Instruction: Generate impression based on findings.

Input: A 78 year old female with personal history of cardiomyopathy with left ventricular thrombus treated with anticoagulants, stroke, peripheral artery disease, hypertension, diabetes mellitus, chronic kidney disease. A recent echocardiography showed mildly reduced systolic function of the left ventricle. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 155 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 73 ml (normal range 31+/-10). There is an extensive apical wall motion abnormality with akinesis and extension to the mid septal and anteroseptal wall. Overall, despite akinesis and thinning the majority of the territory is viable. There is transmural enhancement in the apical inferior wall suggesting non-viability. There is < 50% transmural enhancement in the septal / anteroseptum, but this appears viable , the remaining segments have little enhancement.Left AtriumThe left atrium is mildly dilated. The LA volume is 102 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 57 ml/m2 (normal range 69+/-14), the RVEDV is 103 ml (normal range 110+/-24), the RV end systolic volume index is 19 ml/m2 (normal range 22+/-8), and the RVESV is 34 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild 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 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 low normal systolic function, the LVEF is 53%. There are regional wall motion abnormalities present as described above.. 2. Delayed enhancement imaging suggest predominate viability in the areas of wall motion.3. The left atrium is mildly dilated. 4. The right ventricle is normal in size with normal systolic function, the RVEF is 67%. 5. The aortic valve is trileaflet, opens widely and there is mild aortic regurgitation.6. There is mild tricuspid regurgitation.7. No LV apical thrombus noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 39 years Female (DOB:1/5/1977)Reason: residual tumor posterior fossa History: headachePROVIDER/ATTENDING NAME: BAKHTIAR YAMINI SERVICES ANCILLARY The patient status post cerebellar surgery. There are enhancing lesions present in the left cerebellar hemisphere which were also identified on the recent MRI and have not changed significantlyNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: This a limited MR for the purpose of stereotactic guidance during surgery. To extent of visualization there is no interval change in the appearance of the patient's left cerebellar mass relative to the prior exam from 11/2/2016.


Instruction: Generate impression based on findings.

Input: Abdominal discomfort, acholic stool and 20 pounds weight loss. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The liver is normal in morphology, size and signal intensity. No focal lesion biliary ductal dilatation or vascular abnormality.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: Moderate fatty atrophy of the pancreas without pancreatic ductal dilatation. No focal lesion is identified.There is a small subcentimeter branch type IPMN at the level of pancreatic head versus minimal side branch ectasia/dilatation versus . Normal intrinsic T1-weighted signal intensity of the pancreas. No evidence of acute inflammation. Following secretin administration there is normal dilatation of the main pancreatic duct and excretory function.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: Moderate fatty atrophy of the pancreas without pancreatic ductal dilatation or focal lesion. No specific evidence of acute or chronic inflammation.Probable subcentimeter branch type IPMN at the level of the pancreatic head versus minimal side branch ectasia/dilatation.


Instruction: Generate impression based on findings.

Input: 11-year-old female with history of leukemia and chronic steroid use now post-transplant with persistent chronic ankle, knee, and hip pain. History of Osteochondritis dissecans of left talar dome. Evaluate avascular necrosis. History: Chronic Steroid Use. Bone infarcts of bilateral distal tibia on ankle MRI. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See below.OTHER: Trace amount of free fluid is noted within the pelvis, likely physiologic.BILATERAL HIPS:There is mild collapse and fragmentation of the medial aspect of the left femoral head, with marrow signal changes of the lateral aspect of the left femoral head, compatible with stage III avascular necrosis. Minimal enhancement is noted within the areas of necrosis. The remainder of the proximal left femur demonstrates normal signal intensity. Small left hip joint effusion is present.The right femoral head is normal in bone marrow signal intensity without evidence of avascular necrosis. Remainder of osseous structures of pelvis are normal in appearance and marrow signal intensity.

Output: Stage III avascular necrosis of the left femoral head with small left hip joint effusion.


Instruction: Generate impression based on findings.

Input: 69-year-old female with abdominal pain, hepatic lesions. Patient with abdominal pain, nausea. The outside scan noted hepatic lesion. Please evaluate lesion. ABDOMEN:LIVER, BILIARY TRACT: Diffuse hypointense T2 signal intensity of the hepatic parenchyma with paradoxical shift on the in and out of phase sequences is consistent with iron deposition.There are 2 left hepatic lobe T2 hyperintense foci (series 7 images 5, 11) that demonstrate peripheral nodular arterial enhancement that fill in with contrast on venous and delayed phases consistent with benign hemangiomas. These lesions measure 1.4 x 0.8 cm (series 10 image 271) and 0.9 x 1.2 cm (series 10 image 288). Adjacent to the more lateral hemangioma, there is a subcentimeter nonenhancing T2 hyperintense cyst (series 7 image 4, series 10 image 291). An additional T2 hyperintense focus in the right hepatic lobe (series 7 image 8) also demonstrates peripheral nodular arterial enhancement that fills in with contrast on venous and delayed phases consistent with a benign hemangioma measuring 0.7 x 0.8 cm (series 10 image 280).SPLEEN: No significant abnormality noted. No evidence for iron deposition within the reticuloendothelial system.PANCREAS: Normal bright T1 precontrast hyperintense signal of the pancreatic parenchyma. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable left-sided parapelvic cysts. Small hyperintensities of the right lower renal pole are too small to characterize and favored to be cystic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small T2 hyperintense focus with loss of signal intensity on fat saturated sequences of the T12 and L3 vertebral bodies are most consistent with benign osseous hemangiomas (series 5 images 12, 25). An additional T2 hyperintense probable osseous hemangioma of the L4 vertebral body is only included on the coronal phase (series 4 image 14).OTHER: No significant abnormality noted.

Output: 1. Benign hepatic hemangiomas of the left and right hepatic lobes as described above.2. Iron deposition of the hepatic parenchyma.


Instruction: Generate impression based on findings.

Input: Left cranial nerve VI palsy and left Horner's syndrome. Redemonstrated is a dural based extra-axial left parafalcine mass in left anterior parietal region with homogeneous enhancement, measuring 19 x 13 x 17 mm (AP x TR x CC), previously 19 x 14 x 16 mm. There is very subtle indentation on the adjacent brain parenchyma without detectable signal abnormality. There is an additional smaller meningioma in the right posterior frontal region measuring 10 x 10 mm (AP x TR) also resulting in very subtle indentation of adjacent parenchyma without signal abnormality. The distal cisternal segments of CN6 are seen well on axial 3D T2W images without associated mass. Cavernous sinus appear symmetric. Meckel's caves are clear.There is no evidence of intracranial hemorrhage or acute infarct. There is parenchymal volume loss, but the brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a partially empty sella. The skull and extracranial soft tissues are unremarkable.

Output: 1.Distal cisternal segments of CN6 are seen without associated mass. No evidence of acute intracranial abnormality.2.No significant interval change in left parietal parafalcine and right posterior frontal meningiomas.


Instruction: Generate impression based on findings.

Input: 30 years, Male, Reason: evaluate abdominal pain and change in bowel , please assess for sb inflammation. History: abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: Mildly enlarged left external iliac node measuring 1.6 x 1.2 cm (17/29)BOWEL, MESENTERY: Large amount of stool in the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No findings to account for patient's symptoms.Findings suggestive of constipation.


Instruction: Generate impression based on findings.

Input: Left knee pain while walking MENISCI: Again seen is attenuation of the inner edge of the posterior horn of the medial meniscus with increased signal intensity along the adjacent undersurface fibers likely representing a chronic tear. This appears similar to the prior examination accounting for slight technical differences and may not be of any true clinical significance. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Again seen is what appears to be an ununited fracture fragment along the lateral aspect of the patella with mild edema and cyst formation both within the fragment itself and adjacent patella, suggesting focal instability. Overall these findings appear similar to the prior exam. Small cyst formation is also noted within the soft tissues along the superior interface of the fragment and undersurface of the patella, which is new. A cleft is seen through the articular cartilage overlying the fracture plane with mild heterogeneity of the articular cartilage of the lateral facet indicating mild degeneration.There is a full-thickness cartilage defect of the lateral tibial plateau, similar to the prior exam. The articular cartilage of the medial compartment is relatively intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is thickening and increased signal intensity of the quadriceps tendon with overlying metallic susceptibility artifact and fixation tracts in the patella reflecting prior surgical repair. The abnormal signal intensity and thickening likely reflects a combination of tendinosis and scarring but overall this appears similar to the prior exam. Tendon fibers can be seen extending to the medial patellar fixation tract, but not to the lateral tract; however this is also similar to the prior exam. Thickening and irregularity of the medial and lateral retinacular structures also appears similar. ADDITIONAL

Output: 1. Postoperative changes of quadriceps tendon repair with tendinosis and scarring of the quadriceps tendon, the extent of which appears similar to the prior exam.2. Chronic ununited fracture through the lateral patella with underlying edema and cystic changes suggesting focal instability. 3. Focal cartilage defects with other findings further detailed above.


Instruction: Generate impression based on findings.

Input: 54 year old female with interstitial lung disease, rheumatoid arthritis, pre-lung transplant evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced global systolic function. The overall LV ejection fraction is 50%. The LVEDV is 113 ml (normal range 109+/-23), LV end diastolic volume index is 60 ml/m2 (normal range: 65+/-11), LVESV is 57 ml (normal range 31+/-10), and LV end systolic volume index is 30 ml/m2 (normal range 18+/-5). The LV mass is 95 g (normal range 114+/-24) and the LV mass index is 50 g/m2 (normal range 67+/-11). 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.There is no LV 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 51%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 146 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild to moderate aortic regurgitation.Sinus of Valsalva: 28 x 28 x 27mm.Sinotubular Junction: 19mm 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.MPA 29.5mm.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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.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.Mild to moderate aortic valve regurgitation2.Normal sized left ventricle with mildly reduced systolic function (LVEF 50%).3.Normal sized right ventricle with normal systolic function (RVEF 51%).4.Mild dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 23 year-old female with sickle cell disease and new onset of headaches. Signs and symptoms: New onset headaches. Nonenhanced head CT:No detectable acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Very subtle foci of low attenuation in the periventricular and subcortical white matter of bilateral cerebral hemispheres are likely result of prior strokes of indeterminate age considering provided clinical history of sickle cell disease. There are no prior exams for comparison. CT is insensitive for early detection of acute ischemic strokes. Consider MRI for further evaluation.The cortical sulci and ventricular system is not CSF cisterns are unremarkable.Calvarium is intact.Limited view of paranasal sinuses demonstrate chronic left maxillary, left ethmoid and minimally of the sphenoid chronic sinus disease.

Output: 1.No acute intracranial process. CT is insensitive for early detection of acute ischemic strokes.2.Few small periventricular and subcortical foci of low-attenuation although nonspecific considering history of sickle cell disease there are suspected of age indeterminate strokes pain knee small vessel vascular territory.3.Partially visualized paranasal sinuses demonstrate chronic sinusitis of the left maxillary and left ethmoid air cells.4.Unremarkable calvarium.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:10/6/1949)Reason: worsening of brain tumor History: lethargy, agitationPROVIDER/ATTENDING NAME: HELENE G RUBEIZ HELENE G RUBEIZ Since the prior exam ill-defined T2 and FLAIR signal hyperintensity involving the left anterior temporal lobe both medial and lateral aspect associated with infiltration into the posterior left thalamus and left insula has progressed and now involves more of the insular cortex and internal capsule as well as the left external capsule and extends into the subcortical and periventricular white matter of the posterior aspect of the frontal lobe and of the anterior aspect of the left parietal lobe. Within the left external capsule there is a 12 x 25 mm axial dimension enhancing focus associated with this lesion. There are associated serpiginous flow-voids within this enhancing lesion. Previously the enhancing component was 3 mm in size.Numerous punctate signal hypointense foci are scattered in the subcortical white matter in both hemispheres as well as the cerebellum. These were also present on the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Interval significant progression of left hemispheric lesion known to represent a diffuse astrocytoma as detailed above. Differential consideration includes progression of neoplasm and radiation necrosis.2.Multiple microhemorrhages are scattered throughout both hemispheres of the brain. Differential considerations may include radiation related microhemorrhages. Amyloid angiopathy may have a similar appearance.


Instruction: Generate impression based on findings.

Input: Episodic dizziness and presyncopal episodes. Brain: The examination is limited due to artifact from orthodontic hardware. 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, aside from a mildly convex cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. Cervical Spine: 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 a mild diffuse congenitally narrow spinal canal. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct, although many of the images are degraded by dental brace artifact. 2. Probable right mastoid air cell and left petrous apex effusions.3. No evidence of Chiari type 1 malformation.4. Mild diffuse congenitally narrow spinal canal.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: BRAIN: There are numerous (greater than 20) T2 hyperintense white matter lesions involving the midbrain, pons, medulla, bilateral middle cerebellar peduncles, periventricular and subcortical white matter, and the corpus callosum. Many of these lesions demonstrate a morphology and distribution characteristic of known demyelinating disease. There is diffuse global volume loss with involvement of the corpus callosum as well. Post contrast imaging was not obtained to assess for active demyelination. There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. CERVICAL: There are numerous T2 hyperintense lesions in the cervical spinal cord and medulla, most of which are long segment and confluent. There is extensive involvement from C2 -- C4-5 level, which is somewhat patchy extending inferiorly.The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated.At C2-C3, there is no spinal canal or neural foraminal stenosis.At C3-C4, there is no spinal canal or neural foraminal stenosis.At C4-C5, there is small right paracentral disk osteophyte complex with effacement of the right ventral thecal sac. No high grade spinal canal stenosis. No significant neural foraminal stenosis.At C5-C6, there is a central and right paracentral disk extrusion extending inferiorly with effacement of the right ventral thecal sac. No high grade spinal canal stenosis. No significant neural foraminal stenosis.At C6-C7, there is no spinal canal or neural foraminal stenosis.At C7-T1, there is no spinal canal or neural foraminal stenosis.THORACIC: There are T2 hyperintense lesions involving the thoracic cord at T1-3, T4- T5, T6-7 and T9 levels.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant spinal canal or neural foraminal stenosis.

Output: 1.Numerous white matter lesions involving the supratentorial and infratentorial brain, cervical, and thoracic cord. Findings are consistent with advanced demyelinating disease. No contrast was administered to assess for active demyelination. No priors are available for comparison, and addendum can be issued if prior studies are made available.2. Mild C4-5 and C5-6 degenerative changes without mild spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: 55-year-old male. PSC. Please screen for CCA. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter homogeneously enhancing focus in the left hepatic lobe consistent with a hemangioma, unchanged. Other scattered tiny T2 hyperintense foci without appreciable enhancement in the right hepatic lobe, unchanged and likely cysts.Normal caliber and morphology of the bile ducts with no dominant stricture. No suspicious hepatic mass. Patent hepatic vasculature.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious hepatic mass or new dominant stricture.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, with weakness and paresthesias in the right upper extremity, C5-6 distribution, status post trauma. Image quality is moderately degraded by motion artifact. Within this limitation, the following observations are made.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of significant marrow edema or marrow replacement is seen.The spinal cord shows normal signal intensity and morphology throughout. No epidural abnormality is suspected.C2-3: Unremarkable. C3-4: Minimal rightward disc osteophyte formation. Otherwise unremarkable. C4-5: Minimal rightward disc osteophyte formation. Otherwise unremarkable. C5-6: A right paracentral/subarticular disc protrusion is seen which encroaches upon the right lateral recess and may impinge upon the right exiting C6 nerve root and the C7 nerve root as it passes through the lateral recess. The right neural foramen is mildly narrowed. C6-7: Unremarkable. C7-T1: Unremarkable.

