Instruction: Generate impression based on findings.

Input: 59 year old male with new onset atrial fibrillation and heart failure. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 149 ml/m2 (normal range: 74+/-15), the LVEDV is 336 ml (normal range 142+/-34), the LV end systolic volume index is 114 ml/m2 (normal range 25+/-9), the LVESV is 257 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 151 g (normal range 164+/-36). The LV dysfunction is global. There is a small subendocardial area of late gadolinium enhancement in the basal anteroseptum suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This would fit the pattern of prior myocardial infarction, however the location is atypical. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is normal in size with moderate-severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 242 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 170 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild-moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is bilateral interstitial changes throughout lung fields. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24% The LV dysfunction is global. There is a small subendocardial area of late gadolinium enhancement in the basal anteroseptum suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This would fit the pattern of prior myocardial infarction, however the location is atypical. 2. The right ventricle is normal in size with moderate-severely reduced systolic function (RVEF 30%)3. At least mild to moderate mitral regurgitation. 4. Severely dilated left atrium. 5. See extracardiac findingsI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Hip pain for months with weight lifting. Evaluate for labral tear. ACETABULAR LABRUM: There is a thin linear band of intermediate signal intensity within the anterosuperior labrum at approximately the 1:00 to 2:00 position that I suspect represents a small undersurface tear, but the clinical significance of this finding is uncertain, and I see no large fluid-filled tear. The superior labrum also appears slightly blunted in contour, but the clinical significance of this is uncertain.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the left hip appears normal. Bone marrow signal intensity appears normal. There is slight focal prominence of the femoral head/neck junction at the 1:00 position with an alpha angle measuring between 55 and 60 degrees, suggesting a mild cam deformity.SOFT TISSUES: The musculature of the hip appears normal, as do the remaining soft tissues. ADDITIONAL

Output: 1.Thin linear intermediate signal intensity within the anterior superior labrum may represent a small undersurface tear, but the clinical significance of this is uncertain, and I see no large fluid-filled tear.2.Very mild cam deformity of the anterosuperior femoral head neck junction.3.Rounded retrouterine collection of fluid signal intensity may represent a cyst, but is not optimally evaluated on this hip nonenhanced hip MRI study. Further evaluation with transvaginal ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: 58 years, Male, postoperative examination after resection of tumor. There are expected postsurgical changes of left frontal craniotomy for resection of metastatic enhancing left frontal mass. There is intrinsic T1 hyperintensity filling the resection cavity consistent with blood products. There appears to be total tumor resection without definite areas of residual enhancement identified in this location. Again seen is extensive vasogenic edema in the left frontal lobe extending into the superior temporal lobe. There is effacement of the left lateral ventricle which is slightly improved. Rightward midline shift and subfalcine herniation also appear slightly improved. No uncal herniation.Again seen is an 11 x 11 x 9 mm enhancing focus as measured previously involving the left superior and middle temporal gyri consistent with a second lesion. There is mild associated edema.Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Again seen is a punctate focus of diffusion hyperintensity in the left posterior temporal lobe without T2/FLAIR hyperintensity and is of uncertain significance. No hydrocephalus. No abnormal leptomeningeal or dural enhancement appreciated on the postgadolinium sequences which are motion degraded.

Output: 1. Expected postsurgical changes related to resection of metastatic left frontal lobe lesion. Again seen is extensive surrounding vasogenic edema with slight improvement in mass effect.2. Unchanged small left temporal lobe lesion consistent with metastasis.


Instruction: Generate impression based on findings.

Input: 74-year-old with a history of TIA, peripheral vascular disease, diabetes, status post carotid endarterectomy, brought to the ER after physical therapy with suspected facial droop and slurred speech. Now at baseline per daughter. Rule out acute ischemic or hemorrhagic event. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease of indeterminate age. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease of indeterminant age. No definite acute findings, however if there is concern for an acute stroke an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Male, 76 years old, with GBM status post resection. Evidence of wide left temporoparietal craniotomy is seen. Extracranial soft tissue swelling and a 7 mm layer of extra-axial fluid beneath the craniotomy are expected postoperative findings.A large resection cavity is now present at the site of the previous enhancing left anterior temporal lesion containing fluid and a small amount of dependent layering blood product. At the posterior margin of the resection cavity, along the temporal horn, there is a patch of amorphous enhancement measuring 9 x 7 mm which could represent residual tumor or postoperative change. Elsewhere, only nonspecific amorphous enhancement is seen along the cavity margins.T2 hyperintensity spreading through the parenchyma surrounding the resection cavity into the occipital lobe, the operculum, the parietal lobe, the insula and thalamus appears similar to that seen on the preoperative study.Moderate generalized mass effect is seen in the left cerebral hemisphere with sulcal effacement and partial effacement of the lateral ventricle. Only minimal midline shift is seen without evidence of herniation.No evidence of acute ischemia is seen. Scattered small foci of T2 hyperintensity within the cerebral white matter may reflect chronic microvascular ischemic disease.

Output: 1. Expected findings status post resection of a large left temporal tumor.2. The previously seen tumor has been completely or near completely resected. Only a small amount of enhancing tissue is seen along the posterior margin of the resection cavity which could reflect trace residual tumor or postoperative change.


Instruction: Generate impression based on findings.

Input: Reason: spinal cord astrocytoma s/p RT and TMZ. History: spinal cord astrocytoma. CERVICAL SPINE:T2 hyperintense expansile mass within the right aspect of the cord extending from the C3-C4 level to C7-T1 is not appreciably changed in size measuring approximately 1.5 x 1.2 cm in the transverse and AP dimensions in the axial plane at the mid C6 level. T2 hyperintensity involving the left lateral aspect of the cord at these levels is also again seen and not significantly changed. There are faint small foci of ill-defined enhancement involving the left lateral aspect of the cervical cord at the C5 and C7 levels and also present previously.There is mild reversal of the normal cervical lordosis. Vertebral body heights are maintained. Mild multilevel disc desiccation with mild degenerative disc disease at C5-C6 and C6-C7 is unchanged. Diffuse T1 hyperintensity throughout the vertebral bodies likely related to radiation. Postsurgical changes along the posterior cervical spine with laminectomies at C5 and C6 are unchanged.THORACIC SPINE:T2 hyperintense expansile mass centered on the left aspect of the cord extending from the T2-T3 level to the T8 level is unchanged in size and overall distribution, measuring 11 x 10 mm in the axial plane at the mid T4 level similar to prior. Cord signal abnormality involving the right lateral aspect of the cord is also not significant changed. There is faint diffuse enhancement of the lesion which less conspicuous than on 6/8/2016 with artifacts and differences in contrast timing somewhat limiting comparison. There is however no new suspicious enhancement to suggest progression.No significant spinal or neural foraminal narrowing throughout the thoracic spine. Central disc protrusion at T7-T8 as well as additional mild multilevel degenerative changes are not significantly changed. Vertebral body heights and alignment are normal. T1 hyperintensity in the marrow likely reflects post radiation change.

Output: Compared to 9/7/2016 and 6/8/2016, there is no evidence of interval progression cervical and thoracic astrocytomas.


Instruction: Generate impression based on findings.

