Instruction: Generate impression based on findings.

Input: Cyst decompression and Ommaya reservoir placement. There has been interval insertion of a left transoccipital catheter that terminates in the right cerebral hemisphere cavity. There is scattered pneumocephalus. There are postoperative findings related to right hemispherectomy with an unchanged heterogeneous fluid collection in the right extradural space deep to the craniectomy flap that measures up to approximately 15 mm in thickness and midline shift to the right. The deformed third and lateral ventricles are not significantly changed in appearance. There is no significant interval change in size of the cystic compartments in the left occipital lobe that appear to communicate with ventricular system, although precise comparison is limited due to differences in head positioning. There is unchanged diffuse confluent cerebral white matter T2 hyperintensity in a large portion of the left hemisphere, particularly in the periventricular region. There is a left transparietal tract, but no shunt catheter is present. There is unchanged posterior deviation and areas of encephalomalacia in the upper cervical spinal cord. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The major cerebral flow voids are intact.

Output: 1. Interval insertion of a right transoccipital Ommaya catheter without evidence of acute intracranial hemorrhage or infarction.2. Chronic postoperative findings related to right hemispherectomy with no significant change in the deformed ventricular system, gliotic portions of the left cerebral hemisphere, and cystic compartments in the left cerebral hemisphere.3. Unchanged posterior deviation and areas of encephalomalacia in the upper cervical spinal cord, which may be attributable to adhesions and chronic infarction, respectively.


Instruction: Generate impression based on findings.

Input: Evaluate etiology of headache, positional component: history of right mastoidectomy, lumbar drain. MRI: There are postoperative findings related to right mastoid obliteration with fat graft. There is fluid within the remaining pneumatized portions of the right temporal bone. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There appears to be mild prominence of the bilateral optic nerve sheath cerebrospinal fluid.MRV: There is constriction of the bilateral transverse sinuses. There is otherwise no evidence of

Output: 1. Postoperative findings related to right mastoid obliteration with fat graft. There is fluid within the remaining pneumatized portions of the right temporal bone, which may represent persistent cerebrospinal fluid leakage or effusions. 2. A partially empty sella, mild prominence of the bilateral optic nerve sheath cerebrospinal fluid, and constriction of the bilateral transverse sinuses are suggestive of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Reason: new onset left sided rigidity, concern for ischemic event versus MSA versus atypical parkinson's disease: left sided weakness and bradykinesia, looking for hummingbird sign in brainstem. There is punctate susceptibility effect in the right globus pallidus, but the rest of the basal ganglia are unremarkable. The brainstem is intact, without evidence of the hummingbird or Mickey mouse sign. The brain parenchyma and cerebellum also appear unremarkable, aside from minimal nonspecific cerebral white matter T2 hyperintensity. There is no evidence of intracranial mass or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Nonspecific punctate susceptibility effect in the right globus pallidus, which may represent incipient mineralization. Otherwise, no specific imaging findings for progressive supranuclear palsy or multiple system atrophy. Perhaps a nuclear medicine scan may be useful for further evaluation.2. No evidence of intracranial mass or acute infarct.


Instruction: Generate impression based on findings.

Input: 47-year-old female with known IDC with DCIS in the right breast at 2 sites presents for MRI evaluation. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, there are two irregularly shaped enhancing masses; anterior mass (20 x 11 x 18 mm: AP x LR x CC) located at 8:00 position, and posterior mass (11 x 8 x 7 mm) located at 8:30 position. There is a marker clip within each mass. These two masses are not connected each other. There are three enhancing foci immediately anterior and medial to the anterior mass. These foci are possibly satellites. The size of the anterior mass with three foci is 29 x 15 mm (AP x LR) and total AP distance of two masses with three foci is 46 mm.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Two biopsy proven malignant lesions in the right breast at 8:00 - 8:30 position. Possible satellites anterior and medial from the anterior mass.If conservation surgery is planned, bracketed wire localization by placing one wire at anterior to the anterior mass, and the other wire at the posterior mass under mammographic guidance.2. No MR evidence of malignancy in left breast3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 60 yo female with history of left lumpectomy and sentinel node biopsy 2012 for ILC. Patient received radiation and chemotherapy. Family history of breast cancer diagnosed in sister. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Postsurgical changes in the left upper inner breast are stable. Multiple enhancing foci in both breast are not significantly changed. Area of enhancement in the right lower outer breast, posterior depth, is also not significantly changed. No abnormal lymph nodes are identified in either axillary region. Postsurgical changes in the left axilla are stable.

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


Instruction: Generate impression based on findings.

Input: Visual loss; unable to read but able to see far away. There appears to be a punctate focus of restricted diffusion in the medulla centrally without discernible T2 hyperintensity. There are subcentimeter foci of T2 hyperintensity in the right pons and bilateral basal ganglia. There is also mild diffuse periventricular white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. Apparent punctate focus of restricted diffusion in the medulla centrally may represent an acute infarct versus artifact.2. Probable chronic lacunar infarcts in the right pons and bilateral basal ganglia. 3. Mild diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: 49-year-old female status post ray amputation of the right ring finger for epithelioid sarcoma. Evaluate for recurrence. Again seen are postoperative changes related to prior amputation of the fourth digit through the mid diaphysis of the fourth metacarpal, with transposition of the fifth digit. Evaluation of the fourth metacarpal is limited by metallic susceptibility artifact related to the presence of a plate and screw device affixing the aforementioned transposition. There is a small round focus of signal abnormality overlying the skin of the web space between the ring and middle finger which we suspect represents metallic susceptibility artifact from the patient's prior surgery. We see no masses or other findings to suggest tumor recurrence. The remaining bone marrow signal intensity is within normal limits. There is no abnormal enhancement seen following contrast administration.

Output: Postoperative changes without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: BRAIN: There is a stable 39 x 50 mm right middle cranial fossa arachnoid cyst associated with mild expansion of the right middle cranial fossa. No definite abnormal white matter T2 hyperintense lesions are seen in the cerebral hemispheres, corpus callosum, or the posterior fossa. At most, there may be a very small focus of T2 hyperintensity adjacent to the right temporal horn, but this is equivocal (see image 34 series 501). A 9 x 6 mm extra-axial dural based enhancing nodule is evident along the left postcentral sulcus. This lesion exerts no mass effect on the adjacent parenchyma and is unchanged.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 is mild reversal of the normal cervical lordosis. The osseous marrow signal is benign. There are minimal type I degenerative changes at the C6-7 endplates. No worrisome marrow enhancement is detected.Spinal cord signal is within normal limits. There is no abnormal cord enhancement is seen.C2-3: No disk herniation or spinal stenosis.C3-4: No disk herniation or spinal stenosis.C4-5: Mild facet hypertrophy. No disk herniation or spinal stenosis.C5-6: Disk osteophyte complex effacing the ventral CSF without significant spinal canal stenosis. Bilateral uncovertebral hypertrophy causing no significant neural foraminal stenosis.C6-7. Disk osteophyte complex with ventral CSF effacement without significant spinal stenosis. Mild right neuroforaminal narrowing.C7-T1: No disk herniation or spinal stenosis.The sagittal images show no significant disk herniation or spinal stenosis at T1-2 and T2-3.

Output: 1.Questionable T2 white matter lesion along the right temporal horn suspected. No other discrete white matter lesions are identified in the brain.2.A 9 x 6 mm enhancing dural based nodule is evident adjacent to the left parietal lobe most likely representing an incidental meningioma. This lesion is unchanged.3.Stable arachnoid cyst in the right middle cranial fossa.4.No demyelinating lesions are detected in the cervical spine.5.Mild cervical spondylosis is seen as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Beal is a 48-year-old female with family history of breast cancer in mother, diagnosed at the age of 49. Personal history of bilateral benign breast biopsies (left breast 2:00-fibroadenoma). She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Scattered cysts are identified in both breasts. There is re-identification of a previously biopsied left breast fibroadenoma in the left lateral breast with faint associated enhancement, appearing unchanged in size and appearance when compared to prior MRI examinationsScattered foci of enhancement are seen bilaterally, none of which appear more suspicious than the rest. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 55-year-old male with right knee pain persisting for greater than 6 weeks. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. The medial meniscus appears intact. There is increased signal abnormality within the body of the lateral meniscus which extends to the tibial and femoral articular surfaces consistent with a radial tear.ARTICULAR CARTILAGE AND BONE: There is near full-thickness articular cartilage degeneration along the weightbearing portion of the lateral femoral condyle above and anterior to the posterior horn of the meniscus. There is a small serpentine area of increased signal abnormality within the superior patella, centrally, and along the lateral facet, consistent with a bone infarct.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is thickening with intermediate signal abnormality within the patellar tendon indicating moderate tendinosis.ADDITIONAL

Output: .1. Small bone infarct of the patella as described above.2. Radial tear of the lateral meniscus.3. Findings consistent with moderate patellar tendinosis.4. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Male, 6 years old, with stage I rectal mass, of the left orbit status post 42 weeks in CR1. Infiltrative T2 hyperintensity involving the superolateral aspect of the left extraconal orbit is unchanged from the prior examination. Mild enhancement in this region continues to diminish from prior examinations.No new intraconal or extraconal T2 hyperintense or enhancing lesions are demonstrated. The globes are round and symmetric. The extraocular muscles demonstrate normal signal and enhancement. The optic nerves are unremarkable.Mucosal thickening and opacification of the paranasal sinuses persists, similar to prior. Opacification of the mastoid air cells is stable on the left and decreased on the right.

Output: 1.Post treatment findings in the left orbit with no evidence of recurrent or progressive tumor.2.Persistent pan-sinus inflammation.


Instruction: Generate impression based on findings.

Input: Left sided radicular symptoms. There is multilevel degenerative spondylosis. At C2-3 and C3-4, there are small posterior disc-osteophyte complexes, without significant spinal canal or neural foraminal narrowing. At C4-5, there is a disc-osteophyte complex that abuts the spinal cord and results in left greater than right neural foraminal narrowing. At C5-6, there is bilateral uncovertebral joint hypertrophy with what may represent mild bilateral neural foraminal narrowing. At C6-7, there is a posterior disc-osteophyte complex and bilateral uncovertebral joint hypertrophy that result in left greater than right neural foraminal narrowing, but no significant spinal canal narrowing. At C7-T1 and T1-2, there are posterior disc-osteophytes and uncovertebral hypertrophy associated with left greater than right neural foraminal narrowing, but but no significant spinal canal narrowing. While the usual cervical lordosis is lacking, there is no significant spondylolisthesis. The vertebral body heights are preserved and the bone marrow appears unremarkable. The paraspinal soft tissues are unremarkable.

Output: Multilevel degenerative spondylosis, with left greater than right neural foraminal narrowing at several levels.


Instruction: Generate impression based on findings.

Input: h/o ballismus/myoclonus in all extremitiesSigns and Symptoms: eval for basal ganglia lesion The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the prior exam. It is likely of little clinical significanceThere is redemonstration of a left parafalcine calcification unchanged since prior exams and also seen on the CT scan from 12/7/2011Normal 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.Incidental note is made of partial empty sella.

Output: The examination is stable compared to the previous exam from 2 years ago. No abnormal lesions are appreciated intracranially to explain the patient's symptoms


Instruction: Generate impression based on findings.

Input: Reason: assess for ischemia, aneurysm change, hemorrhage History: sudden headache, h/x of left MCA aneurysm. BRAIN: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. Scattered punctate and confluent foci of increased T2/FLAIR signal within the periventricular and subcortical white matter are nonspecific but compatible with moderate chronic small vessel ischemic changes and appear similar to prior. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. A partially empty sella is again incidentally noted. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA HEAD: Images are mildly degraded by motion which limits assessment of small aneurysms. The intracranial internal carotid arteries are normal in course and caliber. There is redemonstration of an inferiorly directed saccular aneurysm measuring approximately 4 x 3 mm (trav x cranoicuadal) at the right MCA distal M1 segment appearing grossly unchanged. The middle and anterior cerebral arteries are otherwise unremarkable. A left P-comm is not definitively visualized. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or new aneurysm.

Output: 1.No evidence of acute infarction.2.Moderate chronic small vessel ischemic changes.3.MRA mildly limited by motion. Right MCA distal M1-MCA bifurcation 4 mm aneurysm, grossly unchanged.4.Partially empty sella which is nonspecific but can be seen with intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on findings.

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

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Female, 95 years old, with one episode of aphasia, history of meningioma. Assess for changes. A plaque-like extra-axial enhancing lesion is redemonstrated predominantly along the right aspect of the clivus where it measures up to 9 mm in thickness and shows no significant interval growth or expansion. As before, a dural tail associated with this lesion extends to the right internal auditory canal. Superiorly, there is a small contiguous nodular component of the lesion which projects into the suprasellar cistern, also appearing similar to the prior exam. Effacement of the right prepontine cistern and slight flatten of the ventral pons are unchanged. No new intracranial enhancing lesions are seen. Patchy foci of T2 hyperintensity are seen in the periventricular and subcortical white matter of the bilateral cerebral hemispheres and left basal ganglia without significant interval change. No restricted diffusion is seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricles and sulci are mildly and proportionately prominent compatible with volume loss.

Output: 1.Stable presumed meningioma along the right aspect of the clivus.2.No change in the appearance of chronic microvascular ischemic disease.3.No new or acute intracranial findings.


Instruction: Generate impression based on findings.

Input: Headaches and neck pain with C3-4 cervical stenosis and instability. There is a prominent posterior disc-osteophyte at C3-4 that impinges upon the spinal cord, which displays focal signal abnormality at this level. There is also severe left and moderate right neural foraminal stenosis at C3-4. There is uncovertebral joint and facet joint hypertrophy bilaterally at C4-5, which result in moderate bilateral neural foraminal and spinal canal stenosis. There is no significant degenerative spondylosis at the other cervical spine levels. The vertebral body heights and signal characteristics are preserved. There is slight retrolisthesis of C3 on C4. The cervical spine alignment is otherwise anatomic. The paraspinal soft tissues are unremarkable.

Output: 1. A prominent posterior disc-osteophyte at C3-4 impinges upon the spinal cord, which displays focal signal abnormality at this level. There is also severe left and moderate right neural foraminal stenosis at C3-4. 2. Uncovertebral joint and facet joint hypertrophy bilaterally at C4-5 result in moderate bilateral neural foraminal and spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 61-year-old female with occasional headache, partial adrenal insufficiency, central hypothyroidism, and known pituitary adenoma, evaluate for interval change. The examination redemonstrates enlargement of pituitary gland in a uniform fashion which appears similar in signal intensity, morphology and pattern of enhancement since prior study. It again measures 10 x 9 mm on coronal post enhanced images and 12 x 13 mm on sagittal post enhanced images (when measured at the same locations utilized previously). There is also stable minimal thickening of the pituitary stalk however with normal pattern of enhancement since prior study. As before, the macroadenoma approaches the optic apparatus, however without abutment. There is no detectable involvement of the cavernous sinuses.

Output: Stable pituitary macroadenoma in signal intensity, morphology, extent, and overall measurements.


Instruction: Generate impression based on findings.

Input: Left sciatica. For the purposes of numbering, there are 5 lumbar type vertebral bodies. There is minimal L5-S1 retrolisthesis. Alignment of the lumbar spine is otherwise preserved. The vertebral bodies are preserved in height. Scattered T1 hyperintense foci are compatible with focal fat or hemangiomas. There is mild disc desiccation at L4-L5 and L5-S1 . Disc height is fairly preserved. The spinal canal is preserved. The conus medullaris has normal position and signal characteristics. T12-L1, L1-L2 and L2-L3: There is no spinal canal or foraminal narrowing. Facet productive change and ligamenta flava thickening are mild.L3-L4: Disc bulge is mild. Ligamenta flava thickening and facet proliferative change are moderate. There is mild spinal canal and neuroforaminal narrowing.L4-L5: Disc bulge is mild. Ligamenta flava thickening and facet proliferative change are moderate. There is mild spinal canal narrowing.L5-S1: Disc bulge is mild but is slightly eccentric to the left causing mild narrowing of the left subarticular recess (the traversing left S1 nerve root) and minimal left neural foraminal narrowing contacting (without obvious impingement) of the left L5 nerve root.

Output: Mild degenerative changes in the lumbar spine. There is mild disc bulge eccentric to the left at L5-S1 which which very mildly narrows the left lateral recess and left neural foramen at this level, and possibly the etiology of the symptoms. There is no high-grade spinal canal or neural foraminal stenosis at any level. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 59 years old Reason: HCC screening History: HBV cirrhosis ABDOMEN: Examination severely limited due to patient respiratory motion.LIVER, BILIARY TRACT: Cirrhotic morphology to liver and hepatic steatosis. The portal vasculature is patent. No definite mass lesions identified within the hepatic parenchyma; however, this examination is substantially limited, and near nondiagnostic due to patient respiratory motion.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Prominent portacaval lymph node identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic morphology of the liver and splenomegaly, but no definite large lesions identified in the hepatic parenchyma; however, this exam is substantially limited and near nondiagnostic due to patient respiratory motion. CT is recommended for follow-up examinations due to patient's inability to follow breath-hold instructions.


Instruction: Generate impression based on findings.

Input: Possible AC joint separation ROTATOR CUFF: No significant abnormality noted.AC JOINT: There are multiple erosions and subchondral cysts at the acromioclavicular joint, predominantly along the articular surface, which are accentuated by the addition of intra-articular contrast. No fracture or malalignment is present. No specific features of infection are evident.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Multiple erosions and subchondral cysts at the acromioclavicular joint which are non-specific in appearance though possibly a combination of degenerative and post-traumatic. Weight lifting may produce similar changes. An inflammatory arthropathy can also be considered and correlation with imaging of additional joints may be helpful.


Instruction: Generate impression based on findings.

Input: T11 right pedicle and transverse process lesion is not perform CT-guided biopsy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the disk space and adjacent osseous structures. Following needle removal images obtained demonstrate no complications .

Output: T11 right transvere process and pedicle biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: AVM treated with SRS in May 2015: please evaluate for post-radiation change. MRI: There is interval decrease in size of the enhancement surrounding the site of the treated left temporo-occipital region arteriovenous malformation. There is also substantial decrease in the extent of surrounding vasogenic edema. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no discernible arterialized flow at the site of the treated arteriovenous malformation. There is no evidence of significant steno-occlusive lesions in the regular cerebral arteries. There is no evidence of aneurysms.

Output: 1. Interval decreased edema associated with radiation necrosis at the site of the treated left temporo-occipital region arteriovenous malformation. 2. No gross recurrence of the treated left temporo-occipital region arteriovenous malformation, within the limits of MRA.


Instruction: Generate impression based on findings.

Input: 42-year-old female with a history of an anterior cervical fusion. There is an anterior plate with screws entering C4, C5, and C6. No hardware complications are identified. There are intervertebral spacers with bone graft at C4-C5 and at C5-C6 with perhaps early bony bridging at these levels. Moderate degenerative disc disease is present at C6-C7. There is mild to moderate multilevel facet joint osteoarthritis, particularly on the left. Straightening of the cervical spine is noted.

Output: Orthopedic fixation of the cervical spine as described above.


Instruction: Generate impression based on findings.

Input: Ulcerated/chronic proctitis, recurrent abdominal pain on thiopurines with nausea and vomiting in background of UC, r/o pancreatitis, if possible, assess small bowel for evidence of IBD Evaluation suboptimal without IV contrast.ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary duct dilatation and minimal contour irregularity. For example, focal left hepatic duct dilatation (image 21 series 9), concerning for underlying stricture near confluence. Mild prominence of common hepatic duct, measuring up to 5 mm, with distal tapering seen. Findings may also be due in part to patient's postcholecystectomy state. No focus of restricted diffusion seen to suggest underlying lesion. Tiny T2 hyperintense hepatic foci, likely benign. SPLEEN: T2 hyperintense focus in superior aspect of spleen, measuring 1.5 x 1.2 cm on image 30 series 9, likely a cyst or hemangioma.PANCREAS: Decreased intrinsic T1 signal of pancreas. No evidence of peripancreatic edema. Nondilated pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Apparent circumferential narrowing of rectosigmoid colon on image 23 series 17 more likely related to collapsed state as improved distensibility seen on other sequences, for example, series 23. No evidence of submucosal fat deposition to suggest chronic inflammation. Visualized terminal ileum unremarkable. No significant fibrofatty proliferation seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Nonvisualization of uterus, presumably related to prior hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Evaluation suboptimal without IV contrast.2. Mild intrahepatic biliary duct dilatation and minimal contour irregularity, focal left hepatic duct dilatation, concerning for underlying stricture near confluence in setting of sclerosing cholangitis. Mild prominence of common hepatic duct, measuring up to 5 mm, with distal tapering seen. Findings may also be due in part to patient's postcholecystectomy state. No focus of restricted diffusion seen to suggest underlying lesion.3. Decreased intrinsic T1 signal of pancreas, suggestive of chronic pancreatitis. Nondilated pancreatic duct. No evidence of acute pancreatitis.4. Apparent circumferential narrowing of rectosigmoid colon more likely related to collapsed state as improved distensibility seen on other sequences. No evidence of submucosal fat deposition to suggest chronic inflammation. Please note that assessment not optimal secondary to absence of IV contrast.


Instruction: Generate impression based on findings.

Input: Clinical question: 23-year-old male with worsening migraines, weight loss and abnormal tft's. Signs and symptoms: Worsening migraines. Pre and post enhanced pituitary MRI:The pituitary gland demonstrate normal size, signal intensity and morphology and with normal pattern of enhancement. The pituitary stalk demonstrate normal signal intensity and pattern of enhancement. No detectable abnormality of the hypothalamic region.Right lateral cavernous sinuses are well visualized and unremarkable.Images through the skull base are unremarkable and the paranasal sinuses remain well pneumatized.Pre and post enhanced brain MRI:Diffusion weighted images are unremarkable.Examination demonstrates normal anatomical developmental brain and normal signal intensity on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Post contrast images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges and no abnormal enhancement of calvarium or the retro-orbital spaces. Normal pattern of enhancement of the intracranial venous sinuses.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern is.

Output: 1.Negative pre and post enhanced brain MRI.2.Negative pre and post enhanced pituitary MRI.3.Normal pneumatization of all paranasal sinuses and bilateral mastoid air cells and cavities.


Instruction: Generate impression based on findings.

Input: 49-year-old male with history of primary sclerosing cholangitis who presents for evaluation of stricturing/suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with characteristic morphological changes of advanced PSC including scattered biliary ductal dilatation/stricturing, subtle peripheral T2 hyperintensity, which is likely secondary to parenchymal atrophy and fibrosis. The gallbladder is dilated, likely related to cystic duct structures. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with characteristic morphological changes and biliary findings of advanced PSC as detailed.2.No dominant biliary stricture identified.


Instruction: Generate impression based on findings.

Input: Metastatic papillary thyroid carcinoma status post total thyroidectomy, multiple neck dissections and radiation therapy. Most recent SRS to the right occipital resection cavity on 4/25/2014. Increased thyroglobulin. Again seen are postoperative changes of prior right occipital craniotomy. Compared to 11/11/2014 and 7/30/2014, there is slight increase in nodular thickening along the right paramedian occipital lobe resection cavity and posterior falx including a nodular focus of enhancement measuring approximately 1 cm in diameter along the right calcarine fissure. There remains T2/FLAIR hyperintensity along the margins of this resection cavity, slightly more focal anteriorly. No new lesion, new edema, or new mass-effect.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or mass effect. Foci of susceptibility are seen again along the posterior right temporal lobe. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. No destructive lesions within the calvarium. Focus of T1 hyperintensity in the left frontal calvarium remains unchanged.Images of the neck demonstrate posttreatment changes related to total thyroidectomy, neck dissection, and radiation therapy. There is abnormal T2 hyperintensity involving the left true vocal cord and the inferior aspect of the left paraglottic fat which is favored to represent treatment-related change. There is sclerosis involving the left lateral aspect of the cricoid cartilage which is better seen on prior CT. No discrete mass is appreciated. No suspicious lymphadenopathy is seen. No suspicious osseous lesions. Mild degenerative changes are seen in the cervical spine.

Output: 1. Compared to 11/11/2014 and 7/30/2014, there is interval increase in enhancement along the margins of the right paramedian occipital lobe resection cavity including a nodular enhancing focus along the right calcarine fissure. Given history of radiation to this area in 4/2014, finding may represent evolving radiation change, however, suggest continued close follow-up to exclude possibility of local recurrence. Consider including perfusion sequence on next follow-up study. Otherwise no new lesions to definitively suggest progression of intracranial metastatic disease.2. No new neck mass or cervical lymphadenopathy.3. Abnormal T2 signal and enhancement involving the left true vocal cord, inferior paraglottic fat, and sclerosis of the left cricoid cartilage likely represents treatment-related change. Direct comparison MRI is not available and findings are grossly similar to prior CT neck from 8/19/2014. May consider direct endoscopic evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Esophageal cancer with history of brain metastases. Previously seen left frontal lobe lesion with hemorrhage demonstrates decrease in enhancement, with mild residual area of enhancement measuring approximately 11 mm, previously approximately 13 mm on the sagittal sequence. There is cystic change which may relate to volume loss. Surrounding T2/FLAIR hyperintensity is not significantly changed and may represent gliosis and/or edema. Left temporal occipital lesion with T2 hyperintensity demonstrates no significant enhancement and measures 22 x 15 mm similar to prior. Surrounding FLAIR hyperintensity related to edema or gliosis is also not significantly changed.There is a 7 x 7 x 9 mm enhancing lesion involving the right occipital lobe which appears new since prior. There is mild surrounding edema.There is mild increase in T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter, particularly involving the right posterior frontal corona radiata which is favored to be related to posttreatment change. No underlying enhancing lesion is evident. Additional scattered foci of T2/FLAIR hyperintensity are nonspecific but compatible with small vessel ischemic disease and/or posttreatment-related changes. There is global parenchymal volume loss as seen before. No evidence of significant intracranial mass effect, midline shift, or herniation. No hydrocephalus. There is persistent fluid within the bilateral middle ears and mastoid air cells and mild scattered paranasal sinus mucosal thickening. No destructive calvarial lesions are evident.

Output: 1. Slight interval decrease in size and enhancement of hemorrhagic left frontal lesion with surrounding edema/gliosis not significantly changed. Lesion is compatible with treated metastasis. Nonenhancing left temporal occipital lesion is not significantly changed in size and compatible with treated metastasis.2. New 7 x 7 x 9 mm enhancing lesion involving the right occipital lobe. No other new lesions are appreciated.3. Slight increase in T2/FLAIR hyperintensity in the periventricular and subcortical white matter favored to represent posttreatment change.4. No significant intracranial mass effect, midline shift, or herniation.5. Persistent effusions involving the bilateral middle ears and mastoid air cells which may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: Recurrent pancreatitis status post multiple drain placements. ABDOMEN:LIVER, BILIARY TRACT: The common bile duct measures 8 mm, unchanged compared to prior. The dilatation extends to the level of the ampulla. No filling defect is identified within the gallbladder. The hepatic parenchyma is normal in appearance. Mild iron deposition throughout the liver parenchyma. The gallbladder is distended without evidence of cholecystitis. SPLEEN: Splenomegaly, measuring up to 15.4 cm in craniocaudal dimension.PANCREAS: Persistent distal irregularity and dilatation of the main pancreatic duct, measuring up to 5 mm, and involving the sidebranches, unchanged. The duct is irregular, but not dilated, within the head and proximal body. The pancreas enhances normally, without evidence of necrosis. There is interval increased peripancreatic edema. No focal fluid collection is identified. No abnormal enhancement to suggest necrosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel loops are normal in caliber. No evidence of bowel obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The splenic vein is attenuated, however, there is no evidence of pseudoaneurysm.

Output: 1.Acute on chronic pancreatitis with increased peripancreatic edema and unchanged distal pancreatic ductal dilatation, suggestive of stricture in the pancreatic neck. No evidence of discrete peripancreatic collection or pancreatic necrosis.2.Mildly dilated common bile duct bile duct to the level of the ampulla without obstructing stone or lesion identified.


Instruction: Generate impression based on findings.

Input: Patient with worsening mental status, worsening lymphoma evaluate for cns involvement. There are scattered areas of T2/FLAIR hyperintensity in the subcortical and periventricular white matter. No midline shift or mass effect is appreciated. The cortical sulci are in proportion to cerebral ventricles. There is no diffusion restriction to suggest acute or subacute ischemia. No acute intracranial hemorrhage is identified. There is a small amount of fluid present within the right mastoids. Mild scattered paranasal sinus mucosal thickening is seen.

Output: A few scattered foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter are nonspecific however can be seen with mild to moderate chronic microvascular ischemic disease in a patient of this age.


Instruction: Generate impression based on findings.

Input: Non small cell lung cancer, evaluate for metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of high T2 signal in the cerebral white matter, which are nonspecific, but may represent chronic small vessel ischemic disease. There is a punctate defect in the right cerebral peduncle that is compatible with a chronic infarct. There is no abnormal intracranial enhancement. There is diffuse mild cerebral volume loss as well as more focal areas of subarachnoid space dilatation. There are prominent perivascular spaces in the basal ganglia. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: History of HCC status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular contour, left hepatic lobe hypertrophy and fissural widening.Segment 5 ablation cavity measures 3.5 x 1.6 cm (series 10/66), compared to 3.9 x 1.9 cm previously. Demonstrated again is a residual focus of arterial enhancement adjacent to the anterolateral cranial aspect of the ablation cavity measuring 1.7 x 1.5 cm (series 9/68), unchanged.The segment 6 ablation defect measures approximately 3.1 x 1.5 cm (series 10/69), compared to 2.8 x 1.0 cm previously. Interval ablation of the previously described adjacent medial cranial arterial enhancing focus with residual 1.2 x 0.5 cm focus of residual arterial enhancement (series 9/68).Stable punctate subcentimeter focus of arterial enhancement in segment 8 measuring approximately 8 x 7 mm (series 9/74), compared to 7 x 6 mm previously.The segment 3 ablation cavity measures approximately 2.3 x 0.9 cm (series 10/71), compared to 2.6 x 1.1 cm previously. No associated arterial enhancement.Stable porta hepatis lymph nodes are not unexpected in the setting chronic liver disease.Normally distended gallbladder with mild gallbladder wall thickening, nonspecific in the setting of chronic liver disease. No specific evidence of acute gallbladder inflammation.SPLEEN: Splenomegaly measuring 18 cm in craniocaudal dimension with numerous siderotic nodules.Small splenorenal shunt.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: Stable vertebral body enhancing focus is unchanged dated back to 7/29/2014 (series 9/50).OTHER: No significant abnormality noted.

Output: Post ablation changes of the liver. Residual arterial enhancing foci adjacent to segment 5 and segment 6 ablation cavities. The segment 6 lesion is significantly decreased in size from the prior.Stable nonspecific enhancing subcentimeter focus in segment 8.


Instruction: Generate impression based on findings.

Input: Right craniotomy for resection of a large pituitary adenoma on 3/30/2015 Limited study due to patient inability to cooperate.Redemonstration of right frontal temporal craniotomy. There is swelling and fluid in the extracranial soft tissue. There is also small amount of extra-axial fluid and blood subjacent to the craniotomy. There is trace midline shift to the left with effacement of the right lateral ventricle. There are areas of parenchymal T2 hyperintensity of the right anterior temporal lobe, right inferior frontal lobe, right insula, right caudate head, and left basal ganglia. As seen on prior MRI, right caudate head and left basal ganglia show diffusion restriction suggestive of ischemia. Other areas may represent edema or ischemia. Mega cisterna magna again noted.Debulking of a large sellar/suprasellar tumor with residual tumor seen predominant at the right superior aspect of the suprasellar cistern. The residual tumor extends towards the third ventricle with continued mass effect on the third ventricle. There is track/stalk-like area of enhancement from this tissue to the deformed sella, which may be residual tumor or pituitary infundibulum. Residual tumor is also seen extending into the prepontine cistern. There is blood product in the operative bed. Bilateral ICA flow-voids are present.

Output: 1.Postoperative findings of partial resection of the sellar and suprasellar tumor.2.Areas of parenchymal abnormality of the right anterior temporal lobe, right inferior frontal lobe, right insula, right caudate head, and left basal ganglia. As seen on prior MRI, right caudate head and left basal ganglia show diffusion restriction suggestive of ischemia. Other areas may represent edema or ischemia.


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of left-sided weakness. There is a 10 x 7-mm focus restricted diffusion with associated increased T2 signal abnormality within the left aspect of the pontomedullary junction compatible with an acute ischemic infarct. Additionally, there is moderately increased T2/FLAIR signal abnormality within the periventricular and subcortical white matter. No midline shift or mass-effect. There is no evidence of intracranial hemorrhage. The basal cisterns are intact. The ventricles and sulci are symmetric. Flow-voids are appreciated in the major intracranial vessels. The imaged orbits, paranasal sinuses and mastoid air cells are clear.

Output: 1. Small acute ischemic infarction within the left aspect of the pontomedullary junction.2. Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is a similar extent but slight increased confluence of patchy T2 and FLAIR hyperintensity within the deep white matter bilaterally, with involvement of the external capsules. This is progressed since the prior MRI from June 2015. A more asymmetric area persists along the posterior limb of the left internal capsule extending into the corona radiata. There are no areas of pathological enhancement. The previously questioned punctate subtle focus of apparent enhancement in the left medial temporal lobe is no longer appreciated, consistent with prior artifact. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.No abnormal enhancement to suggest recurrent metastatic disease. Previously questioned punctate focus in the left temporal lobe was artifactual in etiology.2.Slight further increased confluence of abnormal signal throughout the deep white matter in a symmetric pattern which is nonspecific but felt to be posttreatment related, increased since June 2015.


Instruction: Generate impression based on findings.

Input: 44 year old female with personal history of right invasive ductal carcinoma status post right mastectomy in 8/2015 as well as radiation, hormonal therapy, and chemotherapy. Left breast benign biopsy in 2015 for PASH/stromal fibrosis. No family history of breast cancer. There is extreme amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.The patient is status post right mastectomy. Multiple scattered benign enhancing foci are present within the left breast, appearing less conspicuous than prior studies. No suspicious enhancement is identified in the left breast. No abnormal lymph nodes are identified in the left axillary region.

Output: Scattered benign enhancing foci in the left breast which appear less conspicuous than on prior studies. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Possible hydrocephalus status post left temporal tumor excision. 1-year-old female. The patient is status post left sided craniotomy. There is a large extra-axial fluid collection present also identified on 4/29 but not on 4/28. It measures 25 mm in width comparedThere is midline shift present with the shift of the third ventricle approximately 12 mm to the right of midline appeared there is a 90 x 20 mm cystic fluid collection in the left temporal lobe. There is associated intracranial air in the subdural and subarachnoid spaces.The right lateral ventricle is larger than the left lateral ventricle and the temporal horn is dilated but not substantially different than the prior exam. the right lateral ventricle measures 24 mm in width on the current exam as well as on the recent MRI exam.There is a right sided subdural collection measuring 7 mm in thickness.

Output: 1.Bilateral subdural effusions left larger than right associated with intracranial air.2.There is a cystic cavity in the left temporal lobe extending to the frontal lobe better demonstrated on the recent MRI3.There is midline shift present as described above4.Recent left frontal and temporal surgery.5.Enlargement of the right lateral ventricle and compression of the left lateral ventricle. The size of the ventricles has not changed since exam of 4/29.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of epidural hemorrhage. The question of underlying spinal AVM as source.IMAGE ACQUISITIONS: CT angiography of the thoracolumbar spine performed after the administration of 80 cc of Omnipaque 350 IV contrast a rate of 4.5 cc/sec. The aortic arch and origin of the great vessels are unremarkable. There is normal opacification of the intercostal and lumbar arteries. Additionally, there are no abnormal radiculomeningeal or radiculomedullary arterial feeders, enhancing intramedullary nidus, or early prominent medullary venous drainage to suggest spinal arteriovenous malformation or dural arteriovenous fistula.The thoracoabdominal aorta is within normal limits, without evidence of aneurysmal dilatation or significant atherosclerotic calcification. Note is made of a duplicated left renal artery. The visualized portions of the celiac axis, superior and inferior mesenteric arteries, common iliac artery, external and internal iliac arteries are unremarkable

Output: No definite evidence of spinal arteriovenous malformation or spinal dural arteriovenous fistula, please note subtle spinal vascular malformations may remain occult on cross-sectional imaging and if clinical suspicion persists, conventional spinal angiography is recommended.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of spinal stenosis with acute worsening of pain. The visualized calvaria and skull base are radiographically normal.Cervical spine alignment is anatomic. Vertebral body heights and density is within normal limits. The foramen magnum is unremarkable.C2-3 is unremarkable.C3-4 demonstrates neuroforaminal compromise bilaterally with mild central spinal stenosis and ventral hypertrophic changes.C4-5 demonstrates mild spinal stenosis and ventral hypertrophic changes with neuroforaminal narrowing but laterally.C5-6 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C6-7 demonstrates bilateral neuroforaminal narrowing, and advanced degenerative disk disease.C7-T1 demonstrates bilateral neuroforaminal narrowing.T10-11 and T11-12 demonstrates severe degenerative disk disease and near complete loss of disk height.T10/11 demonstrates significant neuroforaminal compromise.T12-L1 is unremarkable.L1-2 is unremarkable.L2-3 shows degenerative disk disease with hypertrophy of the posterior elements.L3-4 demonstrates a large diffuse bulging of disk density material that extends to the ventral epidural space greater on the left which may represent diffuse disk bulge or hypertrophic changes. For further elucidation of this level an MRI may be considered. Advanced degenerative disease is noted with sclerotic end plate changes and vacuum phenomenon. Neuroforaminal compromise is noted bilaterally and a high suspicion for central spinal stenosis.L4-5 demonstrates advanced degenerative disease with vacuum phenomenon. There is complete right neuroforaminal compromise by lateral hypertrophic changes. There is a high suspicion for a tight central spinal stenosis.The L5-S1 shows advanced degenerative disease and a significant diffuse disk bulge. Neuroforaminal compromise affects the right side. The left neuroforamina remains patent.

Output: Multilevel degenerative disk disease, neuroforaminal compromise and spinal stenosis as described above.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild focal kyphotic attenuation at the L1-L2 level with straightening suggested in the partially imaged lower thoracic spine. Alignment in the lumbar spine is otherwise within normal limits with no spondylolisthesis. Bone marrow signal is benign. The conus medullaris is normal in position. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. No significant lumbar disc disease or spinal canal or neural foraminal stenosis at any level. 2. Mild focal kyphotic angulation at the L1-L2 level with straightening suggested in the partially imaged lower thoracic spine. Alignment in the lumbar spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 86 years, Male, slurred speech, ischemic stroke Multiple sequences are motion degraded. There are multiple foci of restricted diffusion in the right frontal lobe including the right precentral gyrus as well as the right middle frontal gyrus consistent with acute infarct. There is corresponding T2/FLAIR hyperintensity. Additional extensive confluent T2/FLAIR hyperintensity seen in the bilateral periventricular and subcortical white matter as well as in the pons which is most compatible with advanced chronic small vessel ischemic disease. Foci of susceptibility effect are seen involving the right posterior frontal lobe in the area of the acute infarct suggesting petechial hemorrhages. No associated mass effect. Additional foci of susceptibility in the left cerebellar hemisphere, left thalamus, and brainstem are compatible with chronic microhemorrhages, with a distribution favoring a chronic hypertensive etiology.There is prominence of the ventricular system which is likely reflective of global parenchymal volume loss. No intracranial mass or mass effect. No extra-axial collections. Major flow-voids are preserved. Small bilateral maxillary mucus retention cysts.

Output: 1. Acute infarct in the right posterior frontal lobe including the right precentral and middle frontal gyri.2. Petechial hemorrhagic foci are noted in the region of the right posterior frontal infarct without mass effect.3. Additional foci of chronic microhemorrhages favoring a chronic hypertensive etiology.4. Advanced chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: There is no evidence of any pathologic parenchymal or extra-axial enhancement. No findings to suggest focal parenchymal edema or mass effect are observed. Ill-defined fairly confluent and symmetric periventricular white matter T2 hyperintensity is again noted most compatible with radiation related changes, although there could be superimposed chronic small vessel ischemic disease.Numerous scattered foci of susceptibility are again seen with the largest number clustered in the left parietal-occipital junction and these are unchanged. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricles are stable in size and morphology.

Output: No evidence of active or progressive intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with new left-sided headache. No evidence edema, mass effect, focal signal abnormality or diffusion restriction is seen. The pattern of intracranial enhancement is within normal limits. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection are observed. Ventricular size and morphology are within normal limits.MRA images of the head demonstrate congenital hypoplasia of the left vertebral artery which primarily supplies the left PICA. No significant intracranial vascular stenosis or occlusion is seen. A small laterally directed outpouching from the proximal right ACA at the origin of the orbitofrontal branch most likely represents an infundibulum. No other definite aneurysm or vascular malformation is observed.MRA images of the neck demonstrate conventional aortic branching. The origins of the great vessels are patent. No significant stenosis is detected in the carotid vessels by NASCET criteria. Likewise, the vertebral vessels are patent throughout. The left vertebral artery is congenitally small.

Output: 1.No brain parenchymal abnormalities.2.No abnormalities of the intracranial or neck vessels.


Instruction: Generate impression based on findings.

Input: Status post MVA with loss of consciousness on 8 -- 24 -- 2009. Now with headaches. Evaluate for bleed or new findings. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and also some cisterns remain within normal. There, paranasal sinuses and mastoid air cells are also unremarkable.If clinical symptoms persist an MRI is recommended.

Output: Unremarkable CT of brain without infusion and stable since prior study.


Instruction: Generate impression based on findings.

Input: 26 years Male (DOB:1/25/1990)Reason: pre op planning, needs fiducials. History: pre op planningPROVIDER/ATTENDING NAME: KRUPA G ANDALKAR BAKHTIAR V. YAMINI There are fiducial markers in place. There is a couple enhancing lesions one in the present in the left cingulate gyrus extending towards the corpus callosum which appears smaller compared to prior exam. It measures approximately 30 x 16 mm axial dimensions and is associated with T2 white matter signal hyperintensity surrounding it compatible with vasogenic edema. On the prior exam measured 25 x 52 mm. Another lesion is present in the left precuneus measuring approximately 11 x 17 mm along its enhancing portion also associated with T2 signal hyperintensity along the adjacent white matter suggestive of vasogenic edema. On the prior exam measured 20 x 15 mm.The patient status post left-sided craniotomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are enhancing tumors within the left cingulate gyrus and corpus callosum and within the left precuneus of the parotid left parietal lobe. This compatible with a neoplasms. One possibility based on the enhancement pattern is that this represents lymphoma. Other possiblities include demyelination and granulomatous disorder. The enhancing components appear smaller when compared to the prior exam suggesting status post steroid use or diagnosis other than lymphoma. 2.Examination was performed for the purposes of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Patient with history of seizure, follow up right mesial temporal abnormal T2 signal. There is now volume loss of the right hippocampus, with residual T2 hyperintensity. 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 a right maxillary sinus polyp or mucous retention cyst. There are also small nasopharyngeal retention cysts.

Output: Interval volume loss in the right hippocampus, which is most suggestive of mesial temporal sclerosis, perhaps as a sequela of limbic encephalitis.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. Evaluate for structural lesion. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci of T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are non-specific, but may represent prominent perivascular spaces. 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. There is mild mucosal thickening of the bilateral maxillary sinuses, left ethmoid and left sphenoid sinuses. There is disconjugate gaze. There are small mucous retention cysts within the adenoids and nasopharyngeal soft tissues.

Output: 1. No acute intracranial abnormality.2. Mild paranasal sinus disease.3. Disconjugate gaze. Please correlate with physical exam.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with exaggeration of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. At C5-C6 and C6-C7, there are trace disc bulges without stenosis. There is also mild ligamentum flavum thickening particularly at C6-C7. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. Patchy T2 hyperintensity seen within the pons and the midbrain which is nonspecific but may relate to chronic small vessel ischemic changes, as seen on previous dedicated brain MRI. Incidental note is made of a small oval T2 hyperintense and T1 hypointense structure in the left palatine tonsil measuring 7 x 5 mm on 601/29. This measures 8 mm CC on 401/1. However, correlating with previous brain images where it is partially visualized, there is no significant enhancement.LUMBAR SPINE

Output: 1. Mild lower cervical spondylotic changes without significant stenosis.2. Mild lower lumbar spondylotic changes with focal right foraminal disc protrusion resulting in only mild right foraminal narrowing.3. Questioned slight increased cranial caudal dimension of the liver. Please correlate with physical exam.4. Small deep left palatine tonsil T2 hyperintense lesion which is incompletely assessed, previously not noted to demonstrate associated enhancement. This is nonspecific, but may represent a small cyst. Dedicated CT or MRI of the neck may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: History of metastatic melanoma with brain metastasis treated with CTX: visual changes and headaches. There is a cystic tumor with a heterogeneously enhancing mural nodule in the left occipital lobe and surrounding vasogenic edema that measure up to 45 mm. There is a cystic tumor with a heterogeneously enhancing mural nodule and layering susceptibility effect from hemorrhage in the left cingulate gyrus and surrounding vasogenic edema that measures up to 17 mm. There is a heterogeneously enhancing tumor in the left postcentral gyrus with surrounding vasogenic edema that measures up to 10 mm with surrounding vasogenic edema. There is a cystic tumor with heterogeneous mural nodule with surrounding vasogenic edema that spans the right occipital and parietal lobes and measures up to 42 mm. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is no evidence of acute infarction. There is a left maxillary retention cyst. There are post-operative findings related to left posterior parietal craniotomy. The orbits are grossly unremarkable.

Output: Multiple brain metastases, including a tumor in the left occipital lobe that measure up to 45 mm, a tumor with layering hemorrhage in the left cingulate gyrus that measures up to 17 mm, a tumor in the left postcentral gyrus that measures up to 10 mm, and a tumor that spans the right occipital and parietal lobes and measures up to 42 mm. While the lesions are associated with vasogenic edema, there is no midline shift.


Instruction: Generate impression based on findings.

Input: History metastatic bladder cancer with dizziness. Image quality is degraded by motion artifact. There is no gross evidence of intracranial metastatic disease. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. No extra-axial collections. No hydrocephalus. Skull and extracranial soft tissues are unremarkable.

Output: Study is somewhat limited by motion artifact. However, no evidence of intracranial metastatic disease is appreciated. No evidence of acute infarct or hemorrhage.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 to be answered: Two months old baby boy with sudden cardiac arrest. Recent stroke on MRI, recent seizure activity, check for progression of stroke. Signs and symptoms: Seizures. A well demarcated area of low attenuation in the right posterior temporal region is again identified and with no definitive interval change.A very subtle low-density involving the cortex and subcortical white matter of left posterior temporal and occipital region is suspected. This finding is very subtle and it may also represent an artifactual beam hardening finding. Follow-up with a repeat CT or an MRI is recommended. There is no definitive evidence of any mass effect with this finding. No evidence of any intracranial hemorrhage. Ventricular system and subarachnoid space remains identical to prior study. All CSF cisterns remain widely patent.New since prior examination is thickening of the soft tissues of the scalp on the left side in the posterior parietal region.

Output: 1.Stable area of low attenuation in the right posterior temporal lobe since prior study.2.Artifact or a new area of low-attenuation in the left posterior temporal occipital region as detailed. Follow-up with a CT or an MRI is recommended.3.Stable ventricular system and CSF cisterns.4.No evidence of intracranial hemorrhage.5.Edema of left posterior parietal scalp.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [780.4], Reason for Study: ^Reason: eval for post circulation stenosis, syndrome History: eval for post circulation stenosis, syndrome No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal to mild diffuse brain atrophy which is age appropriate with minimal patchy high signal intensities on periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricular system appear to be slightly prominent but does not show any evidence of periventricular edema or evidence of occlusion of the CSF pathway. In particular, frontal and temporal horn prominency are proportional, no evidence of upward bowing of corpus callosum and approximate callosal angle appears to be normal.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate tortuosity of the intracranial vessels, however, there is no evidence of intracranial arterial luminal stenosis or narrowing. There is no intracranial arterial aneurysm. The right PCA is fetal origin.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous arterial system however, normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial or extracranial arterial luminal stenosis or irregularity. No intracranial arterial aneurysm.3. Slightly prominent ventricular system without evidence of CSF flow stenosis or occlusion.


Instruction: Generate impression based on findings.

Input: Chronic left sided headache with history of left pulsatile tinnitus. There is no acute infarct or intracranial hemorrhage. There are few punctate T2-hyperintense subcortical foci in the frontal lobes. The cerebellar tonsils reach up to 5 mm below the foramen magnum. Otherwise, the brain shows normal signal characteristics and normal morphology. There is no abnormal intracranial contrast enhancement. The ventricles and the other CSF-containing spaces are normal in size. There is no extra-axial fluid collection. There is no midline shift or brain herniation. The major intracranial vascular flow voids are preserved. Major venous sinuses are also patent. No mass within the cerebellopontine angles or internal auditory canals is appreciated. The internal auditory canals are symmetric as well as the seventh/eighth cranial complexes. There is a partially empty sella.There is trace mucosal thickening in the ethmoid sinuses. Mastoid air cells are clear. The orbits are unremarkable.

Output: 1.Few punctate T2-hyperintense lesions in the frontal subcortical white-matter are nonspecific and essentially within normal limits for age. These may be related to prior inflammation, infection or perhaps related to migraines.2.Partially empty sella is commonly an incidental finding, but can be seen with pseudotumor cerebri in the proper clinical setting.3.The cerebellar tonsils are borderline low-lying measuring up to 5 mm below the foramen magnum. This finding can also be seen with pseudotumor cerebri but may also be unrelated.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified disturbances of skin sensationClinical question: left arm and leg paresthesiasSigns and Symptoms: left arm and leg paresthesias MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses 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 posterior communicating arteries are fairly large. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with pressure ulcer. Spinal alignment is anatomic. Mild degenerative vertebral body height loss is seen at L5. No concerning marrow replacement or edema is seen.The visualized spinal cord, conus and cauda equina are unremarkable except as discussed below.Enhancement within the L4-5 and L5-S1 disc spaces is probably degenerative given the absence of enhancement or edema in the adjacent endplates. No evidence of pathologic enhancement is seen within the spinal canal itself. At most, there may be some vascular congestive enhancement due to spinal stenosis at L4-5 and L5-S1.The subcutaneous and paraspinal soft tissues of the lower lumbar and sacral regions show evidence of edema and some mild enhancement. A 4 cm wide region of hypoenhancement is evident within the soft tissues just dorsal to the sacrum. This is evident on only the last several slices of the exam.L1-2: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc with a superimposed central protrusion. Moderate spinal canal stenosis with slight crowding of the cauda equina. Moderate bilateral foraminal narrowing. L5-S1: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc with a large right anteriorly directed disc osteophyte complex. At least moderate spinal canal stenosis with crowding of the cauda equina nerve roots. Severe bilateral foraminal narrowing.

Output: 1.The subcutaneous and paraspinal soft tissues of the lower lumbar and sacral regions show evidence of inflammation. In addition, a region of hypoenhancement within the soft tissues just dorsal to the sacrum is incompletely imaged on this study. Findings could represent the reported pressure ulceration.2.Disc degeneration most severely affecting the L4-5 and L5-S1 levels where significant spinal canal stenoses are seen. In addition, severe bilateral foraminal narrowing is present at L5-S1.


Instruction: Generate impression based on findings.

Input: Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: vein of Galen malformation History: poor perfusion Brain MRI:Very limited exam, only non contrast enhanced T1 sagittal scans were obtained.There is large signal void at the vein of Galen area with tubular structure connecting the lesion to the distal superior sagittal sinus.There is no evidence of abnormal signal intensity of the brain.Ventricle size remains normal size and symmetric.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate enlarged bilateral vertebral arteries and PCAs. Bilateral PCAs are fetal origin.In particular there are multiple vascular in flow signal on the right side of ambient cistern indicating increased vascularity. The left side distal PCA branch appears to show more direct communication with the large aneurysmal pouch indicating direct arteriovenous shunting. The aneurysmal pouch shows relatively stenotic outlet especially transverse direction, but the craniocaudal direction appears to be non-stenotic.There is no evidence of intracranial arterial aneurysm or stenosis.

Output: 1. Arteriovenous shunting drains through an aneurysmal pouch which connects to inferior aspect of superior sagittal sinus, most likely diagnosis is vein of Galen malformation draining through persistent median prosencephalic vein.2. No evidence of abnormal signal intensity of brain although limited exam.3. Normal appearance and size of ventricular system.


Instruction: Generate impression based on findings.

Input: 23-year-old male with history of leukocytosis and recent fasciotomy. Evaluate for osteomyelitis. There are full-thickness defects of the subcutaneous fat along the medial and lateral aspects of the proximal and mid calf containing surgical drains compatible with stated history of recent fasciotomy. There is enhancement of the exposed surfaces of the musculature indicating inflammation as well as enhancement of the adjacent subcutaneous fat, predominantly anteriorly. There is also diffuse subcutaneous edema. There is marked, slightly heterogeneous enhancement of the soleus, tibialis posterior, inferior aspect of the popliteus, and lateral head of the gastrocnemius which is nonspecific and could reflect sequela of ischemia, inflammation, or infection (pyomyositis); however we see no discrete drainable fluid collection. There is relatively mild edema within the peroneal musculature and anterior musculature. There is a small focus of high T1/T2 signal abnormality within the anterior compartment which represents a small hematoma measuring 1 cm. There is intermuscular edema between the heads of the gastrocnemius musculature. The bone marrow signal intensity of the tibia and fibula is normal with no evidence of osteomyelitis.

Output: 1. Postoperative changes of medial and lateral fasciotomies with surgical drains present.2. Muscular enhancement as described above which is nonspecific and could reflect sequela of ischemia, inflammation, or infection (pyomyositis); however we see no discrete drainable fluid collection3. Additional soft tissue inflammatory changes as described above without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 49-year-old male with a history of an extensive right knee injury presents with right knee pain. Surgical buttons are noted along the lateral femoral condyle and anterior margin of the tibial epiphysis. Additional surgical tunnels within the proximal tibial metadiaphysis and distal femoral diaphysis are noted. There is anterior soft tissue swelling with a thickened patellar tendon and a large suprapatellar effusion containing a focus of gas. Intra-articular calcification paralleling the articular surface of the distal femur is presumably posttraumatic in etiology.

Output: Surgical changes of a ligament and tendon reconstruction with a large joint effusion containing a small focus of gas density. Although this may reflect recent intervention, the possibility of infection cannot entirely be excluded.


Instruction: Generate impression based on findings.

Input: HeadNote that only post contrast sequences were obtained. This is in comparison to MRI brain without contrast study on 6/21/2015. 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 or enhancement. 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. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Along the posterior aspect of the T7 vertebral body on the right there is a discrete lesion measuring 11 mm x 9 mm and demonstrates low signal intensity on T1 and heterogeneous signal intensity on STIR sequences with suggestion of mild enhancement (series 1201, image 9). Otherwise there are no additional abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is disc dessication with a linear focus of increased signal on STIR/T2 sequences within the disk posterolaterally to the left which could represent a form of disk degeneration. There is mild disc bulge, minimal facet hypertrophy and ligamentum flavum hypertrophy with no significant compromise to the spinal canal or neural foramina.At L4-5 there is disc dessication with a linear focus of increased signal on STIR/T2 sequences within the disk posterolaterally to the right which could represent a form of disk degeneration. There is mild disc bulge, minimal facet hypertrophy and ligamentum flavum hypertrophy with no significant compromise to the spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a right renal cyst.

Output: 1. Mildly enhancing discrete lesion within T7 vertebral body is nonspecific and follow-up with CT to further characterize the lesion would be useful. Alternatively, follow-up with MRI to ensure stability or resolution can be considered as well.2. No evidence of leptomeningeal disease as clinically questioned. 3. Mild degenerative changes affect the lumbosacral spine with no compromise of the spinal cord or neural foramina.


Instruction: Generate impression based on findings.

Input: 76 year old man with CAD (recent PCI to mLAD), thoracic aorta repair referred for evaluation of underlying ischemia.MEDICATIONS: ASA, Plavix, losartan, Toprol xl, eliquis, aldactone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere are 2 small areas of late gadolinium enhancement noted. One is in the apical lateral wall and the other in the basal inferolateral wall. They are mid-myocardial and in a pattern atypical for infarction. They may represent prior fibrosis, inflammation, or infiltration. There is no evidence of myocardial infarction and the entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 159 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 28 g/m2, and the LV mass is 70 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation. Possible bicuspid aortic valve but only limited views available.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 to moderate tricuspid regurgitation.AortaThe aortic root is mildly dilated. Ascending aorta graft is noted. The proximal portion of the descending thoracic aorta is mildly dilated. 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 FindingsSternotomy wires are present. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. There are 2 small areas of late gadolinium enhancement that are mid-myocardial and in a pattern atypical for infarction. They may represent prior fibrosis, inflammation, or infiltration. 3. Normal LV size and systolic function (LVEF 65%).4. Normal RV size and mildly reduced systolic function (RVEF 48%).5. Severe biatrial dilation.6. Possible bicuspid aortic valve but only limited views available.7. Mild to moderate tricuspid regurgitation.8. Sinus of Valsalva is mildly dilated. Ascending aorta graft is noted. The proximal portion of the descending thoracic aorta is mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of a non-small cell lung carcinoma with brain metastasis and on coagulation. Altered mental status. Examination demonstrates multiple hypodensities in the right frontal lobe and basal ganglia, which are compatible with findings on the prior MRI. New since prior exam is a hypodense area in the right posterior temporal lobe, which involves the cortex. No evidence of intracranial hemorrhage, mass effect, midline shift or extraaxial fluid collection is identified. The ventricles are normal in volume. Deformity of the right lamina papyracea is present. Sinus disease is present. The calvarium is intact.

Output: 1. No evidence of intracranial hemorrhage. 2. Multiple right frontal and basal ganglia hypodensities likely represent metastases given clinical history and prior MRI provided. An infused MRI is suggested for further evaluation. 3. Right posterior temporal hypodensity likely represents ischemia, however, metastasis cannot be ruled out based on the current noninfused exam. 4. Right lamina papyracea dehiscence or blowout fracture. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 49 year old who is status post modified radical mastectomy for IDC with DCIS in March 2015 presents for re-staging MRI. Status post left mastectomy and left axillary lymph node dissection.There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the left mastectomy bed.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.Post surgical changes are seen in the right axilla from contralateral sentinel node biopsy.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: patient with right arm and leg tingling sensation History: right arm and leg tingling sensation , hx of migraine headaches MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No evidence for intracranial mass lesions or focus of demyelination.2.There is no compromise of the cervical spinal canal or exiting nerve.


Instruction: Generate impression based on findings.

Input: History of poorly differentiated sinonasal carcinoma SNUC treated with CRT. There are postoperative findings related to sinonasal tumor excisional biopsy with resection of the left ostiomeatal complex and left middle and superior turbinates. There is no evidence of measurable sinonasal region tumor. There is persistent mucosal thickening and secretions that occupy the left sphenoid sinus. There is also persistent moderate mucosal thickening in the left maxillary sinus and mild mucosal thickening within the right maxillary, right sphenoid, left frontal, and right ethmoid sinuses. The parotid glands are unremarkable. There is encephalomalacia in the inferior right cerebellar hemisphere. There are also scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There are bilateral lens implants. There is multilevel degenerative cervical spondylosis.

Output: 1. Post-treatment findings in the sinonasal region with persistent diffuse mucosal inflammatory changes, but no evidence of measurable tumor recurrence. 2. Chronic right inferior cerebellar infarct.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapseClinical question: mass or anatomic abnormality to explain symptomsSigns and Symptoms: repeated syncope, both associated with sudden emesis The CSF spaces are appropriate for the patient's stated age with no midline shift. Some mild asymmetry in the size of the lateral ventricles (right slightly larger than left) can be considered a normal variantNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is no evidence for intracranial hemorrhage.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery is larger than the left vertebral artery.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: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with cord compression. Image quality is significantly degraded by motion artifact. Within this limitation, the following observations are made. A retropharyngeal fluid collection is partially visualized. Adjacent to the collection, the paraspinal soft tissues demonstrate evidence of edema. The C3, C4 and C5 vertebral bodies, and the intervening discs, are edematous with perhaps a small amount of fluid in the disc spaces. The ventral epidural space from C3 through C5 is thickened. Image quality does not allow for the discrimination between edema, phlegmon or frank abscess. However, this process, along with superimposed degenerative disease of the disks and posterior elements, does result in significant narrowing of the spinal canal and likely some degree of cord impingement at the disc levels. Image quality is not adequate to exclude the possibility of cord edema.

Output: In the context of a presumed retropharyngeal abscess and paraspinal edema, abnormal edematous signal within the C3-C5 vertebral bodies, and fluid like signal within the C3-4 and C4-5 disc spaces, are concerning for the possibility of discitis osteomyelitis.Thickening of the ventral epidural space is noted from C3 through C5 which is concerning for infectious involvement. Image quality does not allow for the distinction between epidural edema, phlegmon or abscess.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with facial numbness and tremor. Nearly symmetric ill-defined T2 hyperintensity is seen in the bilateral thalami, best visualized on axial T2-weighted images (image 20 series 8). In addition, on spin-echo T1-weighted images, the basal ganglia appear somewhat T1 hyperintense such that they are nearly indistinguishable from the cerebral white matter (see series 10). The basal ganglia are not particularly hyperintense on T2/FLAIR, so the T1 findings could potentially be artifactual.No evidence of edema or mass effect is seen. No restricted diffusion is noted. No pathologic parenchymal or extra-axial enhancement is observed. Scattered small foci of FLAIR hyperintensity are seen within the white matter of the cerebral hemispheres. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collections are seen. The ventricles are normal in size and morphology. Brain parenchymal volume is grossly preserved.

Output: Ill-defined but nearly symmetric T2 hyperintensity is seen within the thalami. There may, in addition, be some T1 hyperintensity of the basal ganglia, though this could be artifactual. Numerous small scattered foci of T2 hyperintensity are evident in the cerebral hemispheres.The differential diagnosis for these findings is extremely broad and would include prior demyelination including ADEM, prior hypoxic ischemic injury, small vessel ischemic disease, a metabolic derangement or toxic exposure. The findings are somewhat suggestive of Wilson disease, though the patient age would be atypical. However, hepatic dysfunction in general could produce some of the findings noted above.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage of the medial femoral condyle with full-thickness defects. There is associated bone marrow edema. There is also some generalized thinning of the patella articular cartilage without focal defects. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Marked loss of articular cartilage of the medial femoral condyle