Output: A disc herniation is evident at the C5-6 level in the right paracentral/subarticular zone causing effacement of the right lateral recess. This may impinge upon the exiting C6 nerve root and the descending C7 nerve root.


Instruction: Generate impression based on findings.

Input: Status post fourth ventricular choroid plexus tumor resection. There are postoperative findings related to suboccipital craniotomy with diffuse areas of scalp swelling. There is a residual lobular enhancing mass in the inferior fourth ventricle that measures up to 15 mm. There are patchy areas of high T2 signal and restricted diffusion within the bilateral cerebellar hemispheres. There is a right transfrontal ventricular catheter that terminates in the left lateral ventricle. The ventricles continue to decrease in size, along with the associated periventricular T2 hyperintensity. There is mild high T2 signal in the parenchyma surrounding the catheter. There is no evidence of acute cerebral infarction or intracranial hemorrhage. There is a 6 mm wide arachnoid cyst anterior to the anterior temporal pole. There is a retention cyst in the left maxillary sinus. Scalp fiducial markers are present.

Output: Postoperative findings related to partial resection of a fourth ventricular choroid plexus tumor with patchy areas of acute infarction involving the bilateral cerebellar hemispheres, but essentially resolved ventricular dilatation persistent obstructive hydrocephalus and transependymal edema, with a right transfrontal ventricular shunt catheter in position.


Instruction: Generate impression based on findings.

Input: ORBITS: The globes are symmetric and normal in appearance. There is bilateral proptosis, left greater than right, which is without significant interval change. There is prominent intraorbital fat bilaterally, similar to prior exam. The right optic nerve sheath is slightly more full compared to the left on the order of 1 mm or less, and without significant change. The optic nerves are not thickened and appear symmetric bilaterally with normal signal intensity. The extraocular muscles are within normal limits of size and appear symmetric bilaterally, and unchanged from prior exam. The lacrimal glands enhance symmetrically and are not enlarged. There is a partial empty sella with a thin and somewhat flattened pituitary gland which enhances homogeneously. There is a midline pituitary stalk. The cavernous sinuses enhance symmetrically and show no evidence of mass. The superior ophthalmic vein is not enlarged.BRAIN: There is no suspicious enhancement, acute infarct, mass, or cerebral edema. There are scattered periventricular and subcortical white matter T2 hyperintensities which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.Stable exam of the orbits with bilateral proptosis, left greater than right. No intraorbital mass, extraocular muscle thickening or suspicious enhancement.2.Scattered periventricular and subcortical white matter T2 hyperintensities are nonspecific. The differential diagnosis is wide and includes vascular related etiologies, demyelination, HIV-related etiologies among others.


Instruction: Generate impression based on findings.

Input: Diagnosis: Late effects of accidental fallClinical question: eval for malignancySigns and Symptoms: pathologic fractures, weaknessComments: Already had brain without. Needs with only contrast enhance imaging.| MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small enhancing lesion in the left middle cerebellar peduncle with surrounding T1 hypointensity.There is a large perivascular space in the left basal ganglia possibly related to microhemorrhages when correlation with recent SWI imaging.There is a small right sided subdural effusion present adjacent to the right parietal lobe which is stable since prior exams.Lumbar spine:There is an anterior compression fracture present at L1 associated with mild enhancement. The posterior aspect of the vertebral body is concave in shape. There is a milder superior en-plate compression fracture at T12.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small right paramedian disk protrusion at this level associated with contrast enhancement but no significant compromise to the adjacent nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There are endplate reactive changes present anteriorly at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple small renal cysts present.

Output: 1.Left middle cerebellar peduncle lesion demonstrates some associated breakdown of blood brain barrier. This could suggest that this is inflammatory in nature or reaction to a prior a late subacute/early chronic infarction. It is conceivable that this could relate to neoplasm. If the patient has a known primary tumor elsewhere, this could represent metastasis. A follow-up exam in 6-12 weeks would be useful. Please correlate with clinical symptoms.2.There is a benign appearing compression fracture at L1 in the subacute phase.3.There is a mild superior endplate compression fracture at T12 in a more chronic phase.4.Findings suggest a left adrenal gland lesion. Please refer to abdominal CT for further comments.5.Small right subdural effusion.6.Small L5-S1 disk protrusion with signs of acute/subacute stage.


Instruction: Generate impression based on findings.

Input: 24-year-old female with history of juvenile papillomatosis status post excisional biopsy in 2007 now with new right-sided clear discharge, please evaluate for underlying lesions There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Minimal high T1, proteinaceous fluid noted in the left ductal system. Normal enhancement of bilateral nipple areolar complex noted. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: There are multiple new foci of abnormal parenchymal enhancement suspicious for progression of metastatic disease. -Three foci of abnormal enhancement involving the posterior paramedian frontal lobes which appear new since 2/9/2015. There is a 6 mm enhancing nodule on the right and 4 and 5 mm nodules on the left. These are best seen on series 10 axial images 4-6. -There is also focus of enhancement involving the cortical surface of the right inferior parietal lobule adjacent to a vessel, axial image 11 which is also new.-Additional punctate foci of enhancement are seen in the right occipital lobe, sagittal series 11 image 13, and axial series 10 image 19, and right inferior frontal lobe sagittal image 6 and axial image 14. -Additional scattered foci of T2/FLAIR hyperintensity are seen including the bilateral anterior subcortical frontal white matter as well as lateral aspect of the left precentral gyrus without definite associated enhancement. Punctate focus of susceptibility is associated with the focus of FLAIR hyperintensity in the left precentral gyrus.There is mild edema without significant mass effect associated with these small lesions. No midline shift or herniation. No hydrocephalus. Small arachnoid cyst suspected in the posterior fossa on the left with mild effacement of the left cerebellar hemisphere.Two foci of susceptibility effect in the right frontal lobe and one in the right cerebellar hemisphere are unchanged and compatible with chronic microhemorrhages.Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. Compared to 2/9/2015, there has been development of at least six new subcentimeter foci of abnormal parenchymal enhancement consistent with progression of intracranial metastatic disease. There is mild associated edema without midline shift or herniation.2. Chronic microhemorrhages in the right frontal lobe and right cerebellar hemisphere are unchanged and may represent previously treated metastases. There is also a new focus of susceptibility effect with associated T2/FLAIR hyperintensity involving the left lateral aspect of the precentral gyrus without definite enhancement which may represent a new microhemorrhage. Although no definite associated enhancement is appreciated, underlying metastasis is not entirely excluded.


Instruction: Generate impression based on findings.

Input: 26-year-old female with history of ulcerative colitis status post ileal pouch anal anastomosis with perianal abscess in 10/2014. Patient with burning anal pain. Evaluate the pelvis and perianal region. PELVIS:UTERUS, ADNEXA: Bilateral adnexal T2 hyperintense foci measuring up to 1.5 cm, consistent with physiologic follicles.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific bilateral subcentimeter inguinal lymph nodes.BOWEL, MESENTERY: Postoperative changes of colectomy and ileoanal anastomosis. No evidence of pelvic abscess. Small amount of pelvic fluid, likely physiologic in etiology.BONES, SOFT TISSUES: There is perineal granulation tissue with a subtle area of linear T2 signal which is nonspecific. No evidence of perineal abscess.OTHER: No significant abnormality noted.

Output: 1.No evidence of perineal or pelvic abscess.2.Linear T2 signal in the perineal region may represent non-fluid filled tract versus granulation tissue.


Instruction: Generate impression based on findings.

Input: Developmental delay and epilepsy. Complicated birth history, born via C-section due to breech where mother's heart rate and blood pressure dropped and baby heart rate was non reassuring. The baby was born breech and with cyanosis. There is volume loss and high T2 signal involving the hippocampi and the deep gray nuclei bilaterally. There are scattered areas of high T2 signal in the cerebral white matter bilaterally. There is a diffuse background of mild cerebral volume loss, with tinning of the corpus callosum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild nonspecific mucosal thickening in the paranasal sinuses.