Input: History of autoimmune hepatitis and alcoholic cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology without a focal suspicious lesion on nonenhanced imaging.Partially distended gallbladder without inflammation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderately atrophic kidneys with T2-weighted fluid hyperintense left renal lesion, unchanged and likely a cyst. No hydroureteronephrosis.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: Cirrhosis without a focal hepatic lesion on this limited nonenhanced study.


Instruction: Generate impression based on findings.

Input: 57-year-old man with history of metastatic esophageal cancer, lymphadenopathy, and new onset jaundice. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The left portal vein appears attenuated in caliber. There is narrowing of the extrahepatic common bile duct near the porta hepatis (10/49). An adjacent T2 hyperintense soft tissue mass measures up to 46 x 27 mm (500/25). There is resultant mild, diffuse dilation of the extrahepatic bile duct and moderate diffuse dilation of the intrahepatic bile ducts. The gallbladder wall is irregular and circumferentially thickened measuring up to 9 mm (500/32).SPLEEN: No significant abnormality noted.PANCREAS: The head of the pancreas cannot be reliably differentiated from the porta hepatis/peripancreatic lymph nodes. The remainder of the pancreas appears normal without pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is moderate right hydronephrosis and proximal third hydroureter. No distinct extrinsic compressing lesion identified. Left kidney appears normal.RETROPERITONEUM, LYMPH NODES: There is periportal lymphadenopathy as described above. An additional mass seen anterior to the common hepatic artery (500/21) measures 37 x 22 mm. Retroperitoneal lymphadenopathy also noted.BOWEL, MESENTERY: The stomach is markedly dilated to the level of the aforementioned periportal lymphadenopathy. The partially visualized small bowel appears normal. The hepatic flexure of the colon (500/36) has circumferentially thickened wall. Additionally, there is nonspecific nodularity within the anterior mesentery suspicious for peritoneal disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of free fluid within the abdomen. Bilateral pleural effusions noted.

Output: 1.Bulky periportal and peripancreatic lymphadenopathy causing extrinsic compression on the common bile duct and moderate degree biliary ductal dilatation.2.Circumferential gallbladder wall thickening with adjacent wall thickening of the hepatic flexure of the colon. In addition to scattered mesenteric nodules, these findings are suspicious for carcinomatosis with possible serosal implants.3.Moderate right hydronephrosis and proximal hydroureter without definite extrinsic compressing lesion identified, at site of transition however is ureteral wall thickening (suspicious for additional site of tumor involvement).4.Dilated stomach secondary to likely outlet obstruction from the aforementioned bulky lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: Chiari malformation, syrinx, pseudotumor cerebri, evaluate for 6 months follow-up. Signs and symptoms: 6 months follow-up. Nonenhanced brain MRI:There is no evidence of an acute intracranial process and no convincing evidence of any new findings since prior exam.Stable postoperative changes of suboccipital craniectomy for Chiari decompression with resultant expansion of subarachnoid space. There is posterior tenting of the cervical medullary junction of the cord similar to prior exam and highly suspected of adhesion to the surgical site. Small focus of FLAIR hyperintensity in the right paramedian inferior cerebellum consistent with a small focus of encephalomalacia demonstrate no significant change. The fourth ventricle is mildly prominent however stable since prior exam.Stable well-demarcated focus of mixed signal abnormality involving the left aspect of clivus and left petrous apex since multiple prior exams and including prior head CT from 5-20 5-2011 and likely representing a focus of fibrous dysplasia.Unremarkable nonenhanced brain MRI otherwise.Nonenhanced cervical MRI:Examination redemonstrate postoperative changes of Chiari decompression as detailed above. There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord and without evidence of syrinx.There is a small central and right para median disc protrusion at C5-C6 with resultant flattening deformity of the ventral aspect of the cord and mild central spinal stenosis. There is slight interval progression of disease since prior study. Patent bilateral neural foraminal.C6/C7 also demonstrate shallow central disc protrusion with trace flattening of the cord and no central spinal stenosis. No significant change since prior exam.CSF flow study at the level of foramen magnum demonstrate presence of biphasic flow anteriorly through the foramen magnum and without detectable flow posteriorly similar to prior exam.

Output: 1.Stable post operative changes of Chiari decompression. Posterior tenting of cervical medullary junction of the cord as result of adhesion at the surgical site without change. Stable small focus of encephalomalacia of right inferior paramedian cerebellum and unremarkable exam otherwise.2.MRI of cervical spine demonstrate no evidence of syrinx. Disc protrusion at C5-C6 with interval progression and results in mild central spinal stenosis is noted. A small central disc protrusion at C6/C7 remains stable. Stable focus of fibrous dysplasia involving the left skull base since multiple prior studies.3.CSF flow study demonstrates normal appearing high phasic flow anteriorly through the foramen magnum and absence of flow posteriorly. No detectable flow through the fourth ventricle or the aqueduct.


Instruction: Generate impression based on findings.

Input: History of ulcerative colitis with mildly abnormal LFTs. Evaluate for PSC. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size, measuring 18 cm in craniocaudal dimension. No focal suspicious lesion.Minimal intrahepatic ductal beaded irregularity and prominence is unchanged. No focal dilatation or stricture.Status post cholecystectomy with cystic duct remnant noted. The common bile duct is minimally prominent likely reflecting postcholecystectomy state, unchanged.SPLEEN: The spleen is normal in size measuring 8 cm in length without a focal lesion.PANCREAS: Note is made of a cystic 7 mm focus in the pancreatic body which communicates with a normal caliber pancreatic duct compatible with a sidebranch IPMN without suspicious imaging features. Similar cystic focus in the pancreatic tail measures 1.1 cm with equivocal communication with the main pancreatic duct, unchanged. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing left renal cyst and additional too small to characterize hyperintensities.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 intrahepatic biliary ductal beaded irregularity and prominence appearing similar to the prior study. No dominant stricture or mass. 2.Stable pancreatic body and tail probable sidebranch IPMNs without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: Persistent vertigo. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is an incidental left anterior frontal lobe developmental venous anomaly. 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 small left maxillary sinus retention cyst.Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: 28-year-old male with MCL laxity and tenderness to palpation following twisting injury. Evaluate for MCL tear or meniscal injury. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No evidence of bone marrow edema. No focal articular defect or articular thinning. LIGAMENTS: The proximal aspect of the MCL is not visualized and likely torn. The ACL and PCL appears intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Medial collateral ligament tear as above.


Instruction: Generate impression based on findings.

Input: 61-year-old male with destructive bony lesion L5/S1. Evaluate unknown primary malignancy. History of hemachromatosis and diabetes. The recent PET examination demonstrates no pathologic foci of increased radiotracer accumulation to indicate FDG avid tumor in the neck, chest, abdomen or pelvis. Specifically, the region of L5/S1 is negative on FDG-PET.On the recent PET scan examination show moderate to markedly increased metabolic activity throughout the entire colon suggesting a nonspecific infectious or inflammatory colitis.CHEST:LUNGS AND PLEURA: Mild left lower lobe volume loss and atelectatic changeMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There is hepatosplenomegaly. The liver measures 20 cm craniocaudally, and the spleen measures approximately 14 cm. The hepatic parenchyma is hypodense relative to the spleen suggesting fatty infiltration. There are small calcifications in the liver, probably due to old granulomatous disease. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cortical hypodensities compatible with simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the spineOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitis. No specific abnormality was found in the colon to correspond with the area of increased uptake on the recent PET scan examination.BONES, SOFT TISSUES: Multilevel degenerative disk disease. Abnormal mass lesion infiltrates the spinal column at L5-S1, seen best at axial image 150/222. These findings are compatible with an aggressive process, such as infection or malignancy. No significant interval change since recent MRI and CT scans of the lumbosacral spine.OTHER: Prominent left varicocele at axial image 220/222.

Output: Hepatosplenomegaly. Probable fatty infiltration of the liver. No significant interval change in the L5-S1 aggressive process seen on recent CT and MRI examinations. No local neoplasm. Left varicocele. Findings are discordant with PET-CT exam regarding the colon, where no abnormality was found.


Instruction: Generate impression based on findings.

Input: Ms. Johnson is a 61 year old female with known right breast malignancy status post neoadjuvant chemotherapy. She presents today for imaging evaluation to assess for treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There is revisualization of the biopsy-proven malignancy in the right upper outer breast with associated biopsy marker clip now measuring approximately 0.4 x 0.6 x 0.5 cm (AP x ML x SI) previously measuring 1.5 x 1.4 x 2.2 cm (MRI - 5/13/2016). In addition, there is revisualization of biopsy marker clip with faint associated enhancement anteromedial to the index malignancy, compatible with prior benign MR-guided biopsy site. There is no new abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Interval decrease in size of index malignancy of the right breast.(2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Norman is a 73-year-old female presenting with a suspicious screen detected mass identified in the right upper outer breast. She will have an ultrasound-guided biopsy with clip placement later today. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the right upper outer breast, there is a spiculated enhancing mass identified measuring 1.3 x 1.7 x 1.2 cm (AP x ML x SI). This corresponds to the mammographically detected mass in the right upper outer breast.There is no additional abnormal enhancement identified elsewhere in the right breast or in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1.7 cm spiculated mass in the right upper outer breast for which an ultrasound-guided biopsy with clip placement will be performed later today. Pathology results are pending.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering there are 5 lumbar type vertebral bodies. The vertebral body heights are preserved. Mild L3-4 anterolisthesis. Alignment is otherwise maintained. There is severe loss of disc height with endplate degenerative changes at L5-S1 with vacuum phenomenon. There are scattered T1 hyperintense foci of the lumbar spine, which may represent focal fatty replacement or fat containing hemangiomas. No suspicious osseous lesions. There is no significant spinal canal stenosis. The distal spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Individual levels as below:T9-T10 (sagittal images only): Mild disc bulge. No significant spinal canal or foraminal stenosis. T10-T11 (sagittal images only): Mild disc bulge. Mild right greater than left foraminal stenosis. T11-T12: Mild disc bulge. No significant spinal canal or foraminal stenosis. T12-L1: Bilateral facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Bilateral facet arthropathy and mild disc bulge. Moderate right foraminal stenosis. No significant spinal canal or left foraminal stenosis. L2-L3: Mild disc bulge and bilateral facet arthropathy. Mild bilateral foraminal stenosis. No significant spinal canal foraminal stenosis. L3-L4: Mild disc bulge with superimposed right foraminal protrusion and advanced bilateral facet arthropathy, contributing to mild right foraminal stenosis. No significant spinal canal or left foraminal stenosis. L4-L5: There is mild neural foraminal narrowing on the right related to advanced facet arthropathy. Otherwise no significant spinal canal or neural foraminal stenosis. L5-S1: Disc bulge and bilateral facet arthropathy, contributing to moderate left foraminal stenosis. No significant spinal canal stenosis.

Output: 1. Degenerative lumbar spondylosis as detailed above, relatively worse at L5-S1, with up to moderate left neural foraminal stenosis. No significant spinal canal stenosis at any level.2. Advanced bilateral facet arthropathy, worst at L3-4 and L4-5. 3. No suspicious mass is seen, as questioned.


Instruction: Generate impression based on findings.

Input: History of breast cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a cystic pineal gland. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is an anterior nasal septal defect, which measures up to 15 mm in length.

Output: 1. No evidence of intracranial metastases.2. Anterior nasal septal defect.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with hand tremor and twitching, macrocephaly. Focal epileptiform discharges on EEG. No areas of focal signal abnormality, edema or mass effect are detected. Diffusion-weighted images are within normal limits. No structural or migrational anomalies are suspected. There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with history of T1 N0 left tongue squamous cell carcinoma status post resection and lymph node dissection on 05/20/16, now with falling down and shaking extremities. Brain:Scattered foci of T2 hyperintensity are again seen within the cerebral hemispheres and the pons showing no significant interval change from prior. No edema or mass effect is detected. No pathologic intracranial enhancement is observed. Diffusion-weighted images are within normal limits. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections are demonstrated. Ventricular size and morphology are within normal limits.Neck:Deformity of the left oral tongue is seen compatible with interval surgery. No discrete mass or definite pathologic enhancement is seen within the oral tongue. Mild, ill-defined T2 hyperintense signal along the left floor of mouth is nonspecific but probably related to surgery as well.Evidence of left neck dissection is seen. The left submandibular gland has been removed. No pathologic adenopathy is identified. The residual salivary glands and the thyroid are unremarkable. Bone marrow signal characteristics are within normal limits. Persistent opacification of the left sphenoid sinus is again seen. A 7 mm T1/T2 hyperintense lesion at the midline of the thyroid lobe may represent a thyroid nodule or a thyroglossal duct cyst.

Output: 1.No acute intracranial abnormality or evidence of intracranial metastases. Scattered foci of nonspecific T2 hyperintensity are unchanged and perhaps related to chronic microvascular ischemia.2.Postoperative findings are seen in the neck with no evidence of recurrent tumor or pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: MS, follow-up progression. Signs and symptoms: Paresthesia. Nonenhanced MRI: Minimal findings of demyelinating disease in the posterior fossa involving the left anterior cerebellum, left middle cerebellar peduncle and left aspect of the pons are again identified. Fourth ventricle remains mildly prominent and is stable since prior study. There is new lesion in the right aspect of quadrigeminal plate (R>L).Images through supratentorial space demonstrate significant interval progression of disease in the periventricular white matter of cerebral hemispheres as well as the subcortical white matter and of the corpus callosum. The lesions are slightly more pronounced in the left hemisphere and in particular there is a large left frontal plaque measuring at 17 x 15 mm in transaxial dimensions.There is slight interval progression of supratentorial ventriculomegaly suggestive of ex vacuo dilatation. There is no evidence of mass effect and midline is maintained.Nonenhanced cervical MRI:Examination demonstrate extensive confluent and patchy foci of T2 and T2 STIR hyperintensity throughout the cervical cord consistent with extensive demyelinating disease. There is interval progression of findings and with evidence of foci of decreased cord caliber representing cord volume loss.Normal signal intensity and alignment of vertebral column and without evidence of spinal canal or neural foraminal compromise.Nonenhanced thoracic MRI:This examination also demonstrate extensive findings of demyelinating disease throughout the length of thoracic cord and with suggestion of generalized decreased cord caliber. Compared to prior exam there is suggestion of interval progression of disease.The signal intensity and alignment of vertebral column is unremarkable and without spinal stenosis or neural foraminal compromise.

Output: 1.Brain MRI demonstrate interval progression of demyelinating disease both in supra and infratentorial brain parenchyma and with resultant mild further increased supratentorial ventricular size suspected of volume loss.2.Cervical spine MRI demonstrate extensive findings of demyelinating disease with interval progression since prior exam and with evidence of foci of decreased cord caliber.3.Thoracic MRI demonstrate extensive findings of demyelinating disease with generalized decreased cord caliber and with interval progression since prior study. Unremarkable thoracic spine and without spinal stenosis or neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: History of cholangiocarcinoma with elevated bilirubin and periportal lymphadenopathy. Evaluate for possible stent versus liver dysfunction as etiology of bilirubinemia. ABDOMEN:LIVER, BILIARY TRACT: Lobular mass centered in segment 4 extending to the lateral and medial segments of the liver measuring up to 9.1 x 8.5 cm in cross-section. There are multiple associated T2-weighted mildly hyperintense enhancing satellite lesions in both lobes of the liver. There is associated moderate intrahepatic biliary ductal dilatation involving the right hepatic lobe.Normally distended gallbladder with small gallstones.Moderate volume perihepatic ascites.SPLEEN: Mild splenomegaly measuring 14.5 cm in length. Trace perisplenic fluid.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mildly atrophic kidneys. Left renal simple appearing cyst.RETROPERITONEUM, LYMPH NODES: Several enlarged periportal lymph nodes.BOWEL, MESENTERY: Trace mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild dependent body wall edema.

Output: Large central hepatic mass with multiple satellite lesions in both lobes of the liver. The mass causes moderate intrahepatic ductal dilatation in the right hepatic lobe. No central biliary ductal dilatation. Locoregional adenopathy present. Small volume ascites.


Instruction: Generate impression based on findings.

Input: Reason: S/p R knee ACL reconstruction, MFC allograft, evaluate for meniscus tear or cartilage lesion Evaluation of medial compartment is limited by metallic susceptibility artifact.MENISCI: Evaluation of the medial meniscus is somewhat limited due to adjacent metallic susceptibility artifact. There is attenuation of the medial meniscus, which we suspect is from prior partial meniscectomy, but may reflect chronic attritional tearing if there is no such history. Slight medial extrusion of the body of the medial meniscus is noted. However, we see no intrameniscal fluid signal or other findings to suggest unstable medial meniscal tear.There is a thin vertically oriented increased signal intensity in the anterior horn of the lateral meniscus near the root (series 3 image 10). This may simply reflect normal signal that can be seen in the lateral meniscus at this location, but also could conceivably reflect vertical tear, which may not be of current clinical significance.ARTICULAR CARTILAGE AND BONE: There is slight prominence of the bone along the articular surface of the medial femoral condyle above the posterior horn of the medial meniscus, which presumably reflects the site of medial femoral condyle allograft placement (series 3 image 19). The allograft appears healed. There is mild heterogeneity of the overlying cartilage, which may reflect degeneration, but we see no fluid-filled defect of the cartilage. There is mild heterogeneity of the medial tibial plateau cartilage suggestive of mild degeneration. There is also cyst formation in the posterior tibial plateau.There is small focus of increased signal intensity in the articular cartilage of the lateral tibial plateau below the free edge of the anterior horn of the lateral meniscus (series 3 image 9), likely reflecting focal defect/degeneration. There is also small focus of increased signal intensity in the articular cartilage of the lateral femoral condyle more centrally along the intercondylar notch (series 3 image 14), suggestive of focal defect/degeneration.Increased signal intensity of the articular cartilage of the trochlea centrally reflects focal degeneration (series 3 image 15). Patellar cartilage appears intact.There are small tricompartmental osteophytes.LIGAMENTS: Patient has undergone ACL reconstruction. The ACL graft appears thin but intact (series 3 image 14). There is increased signal intensity of the PCL proximally, which may reflect degeneration or prior injury. Intermediate signal intensity in the vicinity of the cruciate ligaments likely reflect scarring. The medial collateral ligament and lateral collateral ligaments appear intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar ligament are intact.ADDITIONAL

Output: Evaluation of the medial compartment is limited by extensive metallic susceptibility artifact.1. Attenuation and mild extrusion of the medial meniscus without intrameniscal fluid signal or other findings of unstable meniscal tear.2. Vertically oriented increased signal intensity in the lateral meniscus near the anterior horn/root may represent tear of questionable current clinical significance or may simply represent normal signal at this location.3. Postsurgical changes of the medial femoral condyle allograft with mild heterogeneity of the overlying cartilage, which may represent degeneration. However, we see no fluid-filled cartilage defect. Additional foci of cartilage degeneration as described above.4. Postsurgical changes of ACL reconstruction. ACL graft appears thin but otherwise intact.5. Other findings as above.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with history of base of tongue squamous cell carcinoma, status post bilateral neck dissection, now presenting with worsening right tongue pain. The previously seen ulcerative right oral tongue lesion appears to have completely or nearly completely healed. Only mild anatomic distortion is seen along the mucosal surface of the right oral tongue with no definite findings to suggest recurrent tumor in this location.At the left lateral base of tongue, however, there is an asymmetric area of T2 hyperintensity and subtle abnormal enhancement (see image 17 series 701, and image 24 series 1101). This area of abnormal tissue measures up to 19 mm in the axial plane and up to 17 mm in the coronal plane.Edema of the pharynx and supraglottic larynx is again seen compatible with treatment effect. Likewise, reticulation and edema within the subcutaneous tissues of the submental region are also compatible with treatment effect. No airway compromise is seen.No pathologic adenopathy is detected in the neck by size criteria. The visualized salivary glands are unremarkable as is the thyroid. The osseous structures demonstrate normal signal characteristics. Mild peripheral mucosal thickening is seen within the right maxillary sinus.

Output: 1.Complete or near complete healing of the previously seen ulcerated lesion along the right aspect of the oral tongue. No findings to suggest disease recurrence at this location are noted.2.An area of asymmetric signal abnormality and enhancement is noted at the left lateral base of tongue. The nature of this tissue is uncertain. It could be inflammatory and/or related to therapy. However, the possibility of a subtle tumor recurrence cannot be excluded.3.No pathologic adenopathy is detected in the neck. Additional therapy related findings as detailed above are fairly similar to those seen on prior CTs.


Instruction: Generate impression based on findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], laser ablation of seizure focus. Postsurgical findings related to right hippocampal ablation are demonstrated. Progressive interval volume loss of the mesial temporal structures is seen. The size of the post-ablative enhancing tissue has also decreased. No new enhancing lesions are seen. Scattered nonspecific foci of parenchymal T2 hyperintensity are redemonstrated without significant interval change. No evidence of parenchymal edema or mass effect is observed. No abnormal extra-axial collections are seen. Ventricular size and morphology remain within normal limits.

Output: Expected evolution of postoperative findings related to right hippocampus ablation without evidence for acute abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 31 years Female (DOB:8/14/1985)Reason: evaluate for 2/2 cause of memory loss, frontal lobe deficits History: short term memory lossPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. There are T2 and FLAIR hyperintense curvilinear bands present along the medial aspects of the cerebellar hemispheres and vermis as well as medial aspects of the occipital lobes. These are not seen on the T1 images nor on the B0 images. They're suspected represent artifact.History: Is made of a developmental venous anomaly in the left cerebellar hemisphere inferiorly.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.T2 signal noted projecting over the cerebellar hemispheres and medial occipital lobes suspected to represent artifact related the patient's hair or hair extensions.2.No abnormal lesions are appreciated within the brain parenchyma that would explain the patient's memory loss.


Instruction: Generate impression based on findings.

Input: There is a focal 9-mm defect along the right ethmoid sinus roof with apparent herniation of a small focal portion of the inferior right frontal lobe cortex, suspicious for small encephalocele. This is best visualized on series 12 image 9, series 10 image 1 and series 13 image 47.There is no hippocampal signal abnormality or volume loss. There is no evidence of gray matter heterotopia or cortical dysplasia. There is no suspicious intracranial enhancement, acute infarct, mass effect, midline shift or herniation. There is minimal nonspecific periventricular and subcortical white matter is T2 signal abnormality likely representing chronic microvascular ischemic changes. There is moderate left maxillary, severe left ethmoid sinus mucosal thickening. There is a moderate left sphenoid sinus air-fluid level.

Output: 1.Finding suspicious for small encephalocele herniating through a defect in the right ethmoid roof. This can be further evaluated with skull base MRI/CT as clinically indicated. Please see details above.2.No other evidence of seizure foci or intracranial mass.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis follow up. Brain: There are multiple unchanged cerebral white matter T2 hyperintense lesions, primarily in a periventricular distribution, but also in juxtacortical locations, such as in the right occipital lobe. There is no associated enhancement and there is no evidence of intratentorial lesions. The ventricles and sulci are normal is size and configuration. There is no evidence of intracranial mass lesions. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There is now a subcentimeter T2 hyperintense and enhancing lesion in the right lateral spinal cord at the C4-5 level. The rest of the cervical and thoracic spinal cord appears unremarkable. The vertebral column alignment is within normal limits. There are intravertebral disc herniations in the T10 and T11 vertebral bodies. The vertebral body and disc space heights are otherwise preserved. There is a hemangioma in the T9 vertebral body that measures up to 15 mm. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. No significant interval change in the cerebral demyelinating lesions.2. An enhancing demyelinating lesion in the right lateral spinal cord at the C4-5 level is new from 2014.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with lung cancer, stage III, not yet on therapy. Initial staging head CT showed an abnormal finding. The lesion identified on prior CT within the right frontal white matter is demonstrated as an area of mild susceptibility artifact and mild ill-defined FLAIR hyperintensity. This lesion shows no detectable enhancement on the early postcontrast images, and on the later postcontrast images shows only a faint rim of enhancement (image 106 series 1201). The high attenuation of this lesion seen on CT may therefore have represented mineralization. The lesion causes no significant edema or mass effect.No evidence of any other definite pathologic intracranial enhancement is seen. A small ill-defined blush of enhancement within the right precuneus is favored to represent a developmental venous anomaly. No parenchymal edema or mass effect is noted. There are several scattered small foci of T2 hyperintensity within the periventricular white matter which are nonspecific but likely reflective of chronic microvascular ischemic disease. No restricted diffusion is seen.There is no evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection. In addition to the susceptibility noted above, a 2 mm focus of susceptibility is also noted adjacent to the right frontal horn suggesting chronic microhemorrhage. The ventricles and sulci are mildly prominent compatible with parenchymal volume loss, but are otherwise unremarkable.No definite marrow signal abnormality is seen. Thinning of the bilateral parietal bones is an age-related anatomic variant. The odontoid process appears somewhat angulated and/or retroflexed. This may be congenital or reflective of remote trauma. The posterior arch of C1 is not clearly visualized in its entirety.

Output: The lesion identified on prior CT within the right frontal lobe is identified on today's examination as an area of either mineralization or hemosiderin staining with minimal rim enhancement and no significant associated edema or mass effect.The etiology for this lesion is not entirely clear. While metastatic disease cannot be entirely excluded, the presentation is rather atypical. Benign etiologies would also be in the differential including sequelae of prior injury or inflammation. Given the uncertainty, a short-term follow-up examination, perhaps in one to two months, can be considered.


Instruction: Generate impression based on findings.

Input: 10-year-old male with recurrent pancreatitis. Evaluate for pancreatic duct stones or other anomalies. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation. Normal appearance of the gallbladder without evidence of cholelithiasis.SPLEEN: No focal splenic lesions. Small splenule noted.PANCREAS: No focal pancreatic lesions. No pancreatic ductal dilation. Pancreas divisum anatomy is not evident.ADRENAL GLANDS: No adrenal masses.KIDNEYS, URETERS: No focal renal lesion. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Examination is within normal limits.


Instruction: Generate impression based on findings.

Input: There are numerous areas of cystic encephalomalacia, corresponding to areas of previously seen hemorrhagic insult on the previous perinatal MRI. The most conspicuous areas involve the right anterior frontal lobe as well as involving the right superior frontal gyrus near the vertex. Smaller areas of abnormality are seen along the occipital poles bilaterally. There is associated ex vacuo dilatation of the frontal horns. There is also focal ex vacuo dilatation of the lateral margin of the body the left ventricle areas of additional encephalomalacia in the region of the basal ganglia bilaterally. In additiona, the caudate nuclei are barely identifiable. Areas of T2 hyperintensity were seen to involve these deep gray nuclei previously. There is a relative severe paucity of white matter limiting assessment for normal myelination, although this appears delayed.The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is prominence of Waldeyer's ring structures as well as cervical and retropharyngeal lymph nodes, which are nonspecific but most likely reactive in a patient of this age. There is mild fluid signal within the mastoid air cells bilaterally.SPINE

Output: 1. Interval expected evolution of previously seen scattered areas of parenchymal hemorrhagic insult, with subsequent development of encephalomalacia. Also suggestion of previous insult to basal ganglia and bilateral caudate nuclei now with associated encephalomalacia.2. Overall paucity of white matter volume limiting evaluation for degree of myelination, although it appears to be delayed.3. Skin marker along its sacral dimple at most minimal linear low signal within the subcutaneous fat extending to the left aspect of the coccyx, without evidence of a clear sinus tract extending into the central spinal canal.4. No MR evidence of tethered cord. Abnormal focal somewhat linear T2 hyperintense signal along the midline dorsal aspect of the distal cord at the T12 level. Differential diagnosis includes a developmental conus cyst, a small area of focal myelomalacia, atypical cervical hydromyelia, with cystic neoplasm not entirely excluded, and follow-up postcontrast imaging is recommended. Ventricularis terminalis cyst is felt to be less likely given its eccentric location within the cord, and partial split notochord is felt to be unlikely given lack of any associated segmentation anomalies.5. Trace scattered prominence of the central spinal canal within the cord, likely within normal limits.


Instruction: Generate impression based on findings.

Input: Headache, neutropenia, fever, multiple episodes of LP. There are multifocal scattered bihemispheric enhancing nodules.The distribution of enhancing nodules are more likely periventricular white matter as well as appendectomy surface. Especially bilateral lateral ventricles' posterior horn area show linear and nodular enhancements. On the left cerebral hemisphere, there is about 1 cm size and elliptical shaped central high signal intensity lesion with preprocedure low signal intensity rim associated with surrounding edema. The central portion of the lesion does not show restricted diffusion but demonstrate ring enhancement as well as adjacent folia enhancement.Above described findings suggest possibility of diffuse infectious process such as cerebritis including ependymitis, but cannot completely exclude possibility of metastatic lesion. The size of the right lateral ventricle appears to be a bit larger than that of the left side. And the signal intensity of the right lateral ventricle posterior horn is slightly higher than that of the left side, but not definitely show noticeable abnormal signal intensity.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multiple linear and nodular enhancing lesions on bilateral white matter and ependymal surfaces as well as left cerebellar lesion with surrounding edema. Diagnostic possibility is infectious process such as cerebritis, ependymitis and cerebellar abscess formation with differential diagnosis of metastatic process.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There are multiple foci partial and full-thickness cartilage degeneration scattered throughout all 3 compartments with degenerative subchondral signal abnormality within the medial facet of the femoral trochlea. The bone marrow signal is otherwise normal.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of meniscal tear.2. Tricompartmental cartilage defects with probable loose body as described above.3. Faint edema of the popliteus muscle which may reflect a mild strain.


Instruction: Generate impression based on findings.

Input: 71 year old female with a history of chordoma. Evaluate for progression. Again seen is a lobulated hyperintense lesion centered at the S3 level, measuring approximately 6.0 cm in the transverse dimension, 2.5 cm in AP dimension, and approximately 4.5 cm in the craniocaudal dimension. It is difficult to determine whether or not this mass has increased very slightly in size compared to the prior study due to slight positional differences between the examinations. Again seen is extension of the mass into the anterior presacral soft tissues. There is minimal enhancement of the lesion that appears predominantly peripheral in nature.Again seen is a small nodule posterior to the left sacroiliac joint that now measures approximately 2.0 cm in its greatest dimension, which appears to have increased in size when compared to the prior study, although it shows no enhancement following contrast administration.Edema and fluid extending along the posterior inferior right sacrum appears similar to the prior study, which may be postoperative in etiology.The reference subcutaneous lobular mass posterior to the right paraspinal musculature measures approximately 3.2 cm in the greatest dimension which perhaps has increased slightly in size when compared to the prior study, showing little, if any, enhancement following gadolinium administration.There is mild diffuse heterogeneity of the bone marrow which appears similar to the prior study and is of doubtful clinical significance. There is fatty atrophy of the gluteal musculature, right greater than left, appearing similar to the prior study. Note is made of decreased signal abnormality within the uterus consistent with fibroid. Severe degenerative disc disease affects the imaged lower lumbar spine.

Output: Sacral chordoma with satellite soft tissue lesions which have perhaps increased slightly in size when compared to the prior study.


Instruction: Generate impression based on findings.

Input: 55-year-old female with family history of breast cancer in 6 aunts and 4 cousins. Asymptomatic postmenopausal patient presenting for annual high risk breast MRI screening. There is heterogeneous fibroglandular tissue bilaterally, associated with mild background parenchymal enhancement.There is no suspicious mass, morphology or enhancement in either breast.No axillary or internal mammary lymphadenopathy.

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


Instruction: Generate impression based on findings.

Input: Female 67 years old Reason: hx of thyroid nodules History: none RIGHT LOBE MEASUREMENTS: 6.7 x 2.5 x 1.1 cmLEFT LOBE MEASUREMENTS: 5.4 x 2.2 x 1 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Numerous, small, hypoechoic nodules. An index nodule in the upper pole measures 1.2 x 1.3 cm.LEFT LOBE: Numerous, small, hypoechoic nodules. An index nodule in the upper pole measures 6 x 5 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multinodular goiter.


Instruction: Generate impression based on findings.

Input: Pituitary microadenoma, yearly follow up. BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is a right maxillary sinus retention cyst. PITUITARY: There is redemonstration of mild prominence of the pituitary gland measuring 11 x 9 mm in the transverse by craniocaudal dimensions (image 8, series 801 and image 6, series 1101), which is unchanged in size. There is a symmetric convex superior margin of the gland. There is uniform enhancement of the pituitary gland without signal abnormality to suggest a discrete mass. There is minimal leftward deviation of the pituitary stalk, but it is normal in caliber, signal intensity, and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable.

Output: No significant interval change in mild pituitary prominence. No discrete pituitary mass is identified.


Instruction: Generate impression based on findings.

Input: 73 year old male patient with PSA recurrence status post prostatectomy. PELVIS:PROSTATE:The patient is status post prostatectomy without evidence of residual tissue.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat-containing left inguinal hernia.

Output: No evidence of residual tissue or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Papilledema: failed vision test, squinting and rubbing of the eyes. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There appears to be mild contour deformity of the right globe, which bulges slightly along the posteriolateral aspect. The left globe appears to be grossly intact. The optic nerves appear to be unremarkable without discernible signal abnormality or optic disc prominence. There is no evidence of mass lesions or abnormal enhancement within the orbits.

Output: 1. Apparent mild staphylomatous deformity of the right globe. 2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: s/p MVA, neck pain History: neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is no compromise of cervical spinal canal exiting nerve roots appreciated


Instruction: Generate impression based on findings.

Input: Gait disturbance and back pain. History of surgically corrected mid thoracic spinal cord cyst, shunted pseudotumor cerebri, and neuropathy. There are postoperative findings related to T6 through T8 laminectomies. There is unchanged deformity and volume loss of the spinal cord at these levels. There is unchanged facet arthropathy that results in slight narrowing of the dorsal thecal sac from T5-6 through T8-9 and left-sided dorsal indentation at T10-11. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable.

Output: 1. Postoperative findings in the mid thoracic spine with spinal cord signal abnormality and deformity, perhaps with adhesion formation to the overlying dura posteriorly. 2. Unchanged facet arthropathy that results in slight narrowing of the dorsal thecal sac from T5-6 through T8-9 and left-sided dorsal indentation at T10-11.


Instruction: Generate impression based on findings.

Input: Right shoulder pain. No bony abnormality is seen. Unremarkable examination of the right shoulder.

Output: Normal appearing right shoulder with no findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: 53-year-old man with lower back pain and new left leg weakness. Evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. There is multilevel disc osteophyte complex formation with mild canal narrowing at C5-C6 and C6-C7. At L4-L5 there is disc herniation with mild narrowing of the canal. Also at the L4-L5 level the facets are noted to be edematous and degenerated.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Degenerative changes as described above. If further imaging evaluation is clinically warranted, nonemergent MRI of the lumbar spine could be considered.


Instruction: Generate impression based on findings.

Input: 61-year-old male with HCV, cirrhosis, status post hepatectomy for HCC ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation. T2 hyperintense lesion in the gallbladder bed likely represents a remnant cystic duct.T2 and T1 high signal in the dome of the right lobe of the liver, segment seven, compatible with resection cavity with probable blood products. No abnormal enhancement at the margins of the resection cavity. No new focal liver lesions.The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter porta hepatis lymph nodes not pathologically enlarged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post surgical changes of a right hepatic dome resection with no specific evidence of local recurrence. No new suspicious liver lesions.


Instruction: Generate impression based on findings.

Input: Male, 27 years old, with bilateral ischemic infarcts. Assess for vascular stenosis. Also with radiculopathy/plexopathy of the right lower extremity was lower motor neuron and upper motoneuron signs. MRA Neck:Conventional aortic branching is seen. The origins of the great vessels are patent. No significant vascular stenosis is seen within the carotid circulation of the neck by NASCET criteria. No significant stenosis is seen within the vertebral vessels of the neck. The left vertebral artery is dominant.MRA Head:No evidence of significant vascular stenosis or occlusion is seen. No aneurysms or other vascular abnormalities are detected. The right vertebral artery appears to terminate in the right PICA, an anatomic variation.Lumbar spine:T2 hyperintensity and edema affects the right iliacus and iliopsoas muscle bundles. On postcontrast images, small areas of rim enhancement with central hypoenhancement are seen within the iliopsoas musculature. The adjacent marrow of the iliac bone, however, shows normal signal intensity and is free of pathologic enhancement.Mild T2 hyperintensity also affects the obturator and abductor muscles of the right hip, and to a lesser degree the right gluteal muscles. A small amount of tracking fluid is evident within the right retroperitoneum. T2 hyperintensity is also seen within the subcutaneous tissues along the right hip and flank.Although the nerve roots of the lumbar plexus do pass in proximity to the abnormal musculature as discussed above, no discrete nerve lesion is appreciated on this examination. The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits. No pathologic intramedullary or leptomeningeal enhancement is seen.Lumbar spine alignment is anatomic. Vertebral body morphology is normal. No pathologic marrow signal abnormality or enhancement is seen.The intervertebral disks are preserved with no evidence of significant bulging or herniation. No spinal canal or neuroforaminal stenosis is appreciated.

Output: 1.Soft tissue and musculoskeletal injury is seen involving the structures of the right hip girdle as discussed above. Small areas of rim enhancement within the iliopsoas musculature are favored to represent muscle fiber injury with perhaps a small amount of blood product. Infection is not excluded but is considered less likely, particularly in the absence of any clinical or laboratory evidence. Overall, these findings are of uncertain etiology but could be traumatic and related to seizure and fall. A myositis of some other etiology may also be considered.2.No discrete injury to the nerves of the lumbar plexus is suspected. However, these nodes do traverse in proximity to the injured hip musculature and as such they may be affected by the adjacent inflammation.3.The lumbar spine itself is unremarkable with no evidence of osseous injury or significant spinal canal or neuroforaminal stenosis.4.Unremarkable MRA evaluations of the head and neck.


Instruction: Generate impression based on findings.

Input: Ms. Deborah White is a 65 year old female with a personal history of left breast mastectomy in 12/2014 for IDC triple negative followed chemotherapy. She has a family history of breast cancer in her sister, paternal aunt, and paternal cousin. She has no current breast related complaints. MAMMOGRAM: Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Stable benign calcifications are present in the superior right breast. An oval mass is noted in the lower inner right breast, which correlates with a nonenhancing mass on the prior MRI and is compatible with a benign etiology. There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in the right breast.

Output: No mammographic evidence of malignancy in the right breast. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with severe right-sided headache and neck pain. Patchy periventricular T2 hyperintensity is seen along with numerous scattered subcortical foci of T2 signal abnormality. Prominent patchy T2 hyperintensity is also noted within the pons.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.

Output: 1. No acute intracranial abnormality and no specific findings are seen which would clearly account for the patient's symptoms.2. Note is made of fairly extensive white matter signal abnormality which is nonspecific. These findings most commonly represent chronic microvascular ischemic disease, although other etiologies including demyelination, vasculitis, and sequela of prior inflammation may also be considered.


Instruction: Generate impression based on findings.

Input: Intraventricular hemorrhage with ventriculomegaly. There is marked dilatation of the third and lateral ventricles and diffuse thinning of the periventricular white matter. The fourth ventricles is also enlarged. There is a small right transfrontal ventricular catheter. There is absence of muc of the septum pellucidum and there is a thin septation that traverses the frontal horn of the left lateral ventricle. There is susceptibility effect in the bilateral occipital horns and left caudothalamic groove region. There is also susceptibility effect in right cerebellar hemisphere, with extensive encephalomalacia of the inferior right cerebellar hemisphere. There are a few other scattered foci of susceptibility effect in the vermis and left cerebellar hemisphere. There is no evidence of intracranial mass or acute infarct. 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: Diffuse ventricular enlargement may represent communicating hydrocephalus and apparent periventricular leukomalacia may be related to prior germinal matrix hemorrhage with intraventricular hemorrhage. Sequela of prior right inferior cerebellar hemorrhagic infarction and smaller areas of chronic hemorrhage in the rest of the cerebellum are also apparent.


Instruction: Generate impression based on findings.

Input: 59 years, Female, with disequilibrium. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Multiple scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of infarct, hemorrhage, or intracranial mass. 2. Nonspecific foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter, likely representing mild to moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 41 year old female with non-ischemic cardiomyopathy, SLE, HTN, history of nephrotic syndrome and depression, history of low EF, now with fatigue. MRI to evaluate cardiac function. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 44%. The LVEDV is 181 ml (normal range 109+/-23), LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), LVESV is 102 ml (normal range 31+/-10), and LV end systolic volume index is 53 ml/m2 (normal range 18+/-5). The LV mass is 161 g (normal range 114+/-24) and the LV mass index is 84 g/m2 (normal range 67+/-11). There is hypokinesis of the inferolateral wall in the mid chamber. There is late gadolinium enhancement in the basal and mid ventricular inferoseptal and inferolateral walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time in the septum is 1098 ms which is at the high end of normal. The T1 myocardial relaxation time in the area of the late gadolinium enhancement is 1490 ms which is significantly elevated. These values are suggestive of some underlying diffuse fibrosis or infiltration. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 124 ml/m2 (normal range 69+/-14), the RVEDV is 65 ml (normal range 110+/-24), the RV end systolic volume index is 59 ml/m2 (normal range 22+/-8), and the RVESV is 31 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is thickened at the leaflet tips but opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsTrace pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Late gadolinium enhancement in the basal and mid ventricular inferoseptal and inferolateral walls suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process.2.Native T1 myocardial relaxation time in the IVS is 1098 ms which is at the high end of normal. 3.T1 myocardial relaxation time in the area of LGE is 1490 ms which is significantly elevated and suggestive of some underlying diffuse fibrosis or infiltration. 4.Mildly dilated left ventricle with mildly reduced systolic function.5.Normal sized right ventricle with normal systolic function.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with history of adenoid cystic carcinoma. Brain:No evidence of parenchymal edema or mass effect is seen. Diffusion-weighted images are normal. No pathologic parenchymal or extra-axial enhancement is seen. An incidental small developmental venous anomaly is seen within the left frontal lobe.Some residual pathologic soft tissue thickening and enhancement does remain evident within the left pterygopalatine fossa, foramen ovale, foramen rotundum, and to a mild degree in the left cavernous sinus. This soft tissue process has, however, improved when compared to the prior neck MRI. The left parotid gland is smaller than the right which is a stable finding.Although this examination is not tailored for the assessment of the pituitary gland, the right aspect of the gland does remain larger and hypoenhancing relative to the left, a stable finding.No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. A small pineal cyst is noted incidentally.C-spine:Alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement, edema or pathologic marrow enhancement is seen.The visualized spinal cord is normal in signal intensity and morphology. No pathologic intramedullary or leptomeningeal enhancement is seen.Minimal disc degeneration is seen at C5-6 with a small annular fissure but no significant disc bulging or herniation. At no level is there any spinal canal or neuroforaminal stenosis.The paraspinal soft tissues are unremarkable.

Output: 1.No evidence of brain parenchymal metastatic disease.2.Interval improvement in the appearance of perineural disease spread involving the pterygopalatine fossa, foramina ovale and rotundum, and the left cavernous sinus. 3.Redemonstration of a lesion in the right aspect of the pituitary gland.4.No significant abnormalities in the cervical spine.


Instruction: Generate impression based on findings.

Input: 52 year old female with left sided weakness. Evaluate for CVA. White matter changes present with area of low attenuation found in the right internal capsule and subinsular white matter. An additional area of white matter change is located periventricularly on the left. Age of the lesions is indeterminate. This may represent microangiopathic disease, however cannot rule out other white matter disease. Further evaluation with MRI is recommended.

Output: White matter changes in the right internal capsule, subinsular region, and the left periventricular region. Further evaluation with MRI is recommended.


Instruction: Generate impression based on findings.

Input: 31-year-old female with left knee pain MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is increased signal intensity within the articular cartilage along the inferior aspect of the lateral facet of the patella suggesting early degeneration, however we see no fluid-filled articular cartilage defect. The articular cartilage of the medial and lateral compartments is intact. No abnormal marrow edema is evident.LIGAMENTS: The medial collateral ligament is intact. The lateral collateral ligament proper and biceps femoris tendon are intact. The iliotibial band is intact, however there is edema between the iliotibial band and lateral femoral condyle suggesting iliotibial band friction syndrome.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Iliotibial band fraction syndrome.2.Small joint effusion.3.Mild degeneration of the articular cartilage of the patella.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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. Mild mucosal thickening is present within the sphenoid sinuses and right maxillary sinus. The skull and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: 1.No evidence of mass or structural abnormality to account for patient's symptoms.2.Mild non-specific mucosal thickening in the paranasal sinuses.


Instruction: Generate impression based on findings.

Input: Cervical spine: There is no abnormal T2 signal in the cervical cord or abnormal enhancement. Vertebral body heights and alignment are normal. No significant spinal canal or neural foraminal stenosis is appreciated. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable. Thoracic spine: There is no abnormal T2 signal in the thoracic cord or abnormal enhancement. Vertebral body heights and alignment are normal. No significant spinal canal or neural foraminal stenosis is appreciated. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.

Output: No evidence of demyelinating lesions in the cervical or thoracic cord.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 traumatic brain injury and refractory epilepsy. Redemonstrated postsurgical changes from left frontal craniotomy. There is a left frontal ventriculostomy catheter with tip at the midline at the level of the foramen of Monro. There is gliosis related to a prior right frontal ventriculostomy catheter.Stable cystic encephalomalacia in the bilateral frontal lobes is not significantly changed from prior.The anterior horn of the left lateral ventricle remains decompressed. Moderate dilatation of the right lateral and third ventricles appears similar to prior. There is persistent midline shift to the left measuring 3 mm.The pituitary is stable in appearance and remains upper limits normal abutting the overlying optic chiasm and measuring 9 mm in craniocaudal dimension (previously 10 mm).The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Stable posttraumatic findings including extensive cystic encephalomalacia involving the bilateral frontal lobes.2. Left frontal ventriculostomy catheter with stable ventriculomegaly of the right lateral ventricle and third ventricle.3. Stable appearance of the pituitary gland which is upper limits of normal in size.


Instruction: Generate impression based on findings.

Input: Facial weakness [R29.810] / Other specified disorders of muscle [M62.89] / Dysarthria and anarthria [R47.1] / Dysphagia, unspecified [R13.10], Reason for Study: ^Reason: please eval for stroke, CNS lymphoma History: pt with acute onset left hemiparesis, No evidence of acute ischemic or hemorrhagic lesion.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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 71-year-old female. Status post distal pancreatectomy for T1N0 IPMN in 2013. Patient has small cyst in body of pancreas. Evaluate for recurrence of IPMN or growth in body cyst. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic mass. Subcentimeter hepatic cyst, unchanged. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Post-surgical findings of distal pancreatectomy without local recurrence. Normal caliber of the main pancreatic duct. At the most anterior aspect of the residual pancreas, the previously seen cystic focus is less prominent, smaller in AP dimension though unchanged in longitudinal dimension at 6 mm (series 5, image 23), suggestive of an IPMN. Additional two tiny T2 hyperintense foci in the pancreatic head and neck are unchanged (series 10, images 22 and 20), likely additional small side branch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.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.Post-surgical changes of distal pancreatectomy without evidence of local recurrence.2.Decreased size of the cystic lesion at the anterior aspect of the residual pancreas. Other tiny cystic foci in the pancreas are unchanged, likely side-branch IPMNs.


Instruction: Generate impression based on findings.

Input: Female 24 years old Reason: structural abnormality underlying seizures? History: vertigo and seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses and scalp soft tissues are grossly unremarkable.

Output: Normal brain MRI examination.


Instruction: Generate impression based on findings.

Input: 55-year-old male. Patient with pain in left femur radiating to left buttock. Please evaluate for metastatic disease. History of metastatic melanoma. Pelvis: Numerous T1 hypointense and T2 hyperintense lesions in the pelvis (sacrum, bilateral ilia, right superior and inferior pubic rami, left ischium) and visualized lower lumbar spine consistent with metastases. Vertebral body and posterior element metastases are seen from L3 to L5 with posterior epidural extension of tumor at L4 causing partial effacement of the ventral thecal sac (series 6, image 3), which can be better evaluated with dedicated MRI lumbar spine imaging as clinically warranted. No pathologic fracture is identified.Left femur: Multiple T1 hypointense and T2 hyperintense medullary metastases are seen mostly from the intertrochanteric region to the mid diaphysis. An additional small metastasis is seen in the distal femur (series 10, image 19). No cortical breakthrough of these lesions or pathologic fracture is evident. Post-surgical findings of left knee ACL reconstruction. Similarly in the right femur as seen on the large FOV images, there are multiple metastases mostly in the proximal to mid diaphysis.

Output: 1. Multiple pelvic and bilateral femoral metastasis without evidence of a pathologic fracture.2. Lower lumbar spine metastases from L3 to L5 with posterior epidural extension of tumor at L4. This can be further evaluated with dedicated MRI lumbar spine imaging as clinically warranted.


Instruction: Generate impression based on findings.

Input: Type II or unspecified type diabetes mellitus without mention of complication, not stated as uncontrolled [250.00], