9.1 minutesFrontal: 829.64 mGyLateral: 704.73 mGyOPERATORS: Greg Christoforidis Left common carotid artery: There is no evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissectionLeft internal carotid arteryThere is opacification of the left anterior cerebral artery and partial opacification of the left posterior cerebral artery. There is occlusion of the left middle cerebral artery at its origin associated with grade 2 leptomeningeal collaterals. There are foci of stenosis along the left pericallosal artery.Intraprocedural arteriograms:There is progressive recanalization of the left middle cerebral artery.Left internal carotid artery following the procedure:There is recanalization of the left middle cerebral artery including superior and inferior divisions with some slow flow in some of the distal M5 branches ..There are multiple foci of stenosis and narrowing of branches of the MCA and ACARight common iliac artery: No contraindication to closure device.

Output: 1.Left middle cerebral artery occlusion at its origin.2.Embolectomy with TIMI 3 recanalization and TICI 3 reperfusion of the left middle cerebral artery using the Trevo embolectomy device.3.Intracranial atherosclerotic disease involving distal branches.4.Findings were discussed with Dr Ardelt at the end of the procedure.


Instruction: Generate impression based on findings.

Input: 81 years, Female, lung cancer, persistent headaches for a few months. Dementia stable. There is mild motion degradation on almost all of the sequences which limits detection for small lesions. Within this limitation, no evidence of abnormal parenchymal or meningeal enhancement is seen to suggest metastatic disease. No intracranial mass or mass effect. There is no evidence of recent ischemia or hemorrhage. There are multiple scattered foci of susceptibility particularly in the parieto-occipital lobes which were present on prior study. There is moderate degree of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which is nonspecific but compatible with chronic small vessel ischemic disease and/or posttreatment changes. There is mild global parenchymal volume loss commensurate with patient's advanced age. No hydrocephalus. No extra-axial collections. Bilateral lens implants are noted. Calvarium and extracranial soft tissues are unremarkable. There is mild prominence of the retroodontoid soft tissues which may related to CPPD for example. There is associated mild narrowing of the spinal canal at the craniocervical junction.

Output: 1. Examination is motion degraded which limits sensitivity for small lesions. There is however no appreciable evidence of metastatic disease on the current study. No intracranial mass or mass effect.2. Multiple scattered foci of chronic microhemorrhage, which may represent amyloid angiopathy, and grossly similar to prior. Also no significant change in multiple patchy areas and scattered foci of FLAIR hyperintensity in the white matter which are nonspecific and may be related to chronic small vessel ischemic disease and/or posttreatment changes.3. Mild narrowing of the spinal canal at the craniocervical junction related to retro-odontoid soft tissue, which may be due to CPPD but is incompletely assessed.


Instruction: Generate impression based on findings.

Input: Osteoarthritis LUMBAR SPINE: Mild degenerative disk disease with lower lumbar spine facet arthropathy. Anatomic alignment. Preserved vertebral body heights.RIGHT HIP: The metallic femoral component of a total hip arthroplasty device is fixedwithin the femur, unchanged in position. The head of the femoral component is high riding in the ilium, unchanged. The acetabular component is not seen. There has been extensive bony remodeling of the acetabulum with lucency likely representing particle wear osteolysis. Acetabular screw and screw fragments and wire fragments overlie the acetabulum, similar to prior. Additional densities in the vicinity of the hip likely represent a combination of cement and heterotopic ossification.

Output: Lumbar spine degenerative changes. Extensive right hip post-operative changes. No acute fracture identified.


Instruction: Generate impression based on findings.

Input: 43 year old female with BRCA 1 mutation. Personal history of benign right breast biopsy in 2003 as well as an FNA aspiration of a right breast nodule at 7 o'clock in 2009 compatible with a fibroadenoma. Family history of breast carcinoma in her sister at age 36, in two paternal aunts in their 40s, and a grandmother. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.RIGHT BREAST: There is redemonstration of an ovoid homogeneously enhancing mass in the posterior right breast, approximately 7:00 position. This mass measures19 x 10 x 17 mm (AP X ML X CC), previously measured 20 x 13 x 15 mm and is not associated with a biopsy clip. However, it corresponds to ultrasound findings from 2014 and the reported site of FNA aspiration biopsy in 2009 confirming a fibroadenoma. Located just anterior to this mass, there is another smaller lesion compatible with fibroadenoma, unchanged from recent MRI.At approximately the 10 to 11:00 position, posterior depth the previously demonstrated enhancing mass is not seen on today's imaging probably slowly enhancing or hyalinized. A T2 correlate at that site measures 12 x 9 x 14 mm which corresponds to the previously enhancing mass that measured 16 x 9 x 18 mm (this is mostly unchanged in size when I compare to the T2 correlate on the prior MRI). This mass is also most likely a fibroadenoma and was seen on prior ultrasound exam.Multiple other smaller enhancing foci are mostly unchanged. No abnormal axillary lymph nodes are identified in right axillary region. LEFT BREAST:A new oval heterogenously enhancing mass with mostly dark T2 signal is seen in the left breast 6:00 position, posteriorly measuring 17 x 20 x 16 mm (AP x ML X CC). Left axillary lymph node has increased in size with altered morphology (2 foci of high T2 signal within it), measuring 20 x 12 mm. Multiple T2-hyperintense lesions in the liver may represent cysts or hemangiomas but are incompletely characterized but stable.

Output: 1. Previously described enhancing FNA proven fibroadenomas in the right breast 7:00 position are unchanged. 2. New left breast 6:00 heterogenously enhancing mass needs MRI directed ultrasound for evaluation with biopsy under ultrasound guidance (MRI guided biopsy will be difficult due to location). 3. Increase in size and altered morphology of left axillary lymph node also needs MRI directed ultrasound for further evaluation. 4. Multiple other enhancing foci or non enhancing mass (lesion at 10 to 11:00 position posterior depth) are mostly unchanged. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Ms. Valerio is a 31 year old female with a history of chest radiation. Personal history of osteosarcoma, off clinical therapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, limiting the sensitivity of MRI.In the right retroareolar region, there is a stable slowly enhancing circumscribed mass with benign type kinetics. This was previously evaluated via ultrasound in 2013 and is compatible with a benign fibroadenoma. Stable intramammary lymph node in the medial mid left breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Redemonstrated is a mixed cystic and solid left thyroid nodule. Kindly refer to thyroid ultrasound report performed on 6/11/15 for further evaluation.

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


Instruction: Generate impression based on findings.

Input: 71 years, Male, stage II/III melanoma. High risk of recurrence, restage. There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. There is a encephalomalacia involving the left frontal lobe, primarily involving the left middle frontal gyrus, with cystlike cavity and surrounding FLAIR hyperintensity related to gliosis. There is susceptibility along its medial aspect which may reflect hemosiderin deposition from prior hemorrhage or mineralization. No restricted diffusion to suggest acute ischemia. No intracranial mass-effect, midline shift, or herniation. The ventricles are within normal limits in size. Minimal additional scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter are nonspecific, but compatible with very mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Left frontal lobe encephalomalacia, which may relate to chronic infarct or other remote injury.


Instruction: Generate impression based on findings.

Input: A 20 year old male with personal history of episodes of tachycardia, short PR segment on the ECG, normal stress test, echocardiography showed LVEF of 49%. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 175 ml (normal range 142+/-34), the LV end systolic volume index is 51 ml/m2 (normal range 25+/-9), the LVESV is 97 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). There is mild global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no intracavitary thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 177 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 88 ml (normal range 54+/-17). There are no focal RV wall motion abnormalities or evidence of fibro-fatty infiltration. There are no findings compatible with ARVC. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. There is a "pseudo-bovine" pattern" (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 45%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. There are no right ventricular focal wall motion abnormalities or evidence of fibro-fatty infiltration. There are no findings compatible with ARVC. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease with persistent perirectal fistula on recent MRI, evaluate disease status.EXAMINATION: MR enterography without and with IV contrast 12/15/2015 ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity without focal lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys demonstrate normal enhancement and excretion. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an approximately 15 cm segment of distal ileum extending to the ileocecal valve with mild wall thickening, hyperenhancement, restricted diffusion, and mild luminal narrowing. This segment is relatively adynamic on cine sequences. Overall, these changes are slightly less prominent and involve a shorter segment of bowel compared to the 12/16/2014 examination. There is no associated high-grade bowel obstruction. No intra-abdominal fluid collection is present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is an approximately 15 cm segment of distal ileum extending to the ileocecal valve with mild wall thickening, hyperenhancement, restricted diffusion, and mild luminal narrowing. This segment is relatively adynamic on cine sequences. Overall, these changes are slightly less prominent and involve a shorter segment of bowel compared to the 12/16/2014 examination. There is no associated high-grade bowel obstruction. No intra-abdominal fluid collection is present.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Recently described perianal fistula is incompletely visualized and was better evaluated on 12/14/2015 dedicated pelvic MRI.

Output: 1.Active inflammatory changes involving approximately 15 cm segment of distal ileum compatible with Crohn's disease overall slightly less prominent than 12/16/2014 examination.2.Recently described perianal fistula is incompletely visualized and better evaluated on 12/14/2015 dedicated pelvic MRI.


Instruction: Generate impression based on findings.

Input: Syncope and collapse, if the source of nonresponsiveness, evaluate for the cause of syncope. There is no evidence of acute infarct. There is encephalomalacia along the watershed zone between the right anterior and middle cerebral artery territory extending to the centrum semiovale with ex vacuo dilatation of the right lateral ventricle and right-sided cortical sulci. There are patchy and scattered foci of cerebral white matter T2 hyperintensity which are nonspecific, mostly related to chronic small vessel ischemic changes. There is gyriform susceptibility effect involving the right posterior parietal lobe likely related to chronic microhemorrhage. The ventricles and basal cisterns are unchanged, with evidence of diffuse cerebral volume loss. There is no midline shift or herniation. The right internal carotid artery flow void is lacking proximally, with reconstitution of the flow voids at the petrous and cavernous portion, with heterogeneous flow void signal, which may relate to slow flow. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Chronic infarction involving the right frontal and parietal lobes in a watershed distribution, as well as a background of probable chronic small vessel ischemic changes.2. Redemonstration of occlusion of the proximal intracranial right internal carotid artery.


Instruction: Generate impression based on findings.

Input: 19 year-old female with slurred speech, evaluate for stroke and demyelination There are numerous foci of T2/FLAIR hyperintensity within both periventricular and subcortical white matter locations involving the supratentorial brain bilaterally as well as corpus callosum proper, the right cerebral peduncle, and perhaps the right anterior medulla. These foci also demonstrate slight restricted diffusion with ADC which appears mildly hypointense with a few lesions also demonstrating mixture with ADC hyperintense signal. A few of the larger lesions demonstrate T1 hypointensity. Some of these lesions are new, and others have significantly enlarged compared to prior. A previous corpus callosal genu lesion has decreased.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. Normal vascular flow voids are present. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are numerous foci of T2/FLAIR hyperintensity within both periventricular and subcortical white matter locations involving the supratentorial brain bilaterally as well as corpus callosum proper, the right cerebral peduncle, and perhaps the right anterior medulla. These foci also demonstrate slight restricted diffusion with ADC which appears mildly hypointense with a few lesions also demonstrating mixture with ADC hyperintense signal. A few of the larger lesions demonstrate T1 hypointensity. Some of these lesions are new, and others have significantly enlarged compared to prior. A previous corpus callosal genu lesion has decreased. These findings are nonspecific, however would be consistent with demyelination in the appropriate clinical context. Other inflammatory etiologies remain within the differential diagnosis. Given the distribution and lack of defined vascular territorial involvement, ischemia is unlikely.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple myeloma and vision loss left eye. There is heterogeneously low T1 signal in the clivus and upper cervical spine. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Heterogeneously low T1 signal in the clivus and upper cervical spine may represent involvement by multiple myeloma.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with right hip and lumbar pain after a fall. Spinal alignment is anatomic. Vertebral body heights are preserved. No concerning marrow replacement or marrow edema is detected.Disc degeneration is seen at T11-12 and T12-L1 with loss of disc height and T2 signal. In addition, there appear to be intra-vertebral disc herniations arising from both the T11-12 and T12-L1 discs along the posterior midline aspect of T12 just beneath the posterior longitudinal ligament. This results in a slight posterior bowing of the T12 vertebral body, but no significant spinal canal stenosis. Again, no evidence of marrow edema is seen which would suggest that these findings are chronic.The remaining intervertebral discs show normal height and T2 signal characteristics. No evidence of any significant disc bulge or disc herniation is seen. No compromise of the spinal canal or neural foramina is detected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.The stomach is partially visualized and appears to have settled posteriorly in the space normally occupied by the spleen. Furthermore, the stomach contains fluid and a large quantity of linear and curvilinear structures which do not resemble typical food material.

Output: 1.No definite acute lumbar spine injury. No significant spinal canal or neuroforaminal stenosis is observed.2.The T12 vertebral body demonstrates an unusual morphology which appears to reflect intra-vertebral disc herniations arising from T11-12 and T12-L1. These herniations project in the craniocaudal plane along the posterior midline aspect of the T12 vertebral body, just beneath the posterior longitudinal ligament. This results in a mild posterior bowing of the T12 vertebral body, but no significant spinal canal stenosis. Lack of marrow edema would suggest that these findings are chronic.3.The stomach is only partially visualized but appears to contain a large quantity of linear and curvilinear structures which are not typical for food material. The possibility of ingestion of foreign bodies or development of a bezoar should be considered. Dedicated abdominal imaging is suggested.


Instruction: Generate impression based on findings.

Input: 54-year-old male with pain in the left knee. Evaluate medial meniscus. MENISCI: There is a small amount of increased internal signal within the posterior horn of the medial meniscus which does not extend to the articular surface and therefore is not a tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is increased T2 signal within the tibia involving both the medial and lateral tibial epiphysis which extends distally into the metaphysis. The increased signal does not extend to the cortical margin and is somewhat serpentine in contour and likely represents an unusual appearance of bone infarction. There is a small anterior osteophyte within the medial compartment. The patellar cartilage is intact. There is no significant thinning of the remaining intra-articular cartilage.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Increased signal within the medial and lateral tibia which is somewhat serpentine in contour and likely represents an unusual appearance of bone infarction. 2. No evidence of meniscal or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Right lower extremity pain. Right sciatica. Evaluate for radiculopathy. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. A benign hemangioma is evident in the L3 vertebral body. There is mild-to-moderate disc space narrowing at L5-S1, otherwise disc heights are preserved. Endplate edema at L5-S1. The conus medullaris appears normal and terminates at the L1-2 level.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: Mild facet hypertrophy and mild bilateral foraminal narrowing. No significant spinal canal stenosis. L5-S1: Mild facet arthropathy and bilateral mild-to-moderate neural foraminal narrowing. Broad-based disc bulge with osteophytic ridging. No significant spinal canal stenosis.

Output: Facet hypertrophy and bilateral foraminal narrowing at L4-5 and L5-S1 as described above.


Instruction: Generate impression based on findings.

Input: 64-year-old female needs restaging for triple negative breast cancer. Clinical Trial Patient 14-0427. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. RIGHT BREAST:In the right upper outer breast, the index cancer has significantly decreased in size and now measures 9 x 8 x 12 mm (AP X ML X SI) compared to 1.8 x 1.4 x 2.3 cm previously. Susceptibility artifact from biopsy marker clip is seen adjacent to the mass. No abnormal enhancement is seen adjacent to the clip that was previously within the satellite lesion located approximately 2.0 cm anterior to the index cancer and has likely resolved. The previously described faint area of enhancement in the right inferior breast has the appearance of normal glandular tissue on today's exam.The previous enlarged reference right axillary lymph node has decreased significantly measuring 8 x 13 mm compared to up to 32 mm in maximal dimension previously. A clip is noted within the lymph node.LEFT BREAST:No abnormal enhancement seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region. A chemo port is noted in the left chest.

Output: 1.Near complete treatment response in the right breast index cancer, satellite lesion and right axillary lymph node.2.The previously described focus of faint area of enhancement in the right inferior breast appears on today's exam to be normal glandular tissue.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 53 year-old male with pituitary macroadenoma, assess for interval change. Redemonstrated is a well demarcated mass in the pituitary gland with the high signal intensity on T1 and mixed signal intensity on T2 which occupies a majority of the pituitary gland. This interval decrease in size in the mass, now measuring 15 mm transverse by 9 mm craniocaudal by 10 mm AP (previously 16 mm transverse x 13 mm craniocaudal x 13 m AP). Concurrent with this decrease in size, slight bulging of the gland superiorly is no longer evident, and there is less anterior displacement of the pituitary stalk. As before, there is no evidence of any contact or mass effect upon the visual complex. There are normal bilateral cavernous sinuses and internal carotid arteries as well as Meckel's caves.

Output: Decreasing size of the patient's known pituitary macroadenoma.


Instruction: Generate impression based on findings.

Input: History of grade III oligodendroglioma status post resection, RT, and TMZ. There are postoperative findings related to right anterior temporal lobectomy with unchanged confluent T2 hyperintensity along the surgical margins. However, there are punctate foci of enhancement along the adjacent right hippocampal tail. There is also interval increase in size of the enhancing left cerebellar hemisphere lesions and surrounding T2 hyperintensity, measuring up to 6 mm and 15 mm each, previously 4 mm and 7 mm, respectively. There are unchanged numerous scattered supratentorial white matter T2 hyperintense lesions, which may represent chronic small vessel ischemic disease. There is also unchanged encephalomalacia in the anterior frontal lobe, as well as areas of susceptibility effect in the left frontal lobe. There is no evidence of acute infarct. The ventricles are prominent due to cerebral volume loss. The major cerebral flow voids are intact. There is a punctate left maxillary sinus retention cyst. There is minimal fluid within the bilateral mastoid air cells.

Output: 1. Postoperative findings related to right anterior temporal lobectomy with punctate foci of enhancement along the adjacent right hippocampal tail and increase in size of the enhancing left cerebellar hemisphere lesions, which may represent tumor progression and/or a second neoplasm. 2. Unchanged encephalomalacia and areas of chronic blood products in the left frontal lobe.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:11/17/1952)Reason: reports frequent falls History: + RombergPROVIDER/ATTENDING NAME: DANIEL P SULMASY SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. A subtle punctate focus of diffusion restriction along the right thalamus is present.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Findings suggest fetal origin of the posterior cerebral arteries bilaterally.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a minor focus of diffusion restriction in the right thalamus. This could represent a subtle lacunar infarction.


Instruction: Generate impression based on findings.

Input: 31-year-old female with right-sided numbness, tingling and intermittent loss of right eye vision. Evaluate for multiple sclerosis. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. 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.MRI C-spine:The craniovertebral junction appears within normal limits. There is straightening of the cervical spine but the alignment is maintained. The cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild scattered neuroforaminal narrowing but no spinal canal compromise. The paraspinous soft tissue structures appear within normal limits.

Output: No abnormal brain parenchymal or cervical spinal cord lesions to indicate a demyelinating process.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for progression History: abdominal desmoid ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter enhancing segment 5 focus which does not demonstrate washout; this lesion is nonspecific and unchanged going back to 2013 examination.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are scattered T2 hyperintense foci in both kidneys without enhancement; findings consistent with cysts. Mild bilateral perinephric stranding is nonspecific.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference mesenteric nodules without significant change, measurements as below. Small bowel containing ventral hernia appears enlarged prior study without evidence of obstruction.BONES, SOFT TISSUES: Stable appearing soft tissue density in the anterior abdominal wall subcutaneous tissue, measurement as below.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the referenced soft tissue nodules.2.Nonspecific enhancing segment 5 hepatic lesion, unchanged since 2013.


Instruction: Generate impression based on findings.

Input: Clinical question: No sensation in body with orgasm. Pre-and post enhanced complete spine MRI:Cervical spine demonstrate normal signal intensity and alignment the vertebral column.There is no appreciable degenerative changes of cervical spine, no evidence of spinal canal or neuroforaminal compromise at any level. Unremarkable foramen magnum and cervical cord. No detectable perispinal soft tissue abnormalities. Negative post enhanced images.Thoracic spine demonstrate normal signal intensity and alignment the vertebral column. No appreciable degenerative changes of thoracic spine is noted. There is no evidence of spinal canal or neural foraminal compromise at any level. There is normal signal intensity and caliber of thoracic cord. There is no abnormal enhancement of the cord, leptomeninges or the vertebral column.No detectable perispinal soft tissue abnormalities.Lumbosacral spine demonstrate normal signal intensity and alignment of vertebral column. No appreciable clinically significant degenerative changes are present. There is no spinal canal or neural foraminal compromise at any level. There is normal signal intensity and morphology of the conus and cauda equina. There is no detectable abnormal enhancement of vertebral column, conus or in the cauda equina.No detectable. Spinal soft tissue abnormalities.

Output: 1.Negative pre-and post enhanced cervical MRI.2.Negative pre-and post enhanced thoracic MRI.3.Negative pre-and post enhanced lumbosacral spine MRI.


Instruction: Generate impression based on findings.

Input: Reason: eval for rotator cuff tear and labral tear History: shoulder pain for a year or more with pain radiating to biceps ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis muscles and tendons are intact without evidence of tearing or tendinopathy. SUPRASPINATUS OUTLET: There is a tiny amount of fluid in the subacromial bursa. There is no specific evidence of rotator cuff impingement. GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior and posterior glenoid labrum appear intact without evidence of tearing. BICEPS TENDON: The long and short head of the biceps tendon are intact. ADDITIONAL

Output: Tiny amount of fluid in the subacromial bursa. Otherwise normal MR arthrogram of the shoulder.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hemangioma of intracranial structuresDiagnosis Edits: Clinical question: 3T Scanner, QSM/Permeability, CCM Protocol, please evaluate for changesSigns and Symptoms: loss of bowel control, new dizziness and trouble speakingComments: 3T Scanner, QSM/Permeability, CCM Protocol, please evaluate for changes | There is redemonstration of a hemorrhagic lesion centered in the left pons but also involving the left middle cerebellar peduncle which is not changed substantially in dimensions. It currently measures 25 x 45 mm and previously measured the same. When compared to the 9/14/2015 exam signal characteristics within the lesion have a changed slightly especially along the left pontine cystic lesion which previously had a more heterogeneous signal in the size and more cystic signal. A hemorrhagic lesion within the right cerebral peduncle and another one in the left upper posterior midbrain are also stable.A high signal intensity lesion on T2 imaging in the left medulla remains stable.There is a developmental venous anomaly redemonstrated in the left cerebellar hemisphere inferiorly.The patient is status post suboccipital craniotomy.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 a mucous retention cyst in the left maxillary sinus as well as minor opacities in the left ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of multiple cerebral cavernous malformations in the brainstem and cerebellum associated with a left cerebellar developmental venous anomaly. Although the dimensions are relatively stable the associated blood products continue to evolve.2.Status post posterior fossa surgery.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. The vertebral body and disk signal and heights are normal for patient age. The conus shows normal signal and caliber. The conus terminates at L1-2, within normal limits. There is no filum lipoma or cord tethering. There is no dysraphism. There is no suspicious enhancement within the lumbar spine. There is no significant spinal canal stenosis or disk herniation. Upon prone maneuvering, the conus and cauda translate inferiorly.

Output: No evidence of low-lying conus, tethered cord, or dysraphism. Unremarkable exam.


Instruction: Generate impression based on findings.

Input: Resected right parietal grade 2 meningioma, need recent post-op scan for RT planning History: L weakness. There are postoperative findings related to right frontoparietal convexity meningioma resection with a small amount of residual extradural hemostatic agent and fluid deep to the craniotomy flap. There is residual tumor in the adjacent superior sagittal sinus that measures up to approximately 4.5 cm in length. There is intrinsically T1 hyperintense material along the margins of the resection cavity, which may likely represent blood products. The linear enhancement along the periphery of the resection cavity has diminished. There is no evidence of acute territorial infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is unchanged pronounced mineralization of the basal ganglia. 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: Postoperative findings related to right frontoparietal convexity meningioma resection with residual tumor in the adjacent superior sagittal sinus.


Instruction: Generate impression based on findings.

Input: Clinical question: ams s/p arrest. Signs and Symptoms: ams, somnolence Nonenhanced brain MRI:Examination is incomplete due to patient's refusal to continue with the test after acquisition of diffusion-weighted series.Negative diffusion weighted images.

Output: 1.Incomplete exam due to patient's refusal to continue with the test after acquisition of DWI.2.Negative diffusion-weighted images for acute ischemic strokes.


Instruction: Generate impression based on findings.

Input: History of laryngeal carcinoma, now with progressive low back pain. There is generalized osteopenia. At the inferior endplate of L2, there is a lytic lesion, with bone erosion and concave depression of the endplate into the L2 vertebra. There is mild soft tissue thickening in the paraspinal region. There is also lucent lesion involving posterior aspect of the S1 vertebra, with subtle cortical disruption. These lesions are suspicious for metastatic bone disease. There are additional lucent lesions scattered throughout the rest of the lumbosacral spine, which can also potentially represent metastatic disease. Further correlation with MRI of the lumbar spine is recommended.There is a sclerotic focus in the left ilium, which is nonspecific, but is compatible with a bone island. Degenerative disease is seen throughout the lumbosacral spine, resulting in spinal canal and neural foraminal narrowing. Disk bulging / protrusion and degenerative changes of the posterior elements are seen at L1 -- L2 to L5 -- S1 levels. The spinal canal stenosis is worst at L3 -- L4 and L4 -- L5 levels. Neuroforaminal narrowing is visualized at all levels, worst at L4 -- L5 levels, with likely impingement of the exiting nerve on the right.There is enlargement of the prostate gland and thickening of the bladder wall. Aorto-femoral stents are noted.

Output: 1. Lytic lesions at L2 and S1 with bone erosion, suspicious for metastatic disease. Further evaluation with MRI without and with contrast is recommended.2. Degenerative disease of the lumbar spine as described above, with spinal canal and neuroforaminal stenosis. 3. Please also refer to CT pelvis for additional findings.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is minimal mucosal thickening with secretions in the ethmoid sinuses bilaterally. There is a mild right mastoid effusion.

Output: No gross stigmata of traumatic brain injury.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with recent epidural injection, presenting with incontinence. Cord compression MRI:No acute cord compression is seen. However, there is a disc extrusion at L4-5, likely progressed from prior, which is causing a significant narrowing of the spinal canal. Findings are discussed in more detail below. Relatively mild degenerative findings are seen at additional levels.Lumbar spine MRI:A grade 1/2 anterolisthesis of L4 relative to L5 appears similar to prior. Spinal alignment is unremarkable. No concerning marrow signal abnormality is seen.T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. No significant neuroforaminal narrowing. No interval changes.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. No interval changes. L2-3: Marked left and moderate right facet hypertrophy. Ligamentum flavum thickening. Minimal bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. No interval changes. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk with a small superimposed central disk extrusion. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Disk uncovering and disk bulging. A superimposed central disk extrusion with superior extension has substantially increased in size now contributing to a severe spinal canal stenosis with compression of the cauda equina nerve roots. A right foraminal disk protrusion is similar to prior resulting in severe narrowing of the right neural foramen with likely impingement of the exiting nerve root. The left neural foramen remains mildly narrowed similar to prior. L5-S1: Moderate facet hypertrophy. T1/T2 hyperintensity in the disk may reflect disk mineralization or proteinaceous degeneration. Disk bulging and a superimposed central/left paracentral disk extrusion are not significantly changed. Mild effacement of the left ventral thecal sac is unchanged. Mild bilateral foraminal narrowing. No interval changes.

Output: Since the prior examination, a disc extrusion at L4-5 has significantly increased in size resulting in a progressive severe spinal canal stenosis with compression of the nerve roots of the cauda equina. The right neural foramen at this level remains severely narrowed, similar to prior, due to a foraminal disc protrusion which is unchanged.


Instruction: Generate impression based on findings.

Input: Urothelial cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There appears to be a 2 mm wide outpouching of the right internal carotid artery opthalmic segment. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a midline cystic lesion in the posterior nasopharynx that measures up to 12 mm, which may represent a Thornwaldt or retention cyst.

Output: 1. No evidence of intracranial metastases.2. An 2 mm wide outpouching of the right internal carotid artery opthalmic segment may represent an aneurysm versus prominent infundibulum or artifact. Further evaluation via dedicated angiographic imaging may be useful for further characterization.


Instruction: Generate impression based on findings.

Input: Altered mental status. Clinical suspicion of stroke. The study is at least moderately limited by patient motion.Brain MRI:There is no diffusion restriction to indicate an acute/recent stroke. Bifrontal and central pontine white matter T2 hyperintensity may reflect chronic ischemia. The bifrontal abnormality may also reflect gliosis from a previous injury. There is questionable susceptibility effect within this region on the very limited ventricles sequence. The CSF-containing spaces are mildly enlarged which reflects mild volume loss. There is no mass effect or midline shift. Orbits are notable for previous right cataract surgery and left sided calcifications with FLAIR hyperintensity involving the posterior aspect of the left lobe which may be related to chronic retinal detachment. The paranasal sinuses show minimal, if any, mucosal thickening but no fluid.Cranial MR angiography:While the petrous segments of the internal carotid arteries show preserved caliber and flow-related signal, the cavernous and clinoid/supraclinoid segments are narrowed and irregular. While this may partly relate to motion artifact, atherosclerosis can also give a similar appearance. Left A1 is diminutive which may be related to hypoplasia. There is fairly symmetric and preserved flow-related signal and caliber of the more distal branches of the middle and anterior cerebral arteries on both sides. The basilar artery is predominantly supplied by the left vertebral artery. The posterior cerebral arteries show preserved flow-related signal with the left one predominantly supplied through a large posterior communicating artery (fetal origin).Cervical MR angiography:The cervical MR angiogram is even more degraded by motion and vessel morphology/caliber cannot be accurately assessed. Both common and internal carotid arteries show flow-related signal that is fairly symmetric. The right vertebral artery is small at its cervical and intracranial segments. This can be congenital but chronic ostial narrowing can also similar.

Output: 1.Study is at least moderately limited by motion.2.There is no evidence of acute infarct. Pontine T2 signal abnormality may be related to chronic small vessel ischemic disease. Larger area of T2/FLAIR hyperintensity in the bilateral inferior frontal lobes without mass effect is nonspecific but favored to represent gliosis related to prior infarct, trauma, or other injury. No associated mass effect to suggest vasogenic edema. Suggest comparison with outside prior studies or possibly follow-up MRI examination with sedation if there is continued suspicion for an acute process.3.Mild to moderate narrowing of the cavernous and clinoid/supraclinoid segments of the internal carotid arteries with dense atherosclerotic calcifications evident on CT. Left A1 is small which may be related to hypoplasia. Otherwise no high-grade stenosis is evident in the intracranial circulation.4.Cervical MRA is severely limited by motion though shows grossly patent vessels. The small size of the right vertebral artery can be congenital as described above.5.Findings suggestive of retinal detachment on the left with moderate-sized effusion in the posterior aspect of the left globe; suggest correlation with history and examination.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 28-year-old female with history of pancreatic cancer on chemotherapy and new hepatic lesion presents for further evaluation of the hepatic lesion. Patient with history of liver transplant for biliary atresia at age 10 months. ABDOMEN:LIVER, BILIARY TRACT: Segments 5 lesions with central T2 hyperintensity and peripheral enhancement; the reference lesion measures 1.6 x 1.1 cm (series 9, image 59), previously measuring 1.5 x 1.2 cm. Near the hepatic dome, there is ill-defined linear T2 hyperintensity, nonspecific. Additionally, there are 2 nonspecific subcentimeter T2 and T1 hypointense nonenhancing foci in right hepatic lobe (series 9, images 40 and 44). Artifact from stent within the main portal vein limits evaluation of the main portal vein.Additionally, there is focal intrahepatic biliary ductal dilatation (compared to the MRCP July 2015 examination).SPLEEN: No significant abnormality noted.PANCREAS: Heterogeneous T2 hyperintense mass in the pancreatic head with extension to the caudate lobe. This lesion measures 5.6 x 4.3 cm (series 3, image 17), not significantly changed. There is dilatation of the pancreatic duct distally which measures up to 6 mm. The distal body and pancreatic tail are atrophic.The inferior T2 hyperintense focus is also stable in size measuring 5.0 x 3.1 cm (series 3, image 28).The pancreatic mass encases the celiac and hepatic arteries. The inferior cystic mesenteric lesion abuts the superior mesenteric artery. Again noted is attenuation of the splenic vein near the confluence.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal, pancreatic, gastrohepatic, and porta hepatis lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable pancreatic head mass and mesenteric cystic metastatic focus.2.Segment 5 rim-enhancing foci as detailed. Abscesses are favored over metastatic disease.3.Nonspecific subcentimeter T1 and T2 hypointense, nonenhancing right hepatic lobe foci as above.4.Focal intrahepatic biliary ductal dilatation may represent adjacent strictures.


Instruction: Generate impression based on findings.

Input: 49-year-old male with prostate cancer. Questioning status of prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.3 cm in transverse, 2.4 cm in AP, and 3.6 cm in craniocaudal diameter.Peripheral Zone: Heterogenous appearance suggestive of prostatitis. Abnormal T2 and ADC hypointense signal in the posterior-lateral left apex/mid gland suspicious for a small focus of malignancy (series 4 image 8 image 284, series 801 images 13, 14).Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality notedExtracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Abnormal T2 and ADC hypointense signal intensity in the left apex/mid gland suspicious for a small focus of malignancy.


Instruction: Generate impression based on findings.

Input: Reason: biliary obstruction, stent migration, patient with pancreatic cancer History: n/v, abd pain, jaundice ABDOMEN:LIVER, BILIARY TRACT: There is a stent within the common bile duct which appears to be obstructed with increased moderate intrahepatic biliary ductal dilatation.Multiple hepatic metastases are not significantly changed. A right hepatic lobe lesion measures 2.2 x 2.4 cm (13/153), previously 2.2 x 2.6 cm. A Increased enhancement on arterial phase images is likely due to technique.There is increased T1 signal within the lumen of the gallbladder with surrounding hyperenhancement and increased DWI signal. This likely represents tumor with associated hemorrhage, similar to the prior exam.The main portal vein is narrowed (13/265), but remains patent. Tumor extending into the porta hepatis is slightly increased.SPLEEN: No significant abnormality noted.PANCREAS: Enhancing mixed solid and cystic lesion in the pancreatic tail is unchanged in size measuring 5.1 x 4.6 cm (5/27), previously 5.1 x 4.7 cm. There is increased dilatation of the main pancreatic duct with dilated side branches. The main pancreatic duct is cystically dilated up to 1.1 cm in diameter immediately proximal to an ill-defined mass in the pancreatic head. This ill-defined mass in the pancreatic head is not significantly changed in size measuring 4.3 x 3.3 cm (15/47), previously 4.2 x 3.2 cm on remeasurement.There is fatty atrophy within the majority of the body and neck of the pancreas. There is ill-defined tissue at the pancreatic head surrounding the common bile duct which demonstrates enhancement diffusion restrictionADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node is unchanged measuring 2.6 x 1.6 cm (15/58), previously 2.5 x 1.7 cm. Enlarged periaortic lymph nodes are unchanged.BOWEL, MESENTERY: 8 x 6 mm peritoneal nodule is stable (13/255).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal perihepatic and perisplenic ascites is slightly increased. Small right pleural effusion with thickened adjacent pleura is unchanged.

Output: 1.Common bile duct stent is likely obstructed with increased moderate intrahepatic biliary ductal dilatation.2.Increased dilatation of the main pancreatic duct, likely due to obstruction from pancreatic head mass.3.Soft tissue in the porta hepatis is slightly increased. Hepatic metastases are unchanged.4.Pancreatic head mass is unchanged.5.Peritoneal nodularity is unchanged.6.Small right pleural effusion with thickened pleura suggestive of an empyema is unchanged.


Instruction: Generate impression based on findings.

Input: 34 year old man with history of ALL s/p chemotherapy/radiation and stem cell transplant, elevated ferritin and recent diagnosis of LV dysfunction referred for cardiac MRI to evaluate the etiology for his cardiomyopathy. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 136 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 80 g (normal range 164+/-36). There is global hypokinesis. The native T1 time is normal (1050ms). The ECV fraction is normal (25%). Global relative enhancement is normal. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 121 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is iron overload of the liver, as suggested by a significantly reduced T2* decay time (6.1) . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal sized left ventricle with mildly reduced systolic function (EF 45%). There is global hypokinesis. 2. No evidence of late gadolinium enhancement to suggest acute myocarditis or myocardial fibrosis, inflammation, or infiltration.3. Normal sized right ventricle with mildly reduced systolic function (EF 47%).4. Iron overload of the liver and spleen. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 43 years old, with headache and behavioral changes. Pituitary adenoma status post craniotomy and resection on 06/10/16 Please note that the available prior MRI consists of MR angiographic sequences only. There are no conventional brain images or dedicated pituitary MR images to serve as a comparison. The previously demonstrated sellar and suprasellar mass has been significantly debulked, likely via a transsphenoid approach based on the appearance of the postoperative CT. Dark signal within the right aspect of the sella likely represents susceptibility related to chronic blood product and/or mineralization.The residual pituitary gland is heterogeneous and small. The pituitary infundibulum enhances normally and is deviated towards the right. The suprasellar space is clear and there is no impingement upon the optic apparatus.

Output: Expected findings are seen status post debulking of a previous large sellar and suprasellar mass. The residual pituitary gland is small and heterogeneous. The suprasellar space is clear.


Instruction: Generate impression based on findings.

Input: 41 year old with family history of breast cancer and personal history of benign bilateral breast biopsies. Moderate parenchymal enhancement is noted bilaterally. There is heterogeneous amount of fibroglandular tissue in both breasts.No abnormal enhancement is seen in either breast. Stable normal morphology axillary lymph nodes, but no abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: Pt with acute onset of dizziness one week ago characterized as vertigo; initially 1.5 day duration, but no intermittent; rule out central cause History: see above There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Scattered and somewhat patchy FLAIR high signal intensity lesions on periventricular white matter are nonspecific but could represent small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 43-year-old male with left shoulder pain. Suboptimal examination secondary to positioning and inability to obtain the ABER view related to the patient's body habitus.ROTATOR CUFF: There is a full thickness tear of the supraspinatus, measuring approximately 19 mm in the AP dimension, without significant retraction. There is thickening and intermediate signal abnormality within the supraspinatus consistent with mild to moderate moderate tendinosis. The infraspinatus, subscapularis, and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Gadolinium is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Suboptimal evaluation of the glenoid labrum secondary to the inability to obtain the ABER view and positioning secondary to the patient's body habitus. Within these limitations, no gadolinium filled defects are identified within the glenoid labrum to suggest a tear. No articular cartilage defects are identified.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full-thickness tear of the supraspinatus tendon without significant retraction.


Instruction: Generate impression based on findings.

Input: Compared to 9/2/2015, there is unchanged appearance of the chronic infarct involving the right parietal, temporal, and occipital lobes with T1 hyperintensity indicative of laminar necrosis and enhancement demonstrated on prior study. There is subtle diffusion hyperintensity similar to prior. No findings to suggest a new infarct. There are unchanged scattered subcortical and periventricular white matter punctate T2/FLAIR hyperintensities, which are nonspecific but most likely representing chronic microvascular ischemic changes. No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus.There is a redemonstration of left sellar and cavernous sinus mass that measures 11 mm in cc diameter, 13 mm in the transverse diameter, and 12 mm in the AP diameter and better assessed on prior post gadolinium studies. The mass is isointense in the T1 images and has intermediate intensity in T2 weighted images. There is no compression of the optic chiasm. The pituitary stalk is slightly deviated to the right.There is mild opacification of the bilateral ethmoid air cells. Remainder of the paranasal sinuses are clear. Bilateral lens prostheses is seen.

Output: 1. No evidence of acute infarct or intracranial mass effect.2. Unchanged appearance of the chronic infarct involving the right temporal, parietal, and occipital lobes. Diffusion restriction was demonstrated within this region on prior study from 12/16/2014.3. Left cavernous sinus/sellar mass (presumable meningioma) is again seen and better assessed on prior postcontrast studies.


Instruction: Generate impression based on findings.

Input: 18-year-old female with right knee PF and lateral pain. MENISCI: The medial and lateral menisci appear normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal. Bone marrow signal is normal. There is a small amount of fluid within the joint.LIGAMENTS: There is intermediate T2 signal intensity throughout the course of the posterior cruciate ligament compatible with at least a partial thickness tear. The anterior cruciate ligament appears normal. The medial and lateral collateral ligaments appear normal.EXTENSOR MECHANISM: The extensor mechanism is morphologically normal.ADDITIONAL

Output: Findings compatible with at least a partial thickness tear of the posterior cruciate ligament.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: The medial meniscus is intact. The body and posterior horn of the lateral meniscus are intact. The anterior horn appears unusually enlarged likely the result of a combination of chronic degeneration and distortion due to the underlying prior tibial plateau fracture. Additional blunting and abnormal signal intensity of the anterior horn is thought to represent tearing that is suspected to be chronic in nature.ARTICULAR CARTILAGE AND BONE: There are multiple foci of signal void overlying the proximal tibia representing metallic susceptibility artifact from prior orthopedic intervention. There is deformity of the tibial plateau relating to prior fracture with 4 to 5 mm of depression of the lateral tibial plateau anteriorly. There is heterogeneity of the overlying articular cartilage which likely reflects a combination of degeneration and tearing. There is also focal linear signal abnormality of the articular cartilage of the medial tibial plateau overlying the healed fracture plane, likely representing a chronic cartilage tear. The articular cartilage of the patellofemoral compartment appears subjectively thinned but we see no focal fluid-filled defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Mild deformity of the tibial plateau reflecting an old healed fracture. There is depression of the lateral tibial plateau anteriorly and associated heterogeneity of the overlying cartilage which likely reflects a combination of degeneration and chronic tearing.2. Deformity of the anterior horn of the lateral meniscus overlying the tibial plateau likely reflecting a combination of degeneration and chronic tearing. 3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of glioblastoma multiforme. Follow-up exam. Redemonstrated postoperative changes from left parietal tumor resection. There is a residual 7 mm thickness subdural collection with high T1 and high T2 signal compatible with hematoma.The centrally necrotic rim-enhancing mass in the left parietal lobe is increased in both overall size as well as thickness of the enhancing rim when compared to prior. While the irregular morphology somewhat limits comparison measurements, the area of enhancement now measures 5.3 x 4.2 cm in maximum axial dimension, previously 3.5 x 3.8 cm.The central cystic resection cavity has decreased in size. There is been marked interval increase in vasogenic edema involving the left parietal and frontal lobes. This partially effaces the left lateral ventricle and results in approximately 5 mm rightward midline shift. The basal cisterns are preserved and there is no evidence of uncal herniation. The expected intracranial vascular flow voids are present. Scattered minimal opacification of the paranasal sinuses. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Redemonstrated centrally necrotic peripherally enhancing tumor mass in the left parietal lobe. There has been interval increase in lesion size, thickness of the enhancing rim, and associated vasogenic edema. There is now partial effacement of the left lateral ventricle as well as 5 mm rightward midline shift.2. Stable extra-axial collection overlying the left parietal lobe measuring 7 mm in thickness compatible with resolving hematoma.


Instruction: Generate impression based on findings.

Input: Please evaluate pelvic floor muscles, check for atrophy and inflammation. Patient with significant amount of pelvic pain. The osseous structures appear grossly intact other than a mild minimal mottled appearance of the marrow signal consistent with inhomogeneous fatty replacement patient age. Specifically no abnormal enhancement or additional osseous abnormality, no findings of infection.Visualized muscles and muscular compartments are also intact and symmetric. No frank evidence of atrophy or evidence of asymmetry. Attachments are all accounted. No vascular abnormality and again no abnormal enhancement observed.Intrapelvic contents are also unremarkable for age. Minimally cystic ovaries are observed, again consistent with patient age. No abnormal intrapelvic contents or ascites.

Output: No focal soft tissue or musculoskeletal abnormality observed.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for etiology of syncope + L sided numbness. Signs and Symptoms: as above. Pre and post enhanced brain MRI:No acute intracranial finding and negative diffusion weighted series.There is normal anatomical development and morphology of brain and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and the brin myelination.There is no evidence of abnormal parenchymal or the leptomeningeal enhancement.Unremarkable images through the orbits and including enhanced fat sat series. Unremarkable calvarium and soft tissues of the scalp.Normal signal intensity of all visualized paranasal sinuses and bilateral mastoid air cell and middle ear cavities.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: There is abnormal increased T2 signal along the left side of the cervical spinal cord at the C3 and C4 levels. There also appears to be slight volume loss of the spinal cord in this region. There is redemonstration of changes related to C3-C7 laminectomies and posterior decompression with posterior stabilization rods and transpedicular screws bilaterally from C3 through C7. There is also bilateral facet joints fusion from C2-C3 to C7-T1. There is associated straightening of normal cervical lordosis. The vertebral body heights are preserved. There is no acute fracture identified. There is no current evidence of significant central canal stenosis. There is extensive ossification of the posterior longitudinal ligament extending from C3 to C6 vertebral bodies. There is moderate bilateral neural foraminal narrowing at C3-C4 and at least mild left and moderate right neural foramina narrowing at C4-C5. There also appears to be mild neural foraminal narrowing bilaterally at the remaining levels of the cervical spine; however, artifact from posterior fusion hardware limits evaluation. There is partially imaged low T1 and high T2 signal in the T2 spinous process and right T2 and T2 pedicles and facet joint.

Output: 1. Increased T2 signal within the left side of the spinal cord at the C3-C4 level. Given that there appears to be mild volume loss, this likely relates to myelomalacia. Spinel cord contusion, ischemia, or inflammatory/infectious etiology are considered less likely. 2. Postoperative findings related to C3-C7 posterior fusion and laminectomies. However, artifact from the surgical hardware again limits evaluation.3. Extensive ossification of posterior longitudinal ligament extending from C3 to C6 vertebral bodies with mild to moderate multilevel neural foraminal stenoses.4. Partially imaged low T1 and high T2 signal in the T2 spinous process and right T2 and T2 pedicles and facet joint may represent an infectious or inflammatory process. However, assessment is limited without contrast and follow up with dedicated thoracic spine MRI may be useful.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: The menisci are normal in appearance.ARTICULAR CARTILAGE AND BONE: Mild bone marrow edema type signal is seen in the posterior aspect of the lateral tibial plateau, likely representing a contusion.LIGAMENTS: There is mild increased T2 signal about the MCL without ligament thickening, suggestive of a mild sprain. No MCL tear is seen. The LCL complex appears normal. The cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Lateral tibial plateau bone contusion with findings suggestive of a mild MCL sprain.


Instruction: Generate impression based on findings.

Input: 73-year-old female with transient alteration of awareness. Rule out CVA/bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse periventricular and subcortical white matter hypoattenuation consistent with small vessel ischemic disease, age undetermined. If there is clinical concern for acute ischemia, 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, MRI may be considered.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Marked cirrhotic morphology with increased linear T2 hyperintensity with corresponding diffusion restriction; these likely represent fibrotic changes. No arterially enhancing and washing out lesion.Intrahepatic portal vein is narrowed at the bifurcation with evidence of a clot; there is flow distally to the clot. Extensive intra-abdominal varices as well as dilated superior mesenteric vein and splenic veins compatible with portal hypertension.SPLEEN: Mild splenomegaly persists.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ascending colonic wall thickening secondary to portal hypertension.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace right pleural effusion.

Output: 1.Cirrhotic morphology of the liver with findings of portal hypertension including varices, splenomegaly, and with nonobstructing intrahepatic portal venous clot.2.No evidence of arterially enhancing and washing out lesion to suggest hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Further assessment for brain metastases and edema. Signs and symptoms: Headache. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate multiple small enhancing metastatic lesions in bilateral hemispheres and a large metastatic necrotic lesion in the right cerebellum.The lesion within the anterior-inferior right cerebellum measures approximately at 22 x 24 mm in transaxial dimensions. It demonstrates extensive surrounding vasogenic edema, mass effect and mild leftward and anterior deviation of fourth ventricle. There is also a large left cerebellar developmental venous anomaly without an associated cavernoma.Multiple small enhancing metastatic lesions in the right cerebellum with the largest measuring approximately at 11 x 8 mm in transaxial dimensions. The lesions demonstrate surrounding vasogenic edema however without mass effect on the ventricular system and no deviation of midline.There is a single necrotic rim-enhancing metastatic lesion in the left posterior parietal measuring approximately 5 x 6 mm in transaxial dimensions. This finding demonstrates minimal surrounding edema.Unremarkable calvarium and orbits without evidence of abnormal enhancement.Unremarkable soft tissues of the scalp, paranasal sinuses and mastoid air cells.

Output: 1.Negative diffusion-weighted images. Moderate degree of chronic small vessel ischemic strokes is noted.2.Large necrotic enhancing right cerebellar metastatic lesion measuring at 22 x 25 mm and with mass effect on the fourth ventricle.3.Multiple right hemispheric metastatic lesions largest measuring at approximately 11 x 8 mm. Left hemispheric posterior parietal metastatic lesion measuring 5 x 6 mm in transaxial dimensions.4.No mass effect on the ventricular system and no deviation of midline.5.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with history of metastatic breast cancer, baseline exam prior to starting on clinical trial. Assess for brain metastases. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. No pathologic enhancement is detected. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Bone marrow signal is within normal limits. Vertebral body heights are normal. There is mild loss of cervical lordosis. Alignment is otherwise maintained. The cervical cord appears unremarkable. No evidence of epidural tumor or abnormal enhancement within the spine or paraspinous soft tissues.Degenerative changes are seen, as described below:C2-C3: No spinal canal or neural foraminal compromise. Left-sided facet arthropathy.C3-C4: There is trace disc bulging with no significant spinal canal or neural foraminal compromise.C4-C5: Trace disc bulge with no significant spinal canal or neural foraminal compromise. C5-C6: Small disc protrusion with no significant spinal canal or neural foraminal compromise.C6-C7: Minimal disc bulge with no significant spinal canal or foraminal compromise.The visualized portion of the brain demonstrates an enhancing mass in the right cerebellum consistent with the metastasis and as seen in the previous brain MRI.

Output: 1. No evidence of metastatic lesions in the cervical spine. Cervical cord appears unremarkable.2. No significant spinal canal or neural foraminal compromise.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 72-year-old male with hypertensive urgency, CHF, diabetes, chronic kidney disease with mental status changes. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. Atherosclerotic calcification of the cavernous carotid and vertebral arteries are noted. If there is concern for an acute stroke, an MRI may be considered for further evaluation.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 ischemic disease, age indeterminate. If there is concern for an acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Knee pain Note that the evaluation is limited secondary to motion artifact.MENISCI: There is a complex tear of the posterior horn of the medial meniscus which consists of a horizontal component that extends to the tibial articular surface. There is also blunting of the free edge of the posterior horn of the meniscus near its root suggestive of a radial tear with a crescentic focus of low signal intensity near the root itself which may represent a displaced flap fragment. There is abnormal signal intensity within the body of the medial meniscus likely reflecting extension of the tear from the posterior horn. The anterior horn is intact.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Subjectively, the articular cartilage of the medial tibiofemoral compartment appears thinned. The articular cartilage of the lateral compartment appears relatively spared. There is superficial degeneration of the articular cartilage of the lateral patellar facet but the remaining patellofemoral compartment appears relatively spared as well.LIGAMENTS: The ACL appears thickened and poorly defined on the sagittal sequences. The proximal fibers of the ligament are better visualized on the T2-weighted coronal and axial sequences although distally the fibers are less well-defined. We suspect these findings reflect mucoid degeneration, particularly given the presence of a cyst within the adjacent intercondylar eminence; however we cannot exclude the possibility of a chronic tear. Of note, there are no bony contusions to indicate an acute rupture. The PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Complex tear of the medial meniscus with other findings described above.


Instruction: Generate impression based on findings.

Input: 78-year-old male status post cholecystectomy and biliary exploration with abdominal pain. Evaluate for biliary stenosis. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intra-or extrahepatic biliary ductal dilation. There is a 1.2-cm focus of fluid signal intensity in the expected region of the gallbladder fossa (24; series 8). The common bile duct measures up to 7 mm in diameter. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple cysts are identified within the kidneys bilaterally. Subcentimeter foci of fluid signal intensity are identified within the kidneys, which are too small to characterize, but also likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Incidental note is made of a periampullary duodenal diverticulum.BONES, SOFT TISSUES: Note made of moderate to severe spinal canal stenosis with partial effacement of the thecal sac at the level of T10/T11. A dedicated MRI of the thoracic spine could be considered if clinically indicated. OTHER: No significant abnormality noted.

Output: 1. Nonspecific 1.2 cm focal fluid collection in the gallbladder fossa. No evidence of biliary stenosis as clinically, questioned. 2. Degenerative changes, as described above.


Instruction: Generate impression based on findings.

Input: 81-year-old female with primary sclerosing cholangitis, called back for pre and postcontrast sequences only. ABDOMEN:LIVER, BILIARY TRACT: No enhancing hepatic lesions are seen. The patient's known multifocal biliary strictures were better evaluated on the noncontrast MRI dated 9/19/2016. Atrophy of the left hepatic lobe is unchanged. Evaluation of the porta hepatis is slightly limited due to susceptibility effect in the patient's cholecystectomy clip.SPLEEN: No significant abnormality noted.PANCREAS: There is stable mild prominence of the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No enhancing hepatic lesions identified.2.Multifocal biliary stricturing was better evaluated on the prior noncontrast MRI dated 9/19/2016.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddinessClinical question: 1 week of vertigo, concern for stroke The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery is very small on this exam and may be hypoplastic. This finding is unchanged when compared to the prior examThe 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.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 15-year-old male with neurofibromas type II, vestibular and cervical spine schwannomas, postoperative right schwannoma removal. Brain and Internal Auditory Canals:There are changes from interval right sided IAC schwannoma removal including craniotomy, soft tissue swelling with fluid and enhancement, as well as a complex signal collection adjacent to the right cerebellar hemisphere causing mild right cerebellar hemispheric flattening, however without parenchymal signal abnormality. There is also diffuse, smooth, dural enhancement, most consistent with prior surgery.There is a small area of enhancement involving the right internal auditory canal, with a complex morphology, appearing somewhat curvilinear around its circumference at the porus acusticus, with a small nodular component anteriorly at the porous acusticus. It is uncertain if this represents postoperative granulation tissue versus residual schwannoma.There has been no interval change in size of an enhancing mass in the left internal auditory canal, with slight extension medially through the porus acusticus, again measuring 6 x 9 mm in axial cross-section.There are unchanged enlarged perivascular spaces in the left middle frontal gyrus with confluent surrounding T2 hyperintensity. There is a similar finding to a lesser extent in the right middle frontal gyrus. There are unchanged mildly low-lying cerebellar tonsils. The orbits, skull, and scalp soft tissues are unremarkable. There is no evidence of acute intracranial hemorrhage or infarction. There is no midline shift. Cervical Spine: There is stable right anterolateral intradural, extramedullary, tubular, enhancing lesion at the C6-7 level that measures 6 x 2 mm in axial cross-section. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1.There are changes from interval right sided IAC schwannoma removal. There is a small area of enhancement involving the right internal auditory canal, with a complex morphology, appearing somewhat curvilinear around its circumference at the porus acusticus, with a small nodular component anteriorly at the porous acusticus. It is uncertain if this represents postoperative granulation tissue versus residual schwannoma.2.There has been no interval change in size of an enhancing mass in the left internal auditory canal3.Unchanged prominent perivascular spaces in the bilateral middle frontal gyri, left greater than right, with what may represent surrounding gliosis. 4.Unchanged mildly low-lying tonsils.5.Unchanged presumed schwannoma at the C6-7.


Instruction: Generate impression based on findings.

Input: Reason: History of ulcerative colitis, with ilal involvement, R/O Crohn's disease of small bowel. History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Subcentimeter splenic cyst is nonspecific.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: There is loss of haustration and hyperenhancement within the distal sigmoid and proximal rectum (14/1755, 1768, 1780) suggesting active inflammation. There are areas of narrowing, however no stricture is evident at multiple sequential exams. No abscesses or fistulas. There is also hyperenhancement and bowel wall thickening involving the terminal ileum measuring approximately 2.3 cm in length (7/23), also likely representing active inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enhancing regions of bowel involving the rectosigmoid and terminal ileum suggest active inflammation. The colon between these two regions is normal-appearing. Given this pattern of involvement, Crohn's disease may be suspected.


Instruction: Generate impression based on findings.

Input: Subtotal resection of enhancing lesion. There are interval postoperative findings related suboccipital craniotomy for biopsy with an extradural fluid collection that measures up to approximately 15 mm in thickness. There is a persistent focus of nodular enhancement along the posterior aspect of the inferior medulla that measures up to 8 mm. There is a left transfrontal catheter that terminates in the atrium of the left lateral ventricle and a right transparietal catheter that terminates in the right anterior parafalcine region. The ventricles are unchanged in size and configuration. There is unchanged encephalomalacia in the right posterior frontal and parietal lobes. There is no evidence of acute infarction. There is colpocephaly with dysgenesis and thinning of the corpus callosum. There is unchanged beaking of the tectum and prominence of the mass intermedia. The fourth ventricle remains partially effaced, with paucity of choroid plexus tissue. The CSF flow study demonstrates biphasic flow anteriorly at the level of the foramen magnum, but relative paucity of flow posteriorly.

Output: 1. Interval postoperative findings related to inferior cerebellar biopsy with a persistent subcentimeter lesion along the posterior aspect of the medulla, which likely represents ectopic choroid plexus.2. Unchanged intracranial stigmata of Chiari II malformation and the shunted ventricular system.


Instruction: Generate impression based on findings.

Input: History of GBM status post RT and TMZ. Left parieto-occipital craniotomy changes related to prior resection of tumor are redemonstrated. Overall, there is further contraction of the resection cavity. Multifocal peripherally enhancing left parieto-occipital lobe lesions are again seen as well as small enhancing nodules. A more inferolaterally located cystic ovoid component with peripheral enhancement demonstrates interval resolution of internal T1 signal, likely related to resolved blood products within the lesion. There appears to be overall decreased nodular enhancement involving the lesions, particularly involving the most inferior lesion. There is increased enhancement extending along the ependyma of the posterior horn of the left lateral ventricle (series 1403, image 81). There is overall slightly increased craniocaudal extent of T2/FLAIR signal as well as new signal extending along the splenium of the corpus callosum towards the midline. Perfusion images demonstrated slightly increased vascularity involving the largest component of the lesion. No new intra or extra-axial fluid collections are visualized. No midline shift is appreciated. There is no evidence for acute ischemia.

Output: 1. Multifocal left parietal occipital peripherally enhancing lesions overall demonstrate slight decreased central enhancement and nodularity with further contraction of the resection cavity.2. There is slight increased anterior extension of ependymal enhancement involving the posterior horn of the left lateral ventricle.3. Slight increased extent of FLAIR hyperintensity in the left cerebral white matter, which may be post-treatment related given relative hypoperfusion.3. Evolved blood products in small oval cystic cavity.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with multiple sclerosis, assess for progression. Numerous foci of T2 hyperintensity are seen predominantly within the periventricular white matter and corpus callosum. These lesions are of similar size and distribution to that noted on the prior examination allowing for differences in technique. Small lesions are also seen within the right pons and left cerebellar hemisphere, unchanged. Also noted are areas of faint cortical T2 signal abnormality, most notably along the left central and precentral sulci, unchanged.The lesions noted above demonstrate varying degrees of T1 hypointensity ranging from barely detectable to markedly hypointense, appearing similar to prior. None of the above lesions demonstrates significant enhancement. No new lesions are detected.Brain parenchymal morphology is otherwise unremarkable. Brain volume is relatively preserved. No pathologic extra-axial collections are seen.Opacification or mucosal thickening is noted within the left sphenoid sinus.

Output: No significant interval change is seen in the size, number or appearance of multiple white matter and cortical demyelinating lesions.


Instruction: Generate impression based on findings.

Input: 11-year-old boy with history of HLA B-27 positivity and back pain. BONE MARROW: Bone marrow signal in the sacrum, pelvis, and proximal femurs is normal.SOFT TISSUES: The paraspinal and pelvic musculature is normal in signal and morphology. JOINTS: No abnormal signal is seen involving the sacroiliac or hip joints.ADDITIONAL

Output: Normal examination.