Output: Findings suggestive of perinatal hypoxic-ischemic injury in a central and peripheral pattern with associated diffuse cerebral volume loss.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache, heart transplantation patient with immunosuppression. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is a focal small metallic artifacts on the right temporal bone, however, is no evidence of skull bone marrow abnormality.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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. Small metallic artifact on the right temporal bone, otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Abdominal pain in right upper quadrant, evaluate for metastatic disease leading to hepatic obstruction (cancer patient with known metastases now with scleral icterus, dark urine, etc.) ABDOMEN:LIVER, BILIARY TRACT: Multiple enlarging hepatic metastases, demonstrating T2 intermediate signal and postcontrast heterogeneous predominately rim enhancement. At least one possible new lesion, for instance, 1 x 0.9 focus located in hepatic segment 2 on image 31 series 701, not definitely seen on earlier CT study. Hepatic segment 4B lesion now measures 5.2 x 3.8 cm on image 25 series 701, previously measured 3.2 x 3.1 cm. Additional previously referenced porta hepatis lesion now mildly larger, measuring 3.2 x 2.9 cm on image 25 series 701, previously measured 3.1 x 2.2 cm. Associated mass effect on adjacent structures seen with new moderate intrahepatic biliary duct dilatation visualized. Area inferior to this level including pancreatic head not well assessed secondary to susceptibility artifact from postprocedural sequela. Previously alluded to 0.9 cm peripheral right hepatic hypoattenuating focus likely a cyst given corresponding T2 hyperintensity on current MRI. Main portal vein flow void approximately 2 cm from confluence with SMV and splenic vein not visualized, corresponding to tumor invasion and occlusion. Opacification of some intrahepatic peripheral portal venous branches, portion of markedly attenuated right posterior portal venous segment seen on image 26 series 1001, with tumoral invasion, image 409 series 1404. Otherwise, right and left portal veins not well seen. Heterogeneous signal particularly of right hepatic lobe on postcontrast imaging, likely reflecting combination of metastatic disease and perfusional abnormalities secondary to portal venous thrombosis. New luminal narrowing of IVC secondary to mass effect, image 404 series 1/4/2004, and near junction with left renal vein. Gallbladder contracted.SPLEEN: No significant abnormality noted.PANCREAS: Nondilated pancreatic duct. Pancreatic head not well assessed secondary to susceptibility artifact from postprocedural sequela.ADRENAL GLANDS: Accounting for differences in technique/modality, left adrenal nodule without significant change, measuring 1.8 x 0.8 cm on image 23 series 701, previously measured 1.9 x 1.2 cm on CT study.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Bilateral renal cysts.BOWEL, MESENTERY: Right-sided ostomy.BONES, SOFT TISSUES: Spinal degenerative disease.OTHER: Small ascites. Trace pleural fluid. Status post cystoprostatectomy.

Output: Enlarging hepatic metastases with new associated moderate intrahepatic biliary duct dilatation and portal vein invasion/occlusion, at least one new hepatic metastasis suggested, please refer to discussion above.Small ascites, trace pleural effusions.


Instruction: Generate impression based on findings.

Input: There is am extra-axial T2 hyperintense area in the right pineal cistern that measures 5 mm in width, but otherwise 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 a right maxillary sinus retention cyst and mucosal thickening in the right sphenoid sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. An extra-axial lesion in the right pineal region that measures up to 5 mm in width may represent a cystic structure, but is incompletely characterized. Follow up via MRI with contrast and DRIVE/FIESTA sequences may be useful.3. Right sided inflammatory paranasal sinus disease.


Instruction: Generate impression based on findings.

Input: History of recurrent osteosarcoma status post resection. Disease status evaluation pretreatment. Evaluation of the shoulder is markedly limited by metallic susceptibility artifact from the patient's humeral prosthesis. Since the prior study, the patient has undergone resection of the scapula and a large mass arising from the scapula representing metastatic osteosarcoma. There is edema of the surrounding soft tissues likely related to recent surgery. A collection of fluid signal intensity with peripheral rim enhancement extends posteriorly from the lateral margin of the second rib. I suspect this represents a seroma, but I cannot exclude the possibility of abscess development. This collection measures approximately 4.5 cm in AP dimension and approximately 1.5 cm in mediolateral dimension. It is approximately 3.5 cm in oblique craniocaudal dimension. Note is made of small axillary lymph nodes which appear to have fatty hila. Given the the aforementioned limitations of this study, I see no dominant nodular mass to indicate macroscopic residual tumor. Bandlike signal abnormality in the left upper lung likely represents chronic scarring.

Output: Postoperative changes of scapular tumor resection as described above.


Instruction: Generate impression based on findings.

Input: 66 year old female with history of AL amyloidosis, s/p pacemaker for tach-brady syndrome. Referred for MRI for follow up. Left VentricleThe left ventricle is normal in size and systolic function. There is moderate left ventricular hypertrophy. The basal anteroseptum is 14mm (similar to reported on previous study dated 4/2016). The overall LV ejection fraction is 56%, the LVEDV is 124 ml (normal range 109+/-23), the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVESV is 55 ml (normal range 31+/-10), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LV mass is 137 g (normal range 114+/-24), and the LV mass index is 74 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. Based on T1 scouts, the gadolinium kinetics are abnormal (i.e. myocardium and LV cavity null within 80ms of each other). There is diffuse late gadolinium enhancement, which is most pronounced in the basal inferolateral wall and also in the basal septal mid-wall. These findings are strongly suggestive of the diagnosis of cardiac amyloidosis. No intracardiac thrombus. An accurate myocardial T1 measurement is not available, possibly due to artifact from the pacemaker. Left AtriumThe left atrium is moderately dilated. No LAA thrombus.The atrial wall is thickened. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RVEDV is 141 ml (normal range 110+/-24), the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVESV is 63 ml (normal range 35+/-13), and the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8). Pacemaker lead is noted in the RV apex. Right AtriumThe right atrium is dilated. Right atrial pacer lead noted. The atrial wall is thickened. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation. The main PA is mildly dilated and measures 32 mmTricuspid ValveThe tricuspid valve opens widely. There is a pacer lead through the tricuspid valve.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid arteries. The thoracic aorta 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 drains normally into the right atrium. The IVC is dilated.PericardiumSmall pericardial effusion. Extracardiac FindingsWell-circumscribed lesions noted in the liver consistent with hepatic cyst. This study is not designed for the specific evaluation of extra-cardiac findings. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is moderately hypertrophied (IVSd=14mm) with normal systolic function. LV ejection fraction is 56%. There is evidence of abnormal gadolinium kinetics and diffuse late gadolinium enhancement most pronounced in the basal inferolateral wall and basal septal midwall. These findings are strongly suggestive of the diagnosis of cardiac amyloidosis. 2.The right ventricle isnormal in size and function. RVEF is 55%3.Biatrial enlargement and thickening.4.At least mild mitral regurgitation. 5.When compared to the prior study from 4/1/2016, the LV wall thickness is stable but difference between myocardial and LV cavity inversion time has decreased, which could represent increasing myocardial amyloid burden. Comparison of myocardial T1 times not possible. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate mature. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Negative noncontrast MRI of the brain. Specifically, there are no MRI findings to explain the patient's staring spells.


Instruction: Generate impression based on findings.

Input: History of cirrhosis and nonspecific lesion on prior MRI. ABDOMEN:LIVER, BILIARY TRACT: The liver is shrunken and nodular in morphology. There are small esophageal and perigastric varices. Small volume of perihepatic ascites. Borderline enlarged spleen. These findings are consistent with cirrhosis.A TIPS is in place. The portal vein proximal to the TIPS catheter is patent. The hepatic artery is patent as well as the middle and left hepatic veins. The right hepatic vein is not visualized due to artifact from the TIPS.Stable 9 x 9 mm lesion (series 9/17) in the right hepatic dome is difficult to see on T2-weighted imaging, appears mildly hyperintense on T1-weighted images. There is questionable faint arterial enhancement without restricted diffusion, no definite washout on subsequent delayed imaging.Stable peripheral wedge-shaped arterially enhancing focus extending from the distal end of the TIPS to the hepatic dome with persistent enhancement on delayed sequences with mild T2-weighted signal hyperintensity, likely a perfusion abnormality.SPLEEN: Mildly prominent spleen measuring 11 cm. Stable 1.8 cm distal splenic artery aneurysm (series 5/13).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: Small broad-based umbilical hernia containing small bowel without evidence of complication.Small loculated pocket of fluid at the GE junction is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable size and nonspecific appearance of the right hepatic dome lesion not meeting strict criteria for HCC. No new suspicious lesion.2.Cirrhosis, portal hypertension and TIPS placement.3.Stable 1.8 cm distal splenic artery aneurysm.


Instruction: Generate impression based on findings.

Input: 50 year old with history of right lumpectomy for IDC with DCIS. Dense breasts. Mild parenchymal enhancement is noted in the left breast, and there is moderate enhancement in the right breast. There is mild right breast skin thickening and enhancement. A heterogeneous amount of fibroglandular tissue is present. A few high T2 signal cysts are present in each breast. No suspicious enhancing lesion is seen in either breast. Expected post surgical changes are present in the right outer breast lumpectomy site. No abnormal axillary lymph nodes are identified in either axillary region. Post-surgical changes noted in the right axilla.

Output: 1. Diffuse right breast enhancement and skin thickening may relate to post-lumpectomy radiation therapy. Correlation with history and physical exam are recommended.2. No focal suspicious enhancing lesion in either breast. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Other nonspecific abnormal finding of lung field [R91.8], Reason for Study: ^Reason: 80 y/o with newly diagnosed NSCLC please complete staging with brain imaging History: see above There is no evidence of acute ischemic or hemorrhagic lesion. There is no abnormal enhancement.Scattered patchy T2/flair high signal intensity lesions on bilateral periventricular white matter are again seen, indicate nonspecific small vessel ischemic disease, unchanged since prior scan.There are multifocal small lacunar infarcts involving bilateral basal ganglia and brainstem are again seen, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2.No evidence of abnormal enhancement.3.Nonspecific small vessel ischemic disease and multiple lacunar infarcts are seen, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: History of Chiari decompression and tethering, syrinx and T2 signal change, 6 month follow up. Left arm burning. Removal of syringo-subarachnoid shunt on November 28, 2013. Cervical:Again seen are suboccipital postoperative changes of Chiari decompression with preservation of the ventral and dorsal CSF spaces at the foramina magnum. There is faint patchy T2 signal in the cervical cord similar to prior with minimal prominence of the central canal in the upper cervical cord, which is not significantly changed. No discrete syrinx is appreciated within the cervical cord. There is preserved biphasic CSF flow at the foramina magnumAgain seen are degenerative changes in the cervical spine with mild retrolisthesis of C3 on C4, C4 and C5, and minimal at C5 and C6. Disk osteophyte complexes result in mild to moderate spinal canal stenosis at C3-C4 and C4-C5. There is mild to moderate left C4-C5 neural foramina stenosis.THORACIC: Again seen are postsurgical changes of laminectomy at the T1 and T2 levels. Again seen is dorsal displacement of the thoracic cord at the T1-T2 level which appears tethered to the dorsal thecal sac surface. There is mild patchy T2 signal including myelomalacia compatible with postsurgical change. There is minimal prominence of the central canal in the upper thoracic cord with small cystic cavity at the T1-2 level, which is well seen on the 3D T2 BFFE sequence. Overall findings are similar to 8/6/2014.The thoracic spine is in normal alignment, with slight exaggeration of the normal thoracic kyphosis. The vertebral body heights are well maintained. The remainder of the thoracic spinal cord is of normal caliber and signal. Degenerative changes are seen throughout the thoracic spine with small disk bulges without significant spinal canal or neural foramina stenosis.

Output: 1.Postoperative changes of Chiari decompression with preserved CSF flow at the foramen magnum.2.Unchanged mild patchy T2 signal within the cervical cord and trace prominence of the central canal in the upper cervical cord. No discrete syrinx.3.Postoperative changes of upper thoracic laminectomy. Unchanged appearance of the upper thoracic cord which appears dorsally tethered. Stable T2 signal abnormality which in part is related to myelomalacia with minimal residual upper thoracic syrinx.4.Moderate degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at C3-C4 and C4-C5, and mild stenosis at C5-C6. There is also mild to moderate left neural foraminal narrowing at the C4-C5 level.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with nontraumatic subarachnoid hemorrhage. Subarachnoid blood product is again seen within the left central sulcus, some of the left middle frontal sulci, and the right superior frontal sulcus, similar in distribution and quantity to that seen on the prior CTs. No other definite areas of subarachnoid hemorrhage are seen. No parenchymal or intraventricular hemorrhage is detected.The cortex surrounding the subarachnoid hemorrhage shows very mild edema without significant generalized mass effect. Otherwise, parenchymal morphology and signal characteristics are within normal limits. No restricted diffusion is seen apart from that artificially induced by the blood product. The ventricular system is normal in size and morphology.

Output: Subarachnoid blood product is redemonstrated appearing similar in distribution and quantity to that noted on prior CTs. The blood induces very mild edema in the adjacent brain cortex, but there is no significant generalized mass effect. No parenchymal or intraventricular hemorrhage is suspected. No clear underlying etiology for the hemorrhage is seen.


Instruction: Generate impression based on findings.

Input: Questionable Parkinsonian features with numbness to lower extremity. Image quality is degraded by motion artifact. The ventricles and sulci are prominent, consistent with moderate age-related volume loss and slightly more prominent involving the right anterior temporal lobe. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There is a focus of CSF signal involving the left medial basal ganglia adjacent to the foramen of Monro which may represent a lacunar infarct or possibly perivascular space. There is no midline shift or herniation. There is thinning of the right sphenoid bone as seen on recent CT with areas of lucency seen on CT possibly representing prominent arachnoid granulations/related to CSF pulsation. The skull and extracranial soft tissues are otherwise unremarkable. Scattered mucosal thickening of the paranasal sinuses.

Output: 1. Image quality is degraded by motion artifact. No evidence of acute infarct, intracranial mass or mass effect.2. Moderate chronic small vessel ischemic disease.3. There is thinning of the right sphenoid bone with areas of lucency seen on CT possibly representing prominent arachnoid granulations/related to CSF pulsation and of doubtful clinical significance. There is global parenchymal volume loss, commensurate with age, but slightly greater in the right anterior temporal lobe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50-year-old male with left shoulder pain x5 years, no improvement with multiple injections or physical therapy ROTATOR CUFF: There is no fluid signal traversing the supraspinatus tendon to indicate a full-thickness tear. However, there is intermediate signal intensity within and along the undersurface fibers of the distal supraspinatus tendon likely representing tendinosis along with undersurface fraying/tearing. Signal abnormality involves approximately 50% of the tendon thickness and measures 1 cm in long dimension and 1 cm in transverse dimension. Posteriorly, the tendon appears intact. The supraspinatus muscle appears normal. The infraspinatus, teres minor, and subscapularis muscles and tendons are within normal limits.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal for age although there is slight spurring of the anterior acromion. No fluid is noted within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. Given the limitations of a nonarthrographic study, no fluid filled labral tear is evident. A focus of intermediate signal intensity separating the superior labrum from the underlying glenoid could conceivably represent an underlying SLAP tear or a normal variant. BICEPS TENDON: The long head of the biceps tendon is intact. Small lobulated focus of fluid signal intensity along the extra-articular surface of the biceps tendon is likely of no current clinical significance. ADDITIONAL

Output: 1.Intermediate signal within and along the undersurface of the the distal supraspinatus tendon is suggestive of tendinosis and undersurface fraying/tearing. No fluid-filled full-thickness rotator cuff tear is seen. 2.Other findings as above.


