Instruction: Generate impression based on findings.

Input: 61-year-old male with acute mental status changes. Now with change in pupil sizes, right pupil pinpoint. Neither pupil reactive to light. Concern for herniation. There is significant beam hardening artifact affecting the posterior fossa which limits the evaluation. Since the prior study, there is suggestion of decreased density in the left cerebellar hemisphere which may be due to ischemia. The basilar cisterns are less well visualized. An MRI is recommended for further characterization of this region.Other findings appear similar to the prior CT from earlier the same day.These findings were discussed with Dr. Harshal Sheth at the time of interpretation.

Output: Limited examination, but new decreased density in the left cerebellar hemisphere which may be due to ischemia. An MRI is recommended for further characterization of this region.


Instruction: Generate impression based on findings.

Input: 12 year male with history of coarctation s/p stent and recent angioplasty who presents for stress test to evaluate for ischemia in light of an anomalous left coronary arteryMEDICATIONS: Singular, Zyrtec First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim imaging artifact is noted during hyperemia. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 149 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 49 ml (normal range 47+/-19), the LV mass index is 61 g/m2, and the LV mass is 100 g. There are no regional wall motion abnormalities present. A spontaneously closed muscular ventricular septal defect is noted. Coronary ArteriesThere is an anomalous origin of the left coronary artery which arises from the right coronary sinus and travels retroaortic to the take its normal course and bifurcates into the left circumflex artery and left anterior descending. The right coronary artery has a normal origin. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 42 ml/m2 (normal range 82+/-16), the RVEDV is 70 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The descending thoracic aorta has a stent in it and does not allow visualization of the aortic lumen. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Anomalous origin of the left main coronary artery with a retroaortic course. 2. No perfusion defects/ "ischemia" present during hyperemia.3. No prior myocardial infarction. The entire myocardium is viable.4. Normal LV size and systolic function (LVEF 67%) without regional wall motion abnormalities.5. Normal RV size and systolic function (RVEF 64%).6. A spontaneously closed muscular ventricular septal defect is noted.7. A stent is noted in the descending thoracic aorta. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Prostate cancer PELVIS: PROSTATE:Prostate Size: 3.1 x 4.3 x 3.2 cm (AP x TR x CC).Peripheral Zone: Dominant focus of signal abnormality involving the left base extending into the central zone, which measures 1.6 x 1.5 cm (series 801, image 18) compatible with carcinoma. There are additional punctate foci of signal abnormality involving the right gland.Central Gland: Heterogeneous and nodular.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Findings suggest mild extracapsular extension on the left.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant focus of signal abnormality involving the left base peripheral zone extending into the central zone compatible with carcinoma with additional findings suggestive of mild extracapsular extension on the left without evidence of seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: Ms. Oest is a 62 year old female with recent diagnostic workup revealing possible silicone leak of the right breast. She presents for MRI for further evaluation. This is a technical repeat study. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Retroglandular silicone implants are present bilaterally. There is a linguine sign in the implant of the right breast, consistent with intracapsular rupture. In addition, there is an area of silicone signal in the right upper outer quadrant, consisting with silicone granuloma due to extracapsular silicone leakage.The left breast silicone implant appears intact.Silicone signal is also present in multiple right axillary lymph nodes, consistent with silicone adenitis. These findings are compatible with sonographic and mammographic findings.No abnormal lymph nodes are identified in the left axillary region.

Output: 1. Intracapsular rupture of silicone implant of right breast2. Silicone granuloma due to extracapsular silicone leakage in the right breast, and silicone adenitis of right axillary lymph nodes3. Left implant appears intact4. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 19 years Female (DOB:3/10/1997)Reason: 18-year-old female status post rheumatoid cyst/lesion resection, Yearly follow up , evaluate for changes History: yearly follow upPROVIDER/ATTENDING NAME: DAVID M. FRIM SERVICES ANCILLARY There is encephalomalacia involving the left frontal lobe. The patient status post left frontal craniotomy. No abnormal enhancing lesion is appreciated at the surgical bed to suggest local recurrence.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: Status post left frontal surgery for removal of an epidermoid tumor. There is no evidence for recurrence at this time.


Instruction: Generate impression based on findings.

Input: There is a normal ventricular size. No midline shift. Normal gray and white matter differentiation. No evidence of bleed, mass effect, or edema. Nonspecific nonenhancing punctate foci T2 hyperintensity are noted in the periventricular and subcortical white matter without mass effect, restricted diffusion, susceptibility abnormality, or enhancement.Expected vascular flow-voids are demonstrated. The midline structures and the craniocervical junction are within normal limits.

Output: Nonspecific nonenhancing punctate foci T2 hyperintensity are noted in the periventricular and subcortical white matter, most likely representing chronic small vessel ischemic disease or perhaps migraine headache sequelae. Given lesional location and morphology, demyelination is felt to be unlikely.


Instruction: Generate impression based on findings.

Input: Clinical question: Worsening encephalopathy. Signs and symptoms: Encephalopathic Extensive vasogenic edema of the left frontal and parietal lobes and to a lesser degree of right frontal lobe is noted. These findings were not identified on prior CT examination of the brain. Review of prior MRI examination of brain from 11 -- 17 -- 2009 demonstrated similar findings. There is extensive effacement of cortical sulci throughout bilateral cerebral hemispheres. There is no evidence of hydrocephalus and no midline shift is detected. There is no evidence of hemorrhage. Basal cisterns and all the other CSF cisterns remain patent. Calvarium, limited real paranasal sinuses and mastoid air cells are also unremarkable. High density within the superior sagittal sinus it could represent previously recognized thrombosed superior sagittal sinus.

Output: Bihemispheric frontal -- parietal areas of vasogenic edema without hemorrhage secondary to patient's known intracranial sinus thrombosis.


Instruction: Generate impression based on findings.

Input: History of Crohn's ileocolitis with fistula. Presents with abdominal pain and bloating. ABDOMEN:LIVER, BILIARY TRACT: Simple appearing right hepatic lobe cysts. No biliary ductal dilatation or vascular abnormality.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: The small bowel is adequately distended with oral contrast. Contrast has reached the distal colon.Long segment narrowing, severe circumferential thickening, hyperenhancement and restricted diffusion of the distal through terminal ileum with surrounding fibrofatty proliferation involving approximately 21 cm of small bowel. The very endmost segment of the terminal ileum is relatively spared but does have submucosal fat indicating chronic/prior inflammation. Proximally there is mild dilatation up to 3.8 cm. There is a short skip lesion approximately 5 cm proximally, similar to prior. Soft tissue tethering/fistulous network involving the distal ileum to the adjacent sigmoid colon and a left lower quadrant more proximal small bowel loop which is mildly thickened.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace amount of free fluid in the pelvis.Long segment narrowing, severe circumferential thickening, hyperenhancement and restricted diffusion of the distal through terminal ileum with surrounding fibrofatty proliferation involving approximately 21 cm of small bowel. The very endmost segment of the terminal ileum is relatively spared but does have submucosal fat indicating chronic/prior inflammation. Proximally there is mild dilatation up to 3.8 cm. There is a short skip lesion approximately 5 cm proximally, similar to prior. Soft tissue tethering/fistulous network involving the distal ileum to the adjacent sigmoid colon and a left lower quadrant more proximal small bowel loop which is mildly thickened.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Severe active inflammation involving approximately 21 cm of the distal through terminal ileum superimposed on a long segment stricture. Short segment skip lesion immediately proximal to this bowel loop. There is mild upstream bowel dilatation, however contrast has reached the distal colon.2.Fistulous network involving the distal ileum, sigmoid colon and more proximal small bowel in the pelvis without definite fluid in the fistulous tracts. The appearance is similar to the prior.


Instruction: Generate impression based on findings.

Input: Cardiac arrest [427.5], Reason for Study: ^Reason: eval for anoxic brain injury History: s/p cardiac arrest No evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal patchy bilateral periventricular white matter high signal intensity on FLAIR imaging indicate nonspecific small vessel ischemic disease.There is a focal susceptibility artifacts on the left thalamus with encephalomalacia indicating prior hemorrhagic lesion with hemosiderin deposition.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Opacifications on bilateral mastoid air cells.. Opacification of paranasal cyst sinuses including sphenoid sinus, ethmoid sinus, frontal sinus and bilateral maxillary sinuses.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Non specific small vessel disease.3. Chronic hemorrhagic foci on the left thalamus.


Instruction: Generate impression based on findings.

Input: Redemonstrated are multiple lesions visible on susceptibility imaging within both hemispheres of the supratentorial brain, including the brainstem. As before, the largest one is located in the left side of the brainstem at the junction of the pons and the left middle cerebellar peduncle. None demonstrate perilesional edema. There are no definite new lesions.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. 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: Stable multiple cavernous malformations with no significant interval change.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB: 5/7/1945)Reason: spontaneous muscle movement History: muscle twitchingPROVIDER NAME: RIMAS V. LUKAS RIMAS V. LUKAS MRI brain: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 is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:Examination is degraded by patient motion. This obscures adequate visualization of the neural foramina and spinal canal.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. The left neural foramen appears to be narrowed. There appears to be facet hypertrophy in the left side at this level and left uncovertebral osteophyte formation and to a lesser degree right uncovertebral osteophyte formation..At C3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are endplate uncovertebral osteophytes present at this level. There are some effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild to moderate spinal stenosis. There is narrowing of the neural foramina bilaterally at this level. There appears be facet hypertrophy at this level.At C4-5 there is loss of disc space height, desiccation, disc bulge and endplate and uncovertebral osteophytes with some partial effacement of spinal fluid ventral but not posterior the spinal cord. There is facet hypertrophy and narrowing of the neural foramina bilaterally at this level with suspected encroachment of exiting nerve roots.At C5-6 there is loss of disc space height, disc desiccation and a mild disc bulge associated with endplate and uncovertebral osteophytes. Some degree of narrowing of the neural foramina is present. There is mild narrowing of the spinal canal at this level.At C6-7 there is loss of disc space height, disc desiccation and a mild disc bulge associated with endplate and uncovertebral osteophytes. Some degree of narrowing of the neural foramina is present. There is mild narrowing of the spinal canal at this level.At C7-T1 there is loss of disc space height, disc desiccation and a mild disc bulge associated with endplate and uncovertebral osteophytes. Some degree of narrowing of the neural foramina is present.The vertebral artery flow voids appear to be intact.

Output: 1.Examination of the cervical spine is degraded to patient motion artifact which will obscure more subtle abnormalities. There are multilevel degenerative changes present in the cervical spine with findings suspicious for neural foraminal encroachment at multiple levels and findings suspicious for mild to moderate spinal stenosis at the C3-4 level.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Examination of the brain is also degraded due to patient motion which may also obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 58-year-old man with history of lesion 6 adenocarcinoma in the left apex of the prostate. PELVIS:PROSTATE:Prostate Size: 51 x 30 millimetersPeripheral Zone: Multiple foci of decreased T2 and ADC signal are seen in the peripheral zone. The first in the left mid gland (601/60) measures 8 mm. Additional areas in the right base (901/15) and right mid gland (901/12) also demonstrate decreased T2 and ADC signal. No additional suspicious foci are seen in the remaining peripheral zone.Central Gland: BPH nodules noted.Seminal Vesicles: UnremarkableExtracapsular Extension: No evidence of extracapsular extensionBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple areas of abnormal signal in the peripheral zone of the left apex, right base, and right mid gland as described above which are indeterminate. These have been targeted for biopsy.


Instruction: Generate impression based on findings.

Input: Reason: eval paravertebral fatty lesion, c/f liposarcoma History: pneumonia, sepsis CHEST:LUNGS AND PLEURA: Moderate right and small left pleural effusion.MEDIASTINUM AND HILA: See below.CHEST WALL: Right extrapleural paravertebral soft tissue lesion with infiltrative fat demonstrates isointense signal on T2-weighted images and no significant enhancement on postcontrast images. This lesion is not associated with the neural foramina and there is no significant remodeling of the adjacent bone. This lesion measures 3.5 x 1.8 cm (5/50).OTHER: 5 mm cystic lesion in the pancreatic tail is nonspecific. Degenerative changes of the visualized spine.

Output: 1.Right paravertebral nonenhancing soft tissue lesion is of uncertain etiology but most likely benign. One-year follow-up CT with IV contrast is recommended to confirm stability.2.Moderate right and small pleural effusion.3.Nonspecific punctate cystic lesion in the pancreatic tail, most likely represents a small side branch IPMN and is of no clinical significance.


Instruction: Generate impression based on findings.

Input: Assess for post-concussive injury: head injury in October after fall off bike. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. There is a trace posterior disc-osteophyte complex at C4-5, but no significant spinal canal or neural foraminal stenosis at this level or the other cervical spine levels. There is associated mild loss of the usual cervical lordosis, but no spondylolisthesis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of spinal cord injury, spondylolisthesis, or significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Ms. Johnsen is a 43 year old female with a strong family history of breast cancer including her mother (diagnosed at the age of 37) and maternal aunt (diagnosed in her 60's). She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Scattered T2 hyperintense cysts are visualized in both breasts. There is stable appearance of a benign morphology mass measuring 0.8 cm in the far inferior left breast, which demonstrates a typically benign kinetic profile, and T2 signal hyperintensity, likely representing fibroadenoma. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male, 21 years old. Reason: patient with a left-sided thyroid nodule and lateral cervical adenopathy. RIGHT LOBE MEASUREMENTS: 6.5 x 1.5 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.5 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Homogeneous echotexture, without focal lesion.LEFT LOBE: Homogeneous echotexture. A left lower pole nodule measures 1.5 x 1.0 x 1.2 cm, predominately solid, hypoechoic, noncalcified, with internal vascularity. Per patient, this lesion was diagnosed as follicular carcinoma at an outside hospital.ISTHMUS: Homogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified.OTHER: No significant abnormality noted.

Output: A solid, hypoechoic left lower pole nodule as detailed above, without cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, history of metastatic lung cancer to the brain status post SRS. At least 5 small supratentorial enhancing lesions are identified, all of which have decreased in size when compared to the prior examination (see key images). One or two lesions seen on the prior examination are no longer clearly evident. For reference purposes, a left parietal lesion measures 2 mm (image 45 series 12), previously 6 mm. Areas of mild edema previously associated with several of these lesions have resolved.Infratentorially, two ill-defined adjacent foci of enhancement within the right cerebellar hemisphere have not significantly changed. One of these is associated with strong susceptibility artifact. One or two small foci of enhancement seen previously are no longer evident.No evidence of significant parenchymal edema or mass effect is seen. Scattered small foci of T2 hyperintensity in the bilateral cerebral white matter are unchanged and may reflect treated lesions or nonspecific white matter injury.A nonenhancing cystic lesion in the pineal region is unchanged measuring up to 16 mm in diameter. No other abnormal collections are seen. The ventricles are normal in size and morphology.

Output: 1.Since the prior examination, numerous supratentorial and infratentorial enhancing lesions have decreased in size or resolved entirely.2.Two enhancing lesions within the right cerebellum show no significant interval change. No new intracranial lesions are appreciated.


Instruction: Generate impression based on findings.

Input: There is a small area of restricted diffusion in the left hippocampal tail and perhaps in the bilateral centrum semi ovale. There are extensive areas of high T2 signal in the bilateral cerebral and pontine white matter and more focal hypoattenuating lesions in the basal ganglia, corona radiata, and left thalamus. There is a punctate focus of susceptibility effect in the left anterior insula. There are multiple chronic supratentorial and infratentorial foci of susceptibility effect. The ventricles and sulci are unchanged. There is no midline shift or mass effect.

Output: 1. Punctate focus of left anterior insula recent hemorrhage superimposed upon multiple chronic supratentorial and infratentorial microhemorrhages.2. Recent infarction of the left hippocampal tail and perhaps in the bilateral centrum semi ovale superimposed on a background of extensive small vessel ischemic white matter disease and multiple chronic lacunar infarcts.


Instruction: Generate impression based on findings.

Input: 66-year-old male with a right acetabular lesion and pain. Follow-up right acetabular lesion. BONE MARROW: Metallic susceptibility artifact from a right femoral intramedullary rod and screw device limits evaluation of the right hip. Note is made of foci of signal void along the superior and posterior aspect of the right hip which are presumably postsurgical in etiology.The reference ill-defined lesion along the superior aspect of the right acetabulum is not definitively visualized on today's examination and may represent postsurgical or posttraumatic bone marrow edema. There is a 17 x 16 x 15 mm (TR x AP x CC) focus of increased signal abnormality on fluid sensitive sequences within the right sacrum which enhances on postcontrast sequences (image 39; series 11), appearing similar to the prior study. There is an additional 8 mm focus of enhancing signal abnormality along the superomedial aspect of this sacral lesion (image 38; series 11).Note is made of heterogeneous bone marrow signal abnormality which is nonspecific but may reflect residual islands of red marrow.SOFT TISSUES: The imaged musculature of the pelvis is normal in appearance.JOINTS: There is a small amount of fluid within the femoroacetabular joints, bilaterally, which is not necessarily of any clinical significance.ADDITIONAL

Output: 1. Near complete interval resolution of the previously described lesion within the superior right acetabulum as described above.2. There is a 17 mm enhancing lesion within the right sacrum with an additional adjacent satellite lesion which is nonspecific, however, metastatic disease cannot be excluded, particularly in the setting of a known primary malignancy. Follow-up examination is recommended to evaluate for interval change and establish stability.


Instruction: Generate impression based on findings.

Input: 69-year-old female with history of HCV cirrhosis who presents for hepatocellular carcinoma evaluation. ABDOMEN:LIVER, BILIARY TRACT: Smooth contour of the liver. Perigastric and esophageal varices again noted. No suspicious hepatic mass. There is a 1 cm right hepatic lobe cyst with thin septation, unchanged compared to the previous examination. Portal venous system, hepatic veins, and hepatic arteries are patent.SPLEEN: Mild splenomegaly.PANCREAS: The pancreas is normal in signal intensity and morphology. No pancreatic ductal dilatation or suspicious mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged gastrohepatic lymph nodes, likely sequela of cirrhosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Sequela of cirrhosis without suspicious hepatic mass.2.Stable 1 cm cystic lesion in the right hepatic lobe with thin septation, most compatible with benign cyst.


Instruction: Generate impression based on findings.

Input: right facial droop There is high signal intensity on DWI on the left precentral gyrus mid-portion which shows subtle restricted diffusion on ADC map. This finding suggests evolving subacute ischemic infarction. The lesion does not show any evidence of hemorrhagic transformation.There is no other restricted diffusion lesion on this scan.Underlying brain shows multi focal high signal intensities on FLAIR image indicating non specific small vessel ischemic disease.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Evolving subacute ischemic infarction on the left pre central gyrus mid portion as described above without evidence of hemorrhagic transformation.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Left arm heaviness and clumsiness. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. There is no evidence of mass lesions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: No evidence of demyelinating lesions or spinal cord compression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Vomiting with a medullary lesion. There is an expansile, infiltrative, high T2 signal lesion with patchy enhancement involving the medulla and upper cervical spinal cord, which measures up to 48 mm in length and 18 mm in width. There is no evidence of other spinal cord lesions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There is a small amount of fluid in the pelvis, which is likely physiological.

Output: An infiltrative lesion involving the medulla and upper cervical spinal cord may represent a neoplasm, such as an astrocytoma, versus an atypical demyelinating or inflammatory lesion.


Instruction: Generate impression based on findings.

Input: VHL disease and cocaine abuse evaluate for possible brain aneurysm. MRI: There are postoperative findings in the right posterior fossa, with confluent high T2 signal surrounding the right cerebellar hemisphere a mildly T2-FLAIR hyperintense cavity that measures up to 20 mm with a small mural nodule. There is scattered cerebral white matter T2 hyperintensity. 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 are grossly unremarkable.MRA: There is no evidence of aneurysms or significant steno-occlusive lesions.

Output: 1. Postoperative findings in the right cerebellar hemisphere, with what likely represents a hemangioblastoma. Assessment is otherwise limited without intravenous contrast.2. Scattered cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease, but no evidence of acute infarct.3. No evidence of cerebral aneurysms.


Instruction: Generate impression based on findings.

Input: High-resolution images of the sella demonstrate the pituitary gland to be normal in size measuring 8 mm in height. There is no discrete mass to confirm the presence of a pituitary microadenoma. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no sellar, suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally.

Output: Negative MRI of the brain and sella including gadolinium enhancement. There is no discrete mass to confirm the presence of a pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: 82-year-old female with spinal stenosis. Presented with severe back pain and positive blood cultures. Please evaluate for epidural abscess. Please note that while there are no specific findings to suggest an epidural abscess, this exam cannot exclude an epidural abscess. Instead an MR is recommended for further evaluation. The exam is significantly limited by patient motion artifact and large body habitus. Within these limitations, the following observations are made. The bones are diffusely osteopenic. The alignment of the thoracic spine is anatomic. The vertebral body heights are grossly maintained. Multilevel degenerative disk disease is seen. Anterior and posterior osteophyte formation is seen at multiple levels, however there is no significant bony compromise of the central canal. The paraspinal soft tissues are grossly unremarkable. LUMBAR SPINE

Output: 1. Limited exam due to patient motion artifact and large body habitus.2. This exam cannot exclude an epidural abscess. An MR is recommended for further evaluation.3. Multilevel degenerative disk disease with central canal compromise at multiple levels.


Instruction: Generate impression based on findings.

Input: 24-year-old man with history of CT abnormality suggestive of prostate abscess. PELVIS:PROSTATE, SEMINAL VESICLES: In the right prostatic apex (series 601, image 13) there is a 27 x 14 mm collection of T2 hyperintense fluid with diffusion resection. There is no significant wall enhancement, signs of inflammation, or fistulization to the adjacent tissues. The remaining prostatic tissue is normal in appearance.BLADDER: The bladder is decompressed with a suprapubic catheter.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal. There is a large amount of stool in the rectum, similar to the prior CTBONES, SOFT TISSUES: Lumbar fixation hardware and scoliosis noted.OTHER: No significant abnormality noted.

Output: Right peripheral zone prostatic abscess as described above.


Instruction: Generate impression based on findings.

Input: 47-year-old male with renal cell cancer, status post left partial nephrectomy. Evaluate disease status. Rule out metastasis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter left lateral hepatic segment anterior hypodensity in is too small to characterize. This was not definitely seen on the CT scan examination from 11/2010, but the prior examination includes only a single delayed post-contrast phase. The significance is uncertain. Dedicated hepatic CT or MRI examination maybe helpful for further evaluation, if clinical indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status-post left upper pole partial nephrectomy with postoperative changes. No local recurrence. No hydronephrosis or perinephric collections. The left exophytic midpole cyst is stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Subcentimeter hepatic hypodensity can be further characterized with dedicated CT or MRI examination, if clinically indicated.Status post left superior pole partial nephrectomy, with postoperative changes. No local evidence of recurrence or metastasis.


Instruction: Generate impression based on findings.

Input: 29 year-old female with infected OB incision. Question of endometritis. Abdominal pain in both lower quadrants. The examination is limited by the absence of oral contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Postpartum uterus with air in the fundus. No definite findings to suggest endometritis, but pelvic ultrasound or MRI examination may be more helpful, if clinically indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There are midline surgical skin staples in the pelvis with subcutaneous fluid collection most likely due to a wound abscess which extend from axial image 103 -- 125/154 of series 3. The fluid collection is all superficial to the rectus sheath.

Output: Midline subcutaneous wound abscess in the pelvis does not extend beyond the rectus sheath. Small amount of air in postpartum uterus, probably post procedural.


Instruction: Generate impression based on findings.

Input: Head injury, post-concussive syndrome: memory difficulty. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several scattered foci of white matter T2 hyperintensity in the bilateral cerebral hemisphere. The ventricles and basal cisterns are normal in size and configuration. However, there is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is degenerative spondylosis in the partially imaged cervical spine.

Output: . Several scattered foci of white matter T2 hyperintensity in the bilateral cerebral hemisphere are nonspecific and may represent small vessel ischemic disease and/or prior injury, for example. Otherwise, no gross stigmata of traumatic brain injury.


Instruction: Generate impression based on findings.

Input: Preoperative planning. Evaluate for cyst fenestration and biopsy. Limited preoperative MRI of the brain demonstrates no significant interval change in the size and appearance of the cystic structure associated with the left temporal horn. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift.

Output: Examination for operative planning. No significant interval change in the size and appearance of the cystic structure associated with the left temporal horn. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Spinal stenosis, lumbar regionClinical question: eval for nerve compression. Possibly L4-L5Signs and Symptoms: l gluteal and low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a mild sigmoid curvature to the lumbar spine with mild dextrocurvature to the lower lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation, diffuse disc bulge and mild facet hypertrophy at this level.At L4-5 there is loss of disc space height, marked bilateral facet and ligamentum flavum hypertrophy and approximately 6 mm anterior subluxation of L4 on L5. The exiting nerve roots within the neural foramina are surrounded by fat. There is effacement of fat at the lateral recess bilaterally at this level. Overall there is moderate spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level. There is mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level. At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level.

Output: There are multilevel degenerative changes present in the lumbar spine worse at L4-5 where there is anterior subluxation of L4 and L5 associated with facet hypertrophy and moderate spinal stenosis.


Instruction: Generate impression based on findings.

Input: Preoperative planning. Epilepsy, status post hemispherectomy. This is a limited examination performed for preoperative planning. There are findings related to previous right hemispherectomy with distortion and numerous foci of susceptibility effect of the remaining left cerebral hemisphere. The complex right-sided extra-axial fluid collections are grossly unchanged. Likewise, the cystic compartment involving the left lateral ventricle has not significantly changed in size.

Output: No significant interval change in the postoperative findings related to right hemispherectomy and appearance of the cystic compartment involving the left lateral ventricle. The complex right-sided extra-axial fluid collections are grossly unchanged in appearance.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 pituitary tumor. Evaluate for change. Prior tumor debulking. Again seen is an enhancing pituitary mass with suprasellar extension, which measures up to 22 mm in the craniocaudal dimension, 21 mm in the transverse dimension, and 19 mm in the anteroposterior dimension. These measurements are unchanged since 3/23/2016 allowing for slight differences in measurement technique. There is evidence of gradual enlargement compared to prior studies as noted previously. For example on prior MRI from 1/15/2014, the tumor measures 15 mm in the craniocaudal dimension, 18 mm in the transverse dimension, and 19 mm in the anteroposterior dimension. Again noted is the tumor bulging into the medial aspect of the left cavernous sinus. The tumor also abuts the optic chiasm as before. Unchanged thickening and enhancement along the pituitary stalk. Flow voids of the cavernous internal carotid arteries are maintained.Partially imaged brain again demonstrates small vessel ischemic disease and chronic infarcts in the pons and right inferior cerebellar hemisphere.

Output: Gradual mild increase in size of the pituitary macroadenoma across multiple prior studies as described above although there is no significant change compared to most recent study from 3/23/2016.


Instruction: Generate impression based on findings.

Input: Clinical question: status post craniotomy. Signs and symptoms: Same Nonenhanced head CT:Extensive postoperative changes of a left frontal -- temporal craniotomy is again identified. There is no definite evidence of any interval change.Small area of low-attenuation along the anterior aspect of the left temporal lobe is better visualized than prior study. This finding may represent widened left sylvian fissure due to recent surgical intervention. Possibility of focal cortical edema cannot be entirely ruled out. Please correlate with exam and if there is clinical concern for ischemic change recommend an MRI study.There is no evidence of interval hemorrhage since prior study. No evidence of hydrocephalus. Minimal midline shift to the right of approximately 3 mm is again noted with no change. Expected postoperative changes of intracranial air and small epidural blood/fluid collection under the craniotomy flap is again noted.

Output: No definitive interval change since prior study. Please see above comments.


Instruction: Generate impression based on findings.

Input: 59 year old male, status post heart transplant, stress to evaluate for transplant coronary artery disease.MEDICATIONS: Aspirin, metoprolol, pravastatin, losartan, cellcept, tacrilomus First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 85 ml (normal range 47+/-19), the LV mass index is 70 g/m2, and the LV mass is 173 g. There are no regional wall motion abnormalities present. Native myocardial T1 relaxation time is 970-1035ms (all within normal limits). Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size with mildly decreased systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 184 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 106 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant morphology.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and low normal systolic function (LVEF 50%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size with mildly reduced systolic function (RVEF 43%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified type of carcinoma in situ of left breast. Abnormal uptake on PET. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. No suspicious enhancing lesions.Minimal multilevel disc bulges are present in the lumbar spine. Additional details as 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. Mild bilateral facet arthropathy.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. There is moderate degree of bilateral facet arthropathy with edema and enhancement involving the adjacent soft tissues as well as the adjacent L4 and L5 pedicles. Degenerative hypertrophic changes of the facet joints with vacuum phenomenon also evident on prior PET/CT.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. No evidence of metastatic disease in the lumbar spine.2. Moderate degree of facet arthropathy bilaterally at the L4-5 level with mild surrounding edema and enhancement which is most likely reactive.


Instruction: Generate impression based on findings.

Input: History of anaplastic astrocytoma. There are postoperative findings of a right frontal craniotomy. Area of T2 hyperintensity centered in the right superior frontal gyrus consistent with a postoperative cavity is unchanged from the prior exam. Surrounding T2 signal is unchanged in extent. T2 hyperintense signal in the periventricular region, right greater than left, is also unchanged. Susceptibility in the resection cavity likely reflects old blood products. No new areas of abnormal T2 signal. A thin branching focus of enhancement along the resection cavity is stable and likely represents scar tissue. No new areas of abnormal enhancement.No evidence of diffusion restriction. 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: Stable surgical and treatment related changes without evidence of progressive disease.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degeneratives or stenoses. There are no MRI findings of ligamentous injury.

Output: Negative noncontrast cervical spine MRI. Specifically, there are no MRI findings of ligamentous injury.


Instruction: Generate impression based on findings.

Input: 27-year-old female with history of bilateral fibroadenoma and fibrocystic changes, predominantly on the right side, as well of bilateral breast discharge. Patient also has history of benign core biopsies at the left 11:00, right 10:00 and right 3:30 locations on 3/23/2016. Patient also has family history of breast cancer in mother. On recent bilateral breast MRI dated 5/4/2016, and multiple bilateral benign-appearing masses were identified and short-term follow-up recommended to ensure stability findings. There is heterogeneous fibroglandular tissue bilaterally, associated with marked background parenchymal enhancement slightly limiting the sensitivity and specificity of this study.RIGHT BREAST:Within the right upper outer quadrant, 10:00 position, posterior depth, an oval circumscribed homogenously enhancing 1.3 x 0.9 x 1.3 cm mass with focal central susceptibility artifact is reidentified, compatible with biopsy-proven fibroadenoma, stable in appearance. Multiple smaller similar benign-appearing masses are reidentified within the right breast.Focal susceptibility artifact from biopsy clip marker is reidentified within the right upper inner anterior breast, 3:30 position, at site of prior benign biopsy. Ectatic retroareolar ducts containing intrinsic high T1 signal proteinaceous material, stable in appearance. Associated periductal enhancement cannot appear likely assessed on this study due to presence of marked background parenchymal enhancement. There is no suspicious mass, morphology or enhancement in the right breast.LEFT BREAST:Within the left inner breast, an oval circumscribed enhancing 0.8 cm mass is reidentified with focal susceptibility artifact from biopsy clip marker along its posterior aspect, compatible with biopsy-proven fibroadenoma, stable in appearance. Multiple smaller similar benign-appearing masses are reidentified within the left breast.Ectatic retroareolar ducts containing intrinsic high T1 signal proteinaceous material, stable in appearance. Associated periductal enhancement cannot appear likely assessed on this study due to presence of marked background parenchymal enhancement. There is no suspicious mass, morphology or enhancement in the left breast.No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Multiple bilateral similar benign-appearing masses are stable in appearance dating back to MRI study of 5/4/2016. Follow-up MRI in one year is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Back pain Lumbar spine is normal in alignment. Diffuse loss of bone density.Persistent multilevel superior endplate deformities throughout the lumbar spine, similar to prior exam. No new compression deformities.

Output: Persistent multilevel endplate deformities though no new compression deformities are evident when compared to prior.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemia. Signs and symptoms: Right facial droop and right-sided weakness. Nonenhanced brain MRI:Examination demonstrates a large focus of restricted diffusion in the left upper pons measuring at 9 x 18-mm in transaxial dimensions. Finding is consistent with an acute nonhemorrhagic lacunar infarct.In addition the examination demonstrate extensive periventricular and subcortical confluent foci of flair/T2 hyperintensity with resultant ex vacuo dilatation of lateral ventricles consistent with extensive chronic nonhemorrhagic small vessel ischemic strokes. Similar signal changes in bilateral thalami and minimally in bilateral basal ganglial is also noted. Additional chronic pontine lacunar infarct on the right and in the right aspect of cerebellum and right middle cerebellar peduncle are present. Similar signal change in the left middle cerebellar peduncle is also detected.There is prominence of cortical sulci and ventricular system for patient's stated age and suggestive of underlying volume loss secondary to advanced small vessel ischemic strokes.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses is within normal. Calvarium and soft tissues of the scalp as well as orbits, paranasal sinuses and mastoid air cells are unremarkable. Mild left maxillary sinusitis however is noted.

Output: 1.Acute lacunar infarct in the left paramedian pons 9 x 18-mm.2.Extensive supratentorial and infratentorial chronic nonhemorrhagic small vessel ischemic strokes as detailed.


Instruction: Generate impression based on findings.

Input: Pain, radiating down left leg Please note for the purposes of numbering, there is transitional anatomy with the first nonrib-bearing vertebral body labeled L1. As such there are 4 lumbar type vertebral bodies and a transitional segment labeled S1. Vertebral body heights are within normal limits. There is some loss of lumbar lordosis. There is grade 1 anterolisthesis of L4 on S1. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, 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: There is disc desiccation and left foraminal and far lateral disc bulge. There is partial effacement of the left lateral recess as well as mild left neural foraminal stenosis. There may be impingement of the exited left sided nerve root extraforaminally. Right neural foramen is patent. Moderate bilateral facet arthropathy.L4-S1: There is disc bulge and advanced bilateral facet arthropathy. There is no significant spinal canal stenosis. There is moderate to severe right and mild left neural foraminal stenosis. There may be impingement of the exiting right-sided nerve root.Paraspinous soft tissues are within normal limits.

Output: 1. Please note transitional anatomy and numbering scheme with 4 lumbar type vertebral bodies.2. Degenerative changes are present as described above without significant spinal canal stenosis. There is left-sided neural foraminal stenosis at L3-L4 and right-sided neural foraminal stenosis at L4-S1 as described above.3. Grade 1 degenerative spondylolisthesis at L4 S1.


Instruction: Generate impression based on findings.

Input: 34-year-old female with right breast cancer, for surgical planning. There is extreme amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted in the left breast. Within the right breast, the index lesion is heterogeneously enhancing and measures 5.2 x 1.9 x 5.0 cm, spanning 10 to 2 o'clock and contains 2 areas of susceptibility artifact, compatible with prior biopsy clips. There are multiple satellite lesions and extensive non mass enhancement, which measures 9.2 x 3.1 x 11.4 cm (AP x ML x CC) in total. Non mass enhancement extends to the prepectoral fascia (no abnormal enhancement of the pectoralis muscle is noted), and contains an additional 6:00 biopsy clip, at posterior depth. A right axillary lymph node contains a biopsy clip and measures 1.0 x 1.1 cm.Within the left breast there is expected postpartum change. A left axillary lymph node measures 6 x 3 mm and contains a T2 hyperintense fatty hilum, compatible with normal benign lymph node. No suspicious enhancement is identified within the left breast.

Output: 1.Biopsy proven right breast cancer with index lesion measuring up to 5.2 cm, with satellite and non mass enhancement spanning the right breast and abutting the chest wall.2.Right axillary lymph node containing biopsy clip, pathology pending.3.No suspicious finding within the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Iron deposition and FNH lesions. Follow-up. History of Ewing's sarcoma. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma signal intensity is compatible with iron deposition. The liver measures 19 cm in craniocaudal dimension. No biliary ductal dilatation or vascular abnormality.Multiple mildly T2 hyperintense and T1 isointense lesions demonstrating avid arterial enhancement are noted in both lobes of the liver. The largest is a segment 2/3 lesion measuring 2.3 x 2.4 cm compared to 1.8 x 2.0 cm previously. The lesions progressively become isointense to liver on portal venous and delayed/equilibrium phase imaging. The lesions also retain contrast on hepatobiliary phase imaging. They have mildly lobular contours. These are mildly increased in size.SPLEEN: Normal splenic size without a focal lesion.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.Mild interval increase in size of the multiple liver lesions which are consistent with focal nodular hyperplasia.2.Iron deposition of the liver.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with neck pain. The cervical lordosis is mildly reversed. There is a grade 1 retrolisthesis of C6 relative to C7.Fusion of the C3 through C5 vertebral bodies is demonstrated. Mild edema, likely degenerative in nature, is seen within the C5, C6 and C7 vertebral bodies.The visualized spinal cord demonstrates normal signal intensity throughout.A 2-mm nonspecific T2 hyperintense focus is seen within the left lateral thyroid gland.C2-3: Mild facet hypertrophy. Small central disk protrusion. No significant spinal canal or neuroforaminal stenosis. C3-4: Obliteration of the disk space with mild bony ridging in the left paracentral zone. No significant spinal canal or neuroforaminal stenosis. C4-5: Obliteration of the disk space with left paracentral/subarticular bony ridging which results in mild flattening of the left ventral cord. No significant generalized spinal canal stenosis. No significant foraminal narrowing. C5-6: Posterior disk osteophyte formation without significant spinal canal or neuroforaminal stenosis. C6-7: Posterior disk osteophyte formation asymmetric to the left. Mild generalized spinal canal stenosis. Mild right neuroforaminal narrowing. C7-T1: Facet hypertrophy and ligamentum flavum thickening. Posterior disk osteophyte formation. Moderate generalized spinal canal stenosis. No significant foraminal narrowing.

Output: 1.Fusion of the C3 through C5 vertebral bodies with obliteration of the intervening disk spaces.2.At the C4-5 level, there is a bony ridge arising from the level of the obliterated disk space at the left paracentral/subarticular zone. This ridge mildly impinges upon the left ventral cord.3.A moderate spinal canal stenosis is seen at C7-T1 secondary to disk osteophyte and posterior element hypertrophy.


Instruction: Generate impression based on findings.

Input: Reason: hx of R patellar dislocations, please measure TTTG, assess MPFL, etc History: same MENISCI: The medial and lateral meniscus appear intactARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration and superficial fraying along the lateral facet and median eminence of the patella. There is bone marrow signal abnormality within the medial aspect of the patella and lateral aspect of the lateral femoral condyle indicating prior transient lateral dislocation of the patella. There is a subcentimeter focus of fluid signal intensity within the medial and posterior aspect of the distal femoral metaphysis likely representing a benign enchondroma.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is increased signal abnormality about the proximal and mid substance fibers of the medial retinaculum raising the possibility of a partial thickness tear, although the medial retinaculum is poorly visualized on this examination due to lack of axial T2 non fat saturated images.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings indicating prior lateral transient dislocation of the patella with probable partial thickness tearing of the proximal/mid substance fibers of the medial patellofemoral ligament. Patella alta can be seen in patellofemoral instability.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with dull bilateral eye pain and pressure, not typical for optic neuritis. Assess for retro-orbital mass or optic neuritis. Numerous scattered periventricular and subcortical white matter T2 hyperintensities are redemonstrated. Allowing for technical differences, there has been no significant interval change in the appearance of these lesions since the prior MRI.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen. There is no evidence of any significant intracranial hemorrhage. No abnormal extra-axial fluid collections are detected. Ventricles are normal in size and morphology.Dedicated orbital imaging reveals no intraorbital mass, inflammation or pathologic enhancement. The globes are round and symmetric and demonstrate normal signal characteristics. The extraocular muscles are normal and symmetric in size. The optic nerves are likewise symmetric in size and morphology and free of pathologic signal abnormality and enhancement. The remainder the optic pathway is also unremarkable. Limited views of the pituitary are unremarkable and the suprasellar cistern is patent.Note is made of bilateral and symmetric infiltrative T2 hyperintensity spreading through the pterygoid muscle fibers of the masticator spaces. Corresponding infiltrative or intravascular hyperenhancement is also seen. No mass lesion or discrete fluid collection is seen. No adequate prior exams are available for comparison.

Output: 1.Stable examination of the brain. No acute intracranial abnormalities are detected.2.Unremarkable evaluation of the orbits.3.Bilateral and symmetric T2 hyperintensity is seen within the pterygoid musculature, along with infiltrative or perhaps intravascular enhancement. The significance of these findings is uncertain. The pterygoid muscles do contain a rich venous plexus which can manifest as T2 hyperintensity and enhancement on imaging. As such, this may simply represent a variation of normal. However, the possibility of an inflammatory process, perhaps a myositis, can also be considered.


Instruction: Generate impression based on findings.

Input: Lupus with neuropsychiatric lupus and catatonia with acute deterioration in mental status. There is persistent mild periventricular white matter T2 hyperintense surrounding the posterior portions of the bilateral lateral ventricles. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is nonspecific patchy enhancement within the oral tongue.

Output: Unchanged mild residual areas of cerebral white matter abnormity likely related to prior vasculitis, but no evidence of acute infarction or recurrent PRES.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with bilateral optic disc swelling MRI brain and orbits:The dura of the tentorium is bilaterally thickened and enhancing. To a lesser degree, the dura of the interhemispheric falx is also thickened and enhancing. The remainder of the dura is unremarkable.Morphology of the brain is otherwise unremarkable. No structural abnormalities are seen. The brain parenchyma itself is free of pathologic signal, edema and mass effect. No abnormal parenchymal or leptomeningeal enhancement is seen. No cranial nerve enhancement is detected. There is no intracranial hemorrhage or abnormal extraaxial fluid. The ventricles are normal in size and morphology.Mild flattening of the posterior globes is seen at the optic nerve heads, a finding which can be related to increased intracranial pressure. The orbits are otherwise normal. The optic nerves in particular show no abnormal signal or enhancement. The pituitary infundibulum is thickened and enhancing. The pituitary gland itself is small giving the appearance of a partially empty sella, which may be normal for age but which could also indicate elevated intracranial pressure. The parotid glands are prominent and contain several small cysts or nodules. The partially visualized submandibular glands are also prominent.MRA and MRV brain:The intracranial arterial vasculature is unremarkable. No stenosis or occlusion is seen. No aneurysm or vascular malformation is detected. LIkewise, the dural venous sinuses and deep venous structures are patent.

Output: Dural thickening of the tentorium, and to a lesser degree of the interhemispheric falx, is seen. Also noted is a thickened and enhancing pituitary infundibulum. These findings taken together are very suggestive of neurosarcoid. Other granulomatous processes can be considered, but infection and neoplasia are considered unlikely.Findings are seen in the orbits and sella suggestive of elevated intracranial pressure, which in turn may be secondary to the intracranial process described above. No additional lesions of the orbits are seen. Evaluation of the intracranial arteries and veins is within normal limits. Incidentally noted is prominence of the salivary glands which can be seen in connective tissue diseases and in sarcoid.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: neck pain arm painSigns and Symptoms: neck pain arm pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of normal cervical curvature present.At C2-3 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present this level associated with mild to moderate encroachment of the exiting nerve roots within the neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation, diffuse disc bulge and uncovertebral osteophytes at this level. There is moderate encroachment of nerve roots within the left neural foramen at this level and mild encroachment of the nerve roots within the right neural foramen.At C4-5 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation, diffuse disc bulge and uncovertebral osteophytes at this level. There is left-sided facet hypertrophy at this level. There is mild to moderate encroachment of nerve roots within the left neural foramen at this level and mild encroachment of the nerve roots within the right neural foramen.At C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation, diffuse disc bulge and uncovertebral osteophytes at this level. There is moderate encroachment of nerve roots within the right neural foramen at this level .At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation, diffuse disc bulge and uncovertebral osteophytes at this level. There is moderate encroachment of nerve roots within the left neural foramen at this level .At C7-T1 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level associated with mild narrowing of the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine associated with encroachment of exiting nerve roots within the neural foramina at multiple levels as detailed above.


Instruction: Generate impression based on findings.

Input: Dysphagia, unspecified [R13.10], Reason for Study: ^Reason: assess for cause of dysphagia History: dysphagia Motion artifacts degraded image quality especially post enhanced sequences.No evidence of acute ischemic or hemorrhagic lesion.Several scattered T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

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


Instruction: Generate impression based on findings.

Input: 60-year-old male with a left foot diabetic ulcer. Evaluate for osteomyelitis in the left foot. There are extensive arthritic changes of the midfoot as seen on recent radiographs, likely reflecting neuropathic arthropathy. There is fragmentation of the navicular with multiple ossicles situated dorsal to the head and neck of the talus. There are multiple subchondral cysts within the head and neck of the talus with an additional ossicle noted inferior to the head of the talus perhaps also arising from the fragmented navicular bone. The head of the talus now articulates with the cuneiform bones with moderate to severe degenerative arthritic changes affecting the remainder of the midfoot. There is partial ankylosis of the middle and medial cuneiforms. Moderate osteoarthritis affects the calcaneocuboid joint and ankle joint. We see no marrow edema, however, to suggest osteomyelitis. There is subcutaneous edema involving the ankle, particularly along the medial aspect of the ankle. There is mild distortion of the ankle ligaments due to neuropathic arthropathy, but we see no frank tear. The tendons of the ankle likewise appear intact. There is plantar flexion of the talus with loss of much of the sinus tarsus fat likely representing a combination of synovitis and scarring. There is atrophy of the musculature of the foot and ankle.

Output: Neuropathic arthropathy of the midfoot and other findings as described above without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with multiple sclerosis and paresthesias. Assess for progression. Brain:Many round and oval T2 hyperintense lesions are seen within the periventricular white matter, some oriented radially with respect ventricles. A few additional scattered lesions are seen within the juxtacortical white matter bilaterally. Lesions are noted along the posterior limb of the left internal capsule, along the left anterior commissure and hypothalamus, within the pons and at the bilateral superior cerebellar peduncles. A lesion is also seen involving the left aspect of the spinal cord at the foramen magnum.A majority of the above mentioned lesions demonstrate conspicuous correlating T1 hypointensity. None of the lesions demonstrates significant mass effect. Brain volume is preserved. No abnormal extra-axial collections are seen and the ventricular system is normal in size and morphology.Cervical spine:Abnormal T2 hyperintensity is seen in the cervical spinal cord ventrally at the C2-3 level and left laterally at the C4 level. These lesions are associated with no significant mass effect. Morphology of the cord is otherwise unremarkable.Straightening of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body morphology and signal characteristics are normal. No significant spinal canal or neuroforaminal stenosis is observed.Thoracic spine:Foci of abnormal T2 signal are seen within the thoracic spinal cord at the T5 level centrally and at the T11-12 level right laterally. No mass effect is seen and elsewhere the spinal cord morphology is unremarkable.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No spinal canal or neuroforaminal stenosis is seen

Output: 1.Numerous T2 hyperintense lesions are seen within the brain showing morphology and distribution compatible with demyelinating disease. The majority of the lesions are associated with conspicuous T1 hypointensity compatible with chronicity and underlying cellular loss.2.At least four areas of abnormal T2 signal are identified within the spinal cord which are also compatible with demyelinating disease. Evaluation of the cervical and thoracic spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Follow-up on masses seen on prior MRI. Family history of breast cancer (mother 36, maternal aunt 50s, paternal grandmother 70s). There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally, with a prominent edge parenchymal enhancement pattern present bilaterally.No new abnormal enhancement is seen in either breast. Bilateral benign morphology masses are not enlarged compared to the prior study. Especially for the previously noted lesion in the left upper inner breast, degree of enhancement is decreased within the masses. Other areas of benign parenchymal enhancement and benign focal enhancement do not appear significantly changed.No abnormal axillary lymph nodes are identified in either axillary region.

Output: No significant change in bilateral typically benign morphology masses and foci. Follow-up in one year for MRI is recommended. An annual mammogram would be due in March 2017 as well.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: hx colon ca with Brain MEts. Eval change/ recurrence History: none- surveillance imaging - Yearly No evidence of acute ischemic or hemorrhagic lesion.Previously seen post resection status of the left frontal lobe superior frontal gyrus is redemonstrated, unchanged.There is no evidence of abnormal new enhancement.Re demonstration of the left occipital lobe, left frontal lobe and the right occipital lobe encephalomalacia, unchanged.Multiple susceptibility lesions on bilateral hemispheres, unchanged since prior scan.Extensive FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter indicate non specific small vessel disease, unchanged.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Small right maxillary sinus retention cyst is seen, unchanged since prior scan.

Output: 1. Post resection status of left frontal metastatic lesion, unchanged since prior scan.2. Multifocal encephalomalacia, non specific white matter lesions and susceptibility lesions are again seen, unchanged.3. No evidence of new abnormal enhancement suggesting new metastatic lesion.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of connective and soft tissue, unspecified [C49.9], Reason for Study: ^Reason: aphasia History: metastatic sarcoma There is a 41.7mm (AP) x 39.1mm (RL) x 33.4mm (CC) sized relatively well circumscribed multi-stage hemorrhagic lesion with eccentric enhancing portion on the left frontal lobe with surrounding edema and mass effects. The lesion abuts overlying dura and there is a very short segment of dural enhancement (series 1401, image 130).There is focal susceptibility artifact at the right lateral ventricle frontal horn just above the foramen of Monroe. Diagnostic possibility of the lesion include focal hemorrhagic metastasis, calcification of choroid plexus, or confluence of caudate vein and anterior thalamic vein.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no evidence of acute ischemic lesion.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. 41.7mm (AP) x 39.1mm (RL) x 33.4mm (CC) sized left frontal metastatic lesion with mass effects.2. Susceptibility artifacts on the right lateral ventricle frontal horn as described above.3. No evidence of acute ischemic lesion.


Instruction: Generate impression based on findings.

Input: Reason: r/o SLAP tear History: shoulder pain c/w SLAP tear ROTATOR CUFF: There is small fluid collection at the musculotendinous junction of supraspinatus with increased signal of the underlying tendon (series 501 image 10), suggestive of intramuscular ganglion with laminar tear.SUPRASPINATUS OUTLET: AC joint and coracohumeral ligament are unremarkable.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is superior labral tear extending from posterior to anterior without extension into the long head of the biceps (series 301 image 16).BICEPS TENDON: Tendon of the long head of the biceps is normal. ADDITIONAL

Output: 1. Partial laminar tear of the supraspinatus tendon.2. SLAP tear of the labrum.


Instruction: Generate impression based on findings.

Input: 80-year-old male with lower extremity weakness that began 2 days ago and the sudden onset. Evaluate for cord compression. MRI Cord compression protocol:Severely motion limited exam with high suspicion of cord compression spanning from the T5 vertebral level through approximately T7. Therefore, additional sequences were obtained in the axial plane in attempt to better visualized the thoracic spine as described below. Elsewhere outside the thoracic spine, there is evidence of diffuse osseous metastatic disease which is progressed compared to the prior MRI exam from 11/18/2011. There are degenerative changes involving the cervical spine, upper thoracic spine and lumbar spine with scoliosis but without evidence of cord compression or high grade stenosis in these regions. MRI thoracic spine:Again seen is diffuse metastatic disease involving the vertebral bodies of the thoracic spine, progressed compared to the previous MRI exam. Motion degradation artifact limits full evaluation. Within these limitations, there is suspected severe spinal canal stenosis secondary to circumferential tumor encasing the spinal cord and spanning from the T5-6 to T6-7 vertebral body levels. There is questionable cord signal abnormality at this level not well assessed. There is also evidence of tumor within the the spinal canal to a somewhat lesser degree spanning from the T7 level to the T10 level. There is prominent dextroscoliosis of the thoracolumbar spine which has progressed compared to the prior MRI.MRI lumbar spine:There is diffuse osseous metastatic disease involving the visualized lumbar spine and pelvis which has progressed compared to the MRI from 11/18/2011 but unchanged compared to the CT abdomen and pelvis from 2/1/2016. With an unchanged mild compression fracture involving the L1 vertebral body anteroinferiorly, which along with severe disc loss, causes a mild focal kyphosis at this level. There is also mild rightward lateral translation of L2 on L3 and severe loss of disc height at this level. There are areas of minimal to mild vertebral body height loss at multiple levels relatively more prominent at T10.There are multilevel degenerative changes throughout the lumbar spine with disc bulges, facet arthropathy, and ligamentum flavum thickening. There is no significant central spinal canal stenosis at any level in the lumbar spine. There is multilevel neural foraminal stenosis, relatively worst at the right L5-S1 level.

Output: 1.Motion degradation artifact limits full evaluation. Within these limitations, there is suspected severe spinal canal stenosis secondary to circumferential epidural tumor spanning from the T5-T6 to T6-T7 vertebral body levels. There is questionable cord signal abnormality at this level but poorly assessed. Contrast enhanced imaging is recommended for further evaluation. Consider anesthesia assistance given the extensive motion.2.There is also tumor involvement of the spinal canal to a somewhat lesser degree spanning from the T7 level to the T10 level.3.Multilevel degenerative changes are visualized as described above but there is no evidence of high-grade spinal canal stenosis or cord compression in the remainder of the cervical, upper thoracic or lumbar spine.4.Findings were discussed with Dr. Choi of the Heme-Onc service at the time of the preliminary entry for the patient at 08:16 pm on 8/27/2016 by Dr. Veronesi, Neuroradiology Fellow.


Instruction: Generate impression based on findings.

Input: Left sided facial pain: evaluate for lesion along the trigeminal nerve. There is no evidence of acute infarct. There is a punctate focus of susceptibility effect in the left midbrain. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: A punctate left midbrain focus of susceptibility effect may represent a chronic microhemorrhage or cavernous malformation, but no evidence of gross lesions along the imaged portions of the trigeminal nerves. Dedicated trigeminal nerve protocol MRI may be useful for further assessment.


Instruction: Generate impression based on findings.

Input: Reason: cystic abnormality glenoid History: pain ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The teres minor muscle and tendon appear intact. There is thickening of the subscapularis at its insertion indicating tendinosis. Additionally, there is more focal increased signal intensity indicating an interstitial tear that may extend to the articular surface.SUPRASPINATUS OUTLET: No significant fluid is identified within the subacromial/subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is tearing of the majority of the posterior labrum with paralabral cyst formation that extends into the suprascapular and spinal glenoid notch. This posterior labral tear extends into the superior labrum and there is an enlarged anterior labrum with increased signal intensity that may represent mucoid degeneration and degenerative tearing with what appears to be labral tissue interposed between the glenoid and anterior half of the humeral head. There is also loss of the articular cartilage along the posterior aspect of the glenoid with mild scalloping of the articular surface of the posterior aspect of the glenoid that likely corresponds to the abnormality seen on recent radiographs. There is slight posterior subluxation of the humeral head relative to the center of the glenoid. There is a small amount of fluid within the glenohumeral joint but no large effusion.BICEPS TENDON: The tendon of the long head of the biceps appears intact within the limitations of a non arthrogram study.

Output: 1. Labral abnormalities as described above including a posterior labral tear with paralabral cyst formation. There is also loss of the articular cartilage along the posterior aspect of the glenoid with scalloping of the articular surface corresponding to the findings seen on recent radiographs.2. Partial-thickness insertional tear of the subscapularis tendon.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial mass. Signs and symptoms: New onset of focal headaches. Nonenhanced brain MRI:No evidence of acute intracranial process and negative diffusion weighted images.Examination demonstrates normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable surgical cortex, cortical sulci, ventricular system, CSF spaces and myelination of brain.A signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses remains within normal.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. A small right maxillary sinus retention cyst however is detected.

Output: Negative nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: History of brain biopsy with unknown pathology. Evaluate for regrowth or change. There is evidence of prior left frontal approach biopsy. The previously demonstrated rim enhancing lesion within the left basal ganglia is now smaller in size. There remains increased T2 signal along its periphery with some decreased T2 signal internally. There is a partial rim of intrinsic T1 hyperintensity inferiorly. On post-contrast imaging, the enhancement remains heterogeneous, but more solid appearing, likely due to collapse and apposition of the enhancing walls. On perfusion imaging, there is decreased relative cerebral blood volume corresponding to the lesion. Single voxel spectroscopy at multiple TE's over the core of the lesion demonstrate a very large lipid resonance. There is no evidence of detectable lactate, amino acids, choline, creatine or NAA. A voxel placed over the tissue immediately adjacent to the lesion demonstrates no abnormal infiltrative or neoplastic process.There is a new 6 mm focus of diffusion restriction in the right mesial temporal lobe. Elsewhere, no restricted diffusion is seen. A few scattered foci of white matter signal abnormality are noted, at least some of which were present on the prior exam. No new areas of significant edema or mass effect. No extra-axial fluid collection is identified. The left lateral ventricle has reexpanded with otherwise unremarkable ventricular caliber.

Output: Interval decrease in size of the lesion in the left basal ganglia with some change in the pattern of enhancement likely related to lesion collapse. Both perfusion and MR spectroscopy are compatible with necrotic tissue. No evidence of any infiltrative or neoplastic process is seen within or adjacent to the lesion. Given these findings and the presence of a new focus of restricted diffusion suggesting ischemia in the right temporal lobe, the original lesion in the left basal ganglia is also favored to represent a late subacute stroke. At least one additional follow-up exam is suggested to ensure expected evolution.


Instruction: Generate impression based on findings.

Input: Convulsions starting few months ago. There is no evidence of grey matter heterotopia, mesial temporal sclerosis, intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. There is no abnormal intracranial enhancement. There is a partially-empty sella and perhaps flattening of the bilateral optic nerve discs. 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 skull and scalp soft tissues are grossly unremarkable. There are minimal secretions in a left anterior ethmoid air cell.

Output: 1. No discernible evidence of potential seizure foci.2. A partially-empty sella and perhaps flattening of the optic nerve discs may represent idiopathic intracranial hypertension.


Instruction: Generate impression based on findings.

Input: 43-year-old with known left breast cancer with additional MRI findings for which ultrasound is requested. Patient also complains of a newly appreciable palpable area of concern in the left upper outer breast that she feels she has stopped breast-feeding. A targeted bilateral ultrasound was performed.For the patient's area of concern in the left outer breast near 2:00, adjacent simple and complicated cysts are present. This correlates with cysts seen on the MRI.For the MRI detected mass in the left lower outer quadrant, a 1.4 x 1.4 cm hypoechoic oval mass with internal vascularity is present and correlates with the MRI. This should be biopsied under ultrasound guidance.In the left inner breast near 9:00, a 9 x 7 mm hypoechoic region with apical vascularity is seen. This is indeterminant in appearance and should also be biopsied under ultrasound guidance.In the right lower inner quadrant no suspicious cystic or solid mass was apparent. Likely the MRI finding at this site was focal nodular parenchymal enhancement.In the right axillary region several adjacent lymph nodes with thickened cortices are seen. Cortical thickness is up to 5 mm and nonhilar blood flow is noted.

Output: 1. Left lower outer quadrant 1.4 cm hypoechoic mass correlates with MRI can be biopsied under ultrasound guidance.2. Left inner breast 9 mm hypoechoic region with apical vascularity is indeterminant in appearance, could be a correlate for the MRI finding and should also be biopsied under ultrasound guidance.3. No suspicious finding in the right lower inner quadrant, a reasonable result given the the low suspicion for the right breast finding from MRI.4. Indeterminate right axillary lymph node, at least as suspicious in morphology as the known metastatic lymph node in the left axilla. Ultrasound-guided biopsy is recommended.Orders for this biopsy to be performed tomorrow have been placed by Donna Christian and the patient is scheduled for 9:00 AM.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: ischemic stroke History: R sided weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Patchy bilateral somewhat confluent T2/FLAIR high signal intensity periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.There are multiple lacunar infarctions on bilateral basal ganglia and left cerebellar hemisphere.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Bilateral mastoid air cells show opacification.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. No evidence of arterial luminal stenosis on craniocervical arterial system.4. No intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: 9 month old female with history of fall from mother's arms onto concrete floor with scalp hematoma. Limited views of the orbits appear normal.Small right occipital subgaleal hematoma with underlying, minimally overriding occipital fracture with slight depression that is no thicker than the thickness of the bone itself.There is a subcutaneous lesion immediate above the anterior fontanelle that contains soft tissue and a small amount of fat. Suspect this may represent a hemangioma. No associated fat stranding is identified. No boney change is noted underneath the lesion to suggest a meningocele. Suspect hemangioma; correlate with physical examination. If it is not known what this lesion represents; consider an MRI with contrast for further evaluation.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Small right occipital subgaleal hematoma with underlying, minimally overriding occipital fracture with slight depression that is no thicker than the thickness of the bone itself.2. Findings suggestive of anterior subcutaneous hemangioma. If it is not known what this lesion represents; consider an MRI with contrast for further evaluation.