Instruction: Generate impression based on findings.

Input: 38-year-old female with BRCA mutation and family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally, symmetrically increased compared to prior studies.No unique or suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. To maximize the utility of breast MRI, please schedule future studies during the second week of the patient's menstrual cycle in order to minimize the effects of background enhancement. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for possible syrinx versus other spine lesions, likely cervical, likely compressive. Signs and symptoms: 38 year old with headache, generalized hyperreflexia and spasticity. Complete spine MRI:Examination demonstrate normal anatomical alignment of vertebral column. Very minimal degenerative changes in the cervical spine are noted.There is no evidence of spinal canal compromise or stenosis at any level.There is normal signal intensity and caliber of cord and without detectable mass effect.The signal intensity and morphology of the conus and cauda equina on this nondedicated exam appears to be normal.There is no detectable. Spinal soft tissue abnormalities. Images at the level of the foramen magnum are unremarkable.

Output: Negative nonenhanced total spine MRI utilizing cord compression protocol.


Instruction: Generate impression based on findings.

Input: 55-year-old female with headaches and nausea and loss of consciousness. Status post fall this a.m.. Neurologically intact. Multiple small subcortical and periventricular areas of low-attenuation are not a specific all were often these findings are secondary to small vessel disease or demyelinating disease. Considering patient's age findings are more likely to represent small vessel disease. Age of these show cannot be determined on CT.No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus is detected. There is subtle prominence of the basilar tip which demonstrate punctate calcification this can be result of atherosclerotic disease and vascular tortuosity the remote possibility of an aneurysm cannot be entirely ruled out. Further evaluation with an MRI and MRA is recommended to exclude acute stroke and also evaluate for possibility of aneurysm of the basilar tip.The bony density of calvarium is unremarkable. Pneumatization of paranasal sinuses and mastoid air cells also unremarkable.

Output: 1.Nonspecific white matter patchy areas of low attenuation which are suspicious for small vessel disease of undetermined age.2.No evidence of an acute posttraumatic findings.3.Slight prominence of basilar tip as detailed.


Instruction: Generate impression based on findings.

Input: 53 year old male patient with detectable PSA after prostatectomy in 2015. PELVIS:PROSTATE: The patient is status post prostatectomy without evidence of residual tissue. Foci of low T2 signal within the inferior prostatectomy bed likely reflect susceptibility artifact/sequela of surgery.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: There is asymmetric enhancement about the tendinous insertion of the left gluteus medius tendon on the left greater trochanter. OTHER: No significant abnormality noted.

Output: 1.Status post prostatectomy without evidence of residual tissue or lymphadenopathy.2.Enhancement about the left gluteus medius tendon insertion is compatible with tendinopathy and can be further evaluated with dedicated MR imaging if clinically warranted.


Instruction: Generate impression based on findings.

Input: Ms. Hibbs is a 60 year old female with a personal history of left breast lumpectomy for breast cancer in 1997 followed by chemoradiation therapy. BRCA1 positive. Family history of breast cancer in her sister and niece. Mild parenchymal enhancement is noted bilaterally. Scattered fibroglandular tissue is seen. No abnormal enhancement is seen in either breast. Stable postsurgical distortion is present in the left lower outer quadrant. Scattered foci in the right breast are stable, most similar to prior 3T studies. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: The patient is a 57-year-old male with atrial fibrillation he presents for a pulmonary vein and left atrial CT prior to radiofrequency Atrial fibrillation ablation. The left atrium is normal in morphology. There are 4 distinct pulmonary veins each with its own separate ostium. The left atrial volume and pulmonary vein dimensions at the ostia are as follows:left atrial volume: 160 ccright superior pulmonary vein: 27 x 24 mmright inferior pulmonary vein: 29 x 24 mmleft superior pulmonary vein: 26 x 19 mmleft inferior pulmonary vein: 26 x 17 mm

Output: Normal left atrial and pulmonary vein morphology.Please refer to the separate radiologist report for interpretation of the lungs and other soft tissues of the thorax.


Instruction: Generate impression based on findings.

Input: There is redemonstration of a resection cavity involving the right anterior temporal lobe, a portion of the right insula, the frontal operculum, and a portion of the right inferior frontal lobe. The size and morphology of the resection cavity are unchanged. The degree of the T2 signal abnormality surrounding the resection cavity and extending into the right frontal white matter has not significantly changed. There is enhancement along the ependyma of the right frontal horn, which appears significantly more prominent than on the previous studies of 8/28/2015 and 7/10/2015. There is also a new focus of nodular enhancement along the ependyma of the left frontal horn. Enhancement in the midline along the septum pellucidum remains the same. Enhancement along the ependyma of the lateral aspect of the body of the right lateral ventricle is unchanged.There is enhancement along the medial aspect of the resection cavity, which is contiguous with the ependymal enhancement, which is not significantly changed. There is no evidence of restricted diffusion. There is susceptibility effect along the resection cavity, due to old blood products.There is fluid in the right mastoid and in the left maxillary sinus, unchanged.

Output: 1. Redemonstration of findings related to tumor resection and treatment. 2. Progressive ependymal enhancement is seen along the right frontal horn, with a new area of ependymal enhancement along the left frontal horn. 3. Stable appearance of the resection cavity.


Instruction: Generate impression based on findings.

Input: Hydrocephalus. Evaluate ventricles. Status post shunt. There is significant ventriculomegaly of the supratentorial ventricular system is again identified with no interval change. Excessive extra-axial fluid collection within the posterior fossa remains also stable since prior study. The fourth ventricle is not enlarged and remains similar to what was noted on prior MRI. Severely compressed brain parenchyma in the supratentorial space secondary to massive hydrocephalus. No definitive interval appreciable change in comparison to MRI examination of January 29, 2009.

Output: Stable severe hydrocephalus since prior MRI examination from January 29, 2009.


Instruction: Generate impression based on findings.

Input: There is diffuse global volume loss that is more focally pronounced in the bilateral hippocampi, greater on the right. There are scattered predominantly subcortical white matter T2 signal abnormalities, with lesser degree of periventricular white matter involvement, along with symmetric involvement of the bilateral external capsules and subinsular white matter. There is no associated susceptibility abnormality. There is unchanged volume loss in the anterior temporal lobes bilaterally with ex vacuo dilatation of the temporal horns. There is a partial empty sella. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.Extensive predominantly peripheral subcortical white matter T2 signal abnormalities may chronic represent microembolic disease. A variant of CADASIL and metastatic lesions given the history of colon cancer are perhaps less likely. Nevertheless, further evaluation with contrast enhanced MRI can also be considered for the evaluation of metastatic disease, if clinically indicated.2.Global volume loss that is most pronounced in the hippocampi supports the clinical suspicion of Alzheimer's disease.


Instruction: Generate impression based on findings.

Input: 40 year old woman s/p heart transplant on 3/2012 and LAD stent in 9/2014. Referred to evaluate for transplant vasculopathy. First Pass PerfusionDuring hyperemia, there is a perfusion defect involving the mid septum, anterolateral and inferolateral walls. The overall ischemia score is 3 out of a possible 32. 9% of the myocardium is ischemic.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 93 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is enlarged consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 41 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 mild 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 FindingsSternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, there is a perfusion defect involving the septum, anterolateral, and inferolateral walls.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 70%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 65%).


Instruction: Generate impression based on findings.

Input: Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement.L1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: UnremarkableL5/S1: Unremarkable

Output: Negative contrast enhanced MRI of the thoracic and lumbar spine. Specifically, there are no MR findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 17-year-old male patient with medial knee pain and instability. Note that evaluation on several sequences is limited due to patient motion artifact.MENISCI: The lateral meniscus appears intact. There is linear obliquely oriented increased signal intensity within the peripheral fibers of the posterior horn of the medial meniscus extending to the tibial articular surface, suggesting a longitudinal undersurface tear. The body and anterior horn of the medial meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is edema type signal within the posterior aspect of the lateral tibial plateau as well as the anterior aspect of the lateral femoral condyle. There is slight flattening of the lateral femoral condyle overlying the contusion, indicating a mild impaction fracture. A small contusion is also noted in the far medial aspect of the medial tibial plateau. We see no fluid-filled articular cartilage defects.LIGAMENTS: There is a full-thickness midsubstance tear of the anterior cruciate ligament. The superficial band of the medial collateral ligament is intact. There is a curvilinear low signal intensity structure extending superiorly from the body of the medial meniscus between the medial femoral condyle in the superficial band of the MCL that is of uncertain clinical significance. While this could conceivably represent a meniscofemoral coronary ligament tear, this seems unusual in light of the intact superficial band of the medial collateral ligament. The posterior cruciate ligament, lateral collateral ligament complex, and patellar retinacula are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Midsubstance rupture of the anterior cruciate ligament with bone contusions, medial meniscus tear, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS, f/u progression History: weakness Brain MRIMultifocal bilateral confluent FLAIR/T2 high high signal intensity lesions on periventricular white matter, centrum semiovale and some on subcortical white matter. Bihemispheric sulci are prominent indicating mild volume loss. These findings are consistent with white matter disease such as multiple sclerosis. Comparing to prior scan, there is no significant interval change in terms of extent, distribution and number of those lesions. The ventricles, sulci and cisterns are 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 are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRISubtle T2 high signal intensity lesions distributed on cervical spinal cord, C23 level and C4 and C5 level are again seen without evidence of cord swelling.These findings are more conspicuous on today's scan especially on axial images. However, this could be related to different imaging techniques.Spinal alignment is anatomic. Vertebral body heights are preserved. Minimal neuro-foraminal narrowing is seen at the level of C4-5 right side otherwise unremarkable.

Output: 1. Unchanged bilateral white matter lesions of brain since prior scan in terms of size, distribution and extent.2. Unchanged ill defined spinal cord lesions since prior scan, though lesions are more conspicuous on today's scan most likely related to different imaging technique.


Instruction: Generate impression based on findings.

Input: 55-year-old female with bilateral osteoarthritis, walking with a cane, limping, difficulty climbing stairs. Evaluate for meniscal tear. There is intermediate/high T2 signal along the subcutaneous soft tissues anterior to the patella.

Output: 1. Articular cartilage degeneration along the medial facet of the patella with full-thickness extension to the subchondral bone surface with underlying bone marrow edema.2. Small knee joint effusion. 3. Inflammatory changes within the subcutaneous soft tissues anterior to the patella.4. No evidence of meniscal tear as clinically questioned.


Instruction: Generate impression based on findings.

Input: 5 years, Male, seizures. Sulcation and myelination appear within normal limits. No intracranial mass or mass effect. No midline shift or herniation. There are no diffusion or susceptibility abnormalities to suggest infarct or hemorrhage. No extra-axial collections. Ventricles and sulci are normal in size. There is T2 hyperintensity involving the anterior aspect of the superior frontal gyrus which almost entirely suppresses on the FLAIR sequence and favored to represent prominent perivascular space. Bilateral hippocampi are symmetric There is moderate mucosal thickening involving the left maxillary sinus and mild opacification involving the left ethmoid air cells. Calvarium and extracranial soft tissues are unremarkable.

Output: No structural lesion to suggest seizure focus is definitively appreciated. There is small focus of T2/FLAIR hyperintensity involving the subcortical white matter in the right superior frontal gyrus, which is favored to represent a prominent perivascular space and less likely related to cortical dysplasia, but would suggest correlation with EEG findings. Examination is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 53 year old woman with history of left breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.This exam is somewhat limited by motion artifact. The index lesion is a round, circumscribed mass in the left breast at 1:00 position, middle depth which enhances and measures 2.0 x 2.0 x 1.9 cm. Focus of T2 hyperintensity immediately lateral to this lesion represents the Hydromark biopsy clip. An addition, poorly marginated focus of enhancement measuring 0.5cm is seen in the central left breast, middle depth, representing a satellite lesion. Adjacent signal void represents the second biopsy clip. The extent of breast tissue spanned by these lesions measures 5.2 cm in craniocaudal dimension. An enlarged, abnormal morphology lymph node is partially visualized in the left axilla measuring 3.4 x 1.9 cm. Artifact from biopsy clip noted.In the right breast, there is an enhancing 1.4 x 0.9 cm oval, circumscribed mass at the 9:00 position, posterior depth. Normal-appearing lymph nodes are noted in the right breast and axilla. A T2 hyperintense lesion in the right lobe of the liver is noted and likely represents a hemangioma as seen on CT from 2007.

Output: 1.Left breast mass with additional satellite focus of abnormal enhancement both of which are biospy proven malignancies.2.Abnormally enlarged left axillary lymph node which has been biopsied.3.Mass in the right breast which may be benign in etiology such as a fibroadenoma. MR directed ultrasound is recommended for further evaluation.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Li Fraumeni syndrome with prior breast cancer, rectal cancer and family history of sarcoma and glioblastoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is bilateral sphenoid and maxillary sinus retention cyst formation and perhaps secretions.

Output: No evidence of intracranial tumors.


Instruction: Generate impression based on findings.

Input: The exam is motion degraded limiting evaluation, which is further limited due to lack of IV contrast due to patient's low GFR. The last well-formed disk space is referred to as L5-S1. The osseous marrow signal is diffusely low on T1 as compared to the disk signal, compatible with patient's history of multiple myeloma. There is normal alignment of the lumbar spine. There is loss of T2 disk signal in multiple levels with loss of disk height at L5-S1, along with type II degenerative endplate changes. There is no evidence of acute fracture with preserved vertebral body heights. The conus terminates at L2 and shows grossly normal signal.There is mild posterior cortical bulge of T11, T12, L4 and L5 with mild expansion of the T11 and T12 pedicles. At these levels, there is effacement of the ventral CSF space due to posterior cortical bulging without significant spinal canal stenosis. These findings are compatible with expansile myelomatous lesions. Level by level details are as follows:T11-12: Effacement of ventral CSF space without significant spinal canal stenosis secondary to posterior cortical bulging at T11. No significant disk herniation. Expansion of the pedicles results in severe right and mild left neural foraminal stenosis.T12-L1: Effacement of ventral and lateral CSF space at T12 level due to epidural tumor without significant compression/deformity of the cord or abnormal T2 signal within the cord. No significant disk herniation or neural foraminal stenosis.L1-2: No significant disk herniation, spinal canal or neural foraminal stenosis.L2-3: Mild disk bulge and bilateral facet arthropathy with ligamenta flava thickening causing mild to moderate right and mild left neural foraminal stenosis with no spinal canal stenosis.L3-4: Mild diffuse disk bulge and bilateral facet arthropathy with ligamenta flava thickening causing mild to moderate right and mild left neural foraminal stenosis.L4-5: Posterior cortical expansion/epidural tumor at L4 abutting the bilateral traversing L5 nerve roots in the subarticular zones without significant displacement. Diffuse disk bulge, bilateral facet arthropathy and ligament flava thickening causing minimal bilateral neural foraminal stenosis and no significant spinal canal stenosis.L5-S1: Posterior cortical expansion/epidural tumor at L5 which is asymmetric to the left encroaching upon and causing stenosis of the left subarticular zone; suspect mild traversing left L5 nerve root compression. Diffuse disk bulge, and mild bilateral facet arthropathy causing mild left neural foraminal stenosis and no significant right neural foraminal stenosis.

Output: 1.Motion degraded examination which is further limited due to lack of IV contrast secondary to patient's chronic renal disease and low GFR.2.Diffusely low T1 signal in the osseous marrow compatible with diffuse myelomatous infiltration. No evidence of acute fracture.3.Myelomatous lesions in T11, T12, L4 and L5 vertebral bodies cause posterior cortical expansion/epidural tumor invasion.4.Marked effacement of the CSF space around the cord without significant compression/deformity or T2 signal within the cord. Spinal canal is most compromised at this level, followed by L5 vertebral body level where epidural tumor compresses upon the traversing left L5 nerve root in the left subarticular zone. Please correlate for left L5 radiculopathy.5.Variable degrees of neural foraminal narrowing as described above. In particular, at T11-12, there is tumor expanding the pedicles of T11 and T12 causing severe right and mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 36-year-old male with left side and frontal headaches. The axial T2 FLAIR sequence is moderately degraded by motion artifact.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Normal noncontrast brain MR.


Instruction: Generate impression based on findings.

Input: 75-year-old female with drop attacks, subsequent nausea; rule out posterior circulation hemorrhage, TIA There are increasing periventricular and subcortical hypoattenuating lesions which is nonspecific but may represent increased small vessel disease of indeterminate age. Recommend MRI if high clinical concern for ischemic CVA. Again seen is an evolving right basal ganglia lacunar infarct. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and sulci are prominent which is consistent with mild parenchymal volume loss. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Increased small vessel disease of indeterminate age. No evidence of acute intracranial hemorrhage. Recommend MRI if high clinical concern for ischemic CVA.Mild parenchymal volume loss and evolving lacunar infarct as described above.


Instruction: Generate impression based on findings.

Input: Posterior circulation stroke: dizziness. Brain MRI: There is a subcentimeter area of restricted diffusion and high T2 signal in the superior cerebellar vermis. The brainstem and supratentorial brain are otherwise unremarkable, aside from minimal nonspecific T2 hyperintensity in the left frontal lobe white matter. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses.Brain MRA: There is apparent paucity of flow-related enhancement of the distal portion of the right PICA. The segment of the left vertebral artery distal to the left PICA is markedly diminutive. There is a fetal left PCA. There is an azygous left ACA. The rest of the intracranial arteries are grossly unremarkable and there is no evidence of saccular cerebral aneurysms.Neck MRA: The exam is non-diagnostic due to suboptimal contrast bolus timing.

Output: 1. Small acute infarct involving the superior cerebellar vermis.2. Apparent paucity of flow-related enhancement of the distal portion of the right PICA may indicated steno-occlusive disease versus artifact. 3. The segment of the left vertebral artery distal to the left PICA is markedly diminutive, which may be developmental. 4. The neck MRA is non-diagnostic due to suboptimal contrast bolus timing.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is attenuation of the posterior horn and body of the medial meniscus representing degenerative tearing. Additionally, there is abnormal signal intensity within the body and posterior horn which extends to the tibial articular surface representing more focal tearing. There is deformity of the posterior horn of the medial meniscus near the root likely representing additional tearing with a displaced flap fragment.There is globular increased signal throughout much of the lateral meniscus representing intrasubstance degeneration with linear signal intensity of the posterior horn extending to the femoral articular surface indicating more focal tearing. There is truncation of the root of the posterior horn of the lateral meniscus likely representing a large radial tear with associated lateral extrusion of the body of the lateral meniscus. Signal abnormality within the body of the lateral meniscus extending to the tibial articular surface represents additional tearing as does branching signal abnormality and fragmentation of the anterior horn.ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritis of the lateral compartment with areas of full-thickness cartilage loss, subchondral cystic change, and subchondral edema along the weightbearing portions of both the lateral tibial plateau and lateral femoral condyle. There is relatively mild cartilage degeneration of the medial compartment. There are full-thickness clefts involving the articular cartilage of the patella along the median eminence and medial facet with additional superficial degeneration along the lateral facet. There is also a low signal intensity full-thickness cleft of the articular cartilage of the femoral trochlea centrally. There are tricompartmental osteophytes and osteoarthritis of the proximal tibiofibular articulation.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Severe osteoarthritis of the knee, particularly of the lateral compartment, with extensive tearing of both the lateral and medial menisci. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: 72 years Male (DOB:9/7/1944)Reason: ro stroke History: vertigoPROVIDER/ATTENDING NAME: NAOUM ISSA MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. A couple punctate lesions are also present in the brainstem which are hyperintense on T2 and FLAIR MRI.Punctate focus of loss of signal on susceptibility weighted imaging is present in the right occipital lobe subcortical white matter. In isolation this is nonspecific and likely of little clinical significance..No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is hypoplastic The left posterior communicating artery is very small. There is fetal origin of the right posterior cerebral artery. The right P1 segment is small to medium sized. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The origins of the vertebral arteries appear to be narrowed bilaterally with findings suggestive of stenosis of the left vertebral artery at its origin as well as the right vertebral artery at its origin.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for acute ischemic cerebral infarction.3.Findings suggest stenosis at the origins of the vertebral arteries bilaterally.4.Several periventricular and subcortical white matter lesions as well as a couple lesions in the brainstem are present which are nonspecific nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: History of prostate cancer in right apex (Gleason 7). PELVIS:PROSTATE:Prostate Size: Prostate measures 3.9 x 5.1 x 3.5 cm (cc by transverse by AP)Peripheral Zone: There is heterogeneous low T2 signal that is asymmetrically more prominent on the right which slightly limits evaluation. Within the right apex there is a small focus is slightly more prominent low T2 signal (series 401 image 62) with corresponding low ADC signal suspicious for tumor.Central Gland: There are mild changes of benign prostatic hypertrophy.Seminal Vesicles: Seminal vesicles are unremarkable. No evidence of tumor invasion.Extracapsular Extension: No definite extracapsular extension is identified.BLADDER: There is a partially visualized dilated right distal ureter.LYMPH NODES: Contour abnormality adjacent to the right internal iliac vessels is felt to represent a small focal varix as opposed to a prominent lymph node based on series 1001 image 72 and 612. No definite pelvic or inguinal lymphadenopathy.BONES, SOFT TISSUES: Patchy bone marrow signal throughout the pelvis likely reflects residual red marrow. There are postsurgical changes in the right inguinal region.OTHER: There is a simple midline cyst at the base of the prostate gland in line with the urethra which may reflect either a mullerian duct or utricle cyst which measures 13 mm in maximum dimension.

Output: 1. Findings suspicious for tumor in the right peripheral zone apex. No evidence of extracapsular extension or metastatic disease.2. Contour abnormality adjacent to the right internal iliac vessels is felt to represent a small focal varix as opposed to a prominent lymph node based on series 1001 image 72 and 612. No definite pelvic or inguinal lymphadenopathyy otherwise.3. Partially imaged dilated right distal ureter.


Instruction: Generate impression based on findings.

Input: Clinical question: 61yo with h/o aortic occlusion resulting in spinal cord infarct and gangrene of toes from thrombosis. Having persistent Left facial numbness (temporal sparing) and L hand/wrist. R/o acute ischemia or central lesion or peripheral pathologySigns and Symptoms: L facial numbness, L hand numbness 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 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 left vertebral artery is larger than the right vertebral artery.On susceptibility imaging, some asymmetry in the posterior fossa venous drainage pattern is present which is unchanged since the prior exam. This may be developmental in origin.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: 27-year-old female with history of myasthenia gravis. Evaluate for thymoma or hyperplasia. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No evidence of anterior mediastinal mass.CHEST WALL: No significant abnormality noted.

Output: No evidence of anterior mediastinal mass.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to right frontal craniotomy for subjacent ganglioglioma resection. There are subjacent foci of susceptibility effect compatible with chronic blood products. There is minimal unchanged T2 hyperintensity along the resection margins without significant edema or nodular enhancement. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged postoperative findings related to right frontal craniotomy for subjacent ganglioglioma resection without evidence for tumor recurrence or for carcinomatosis.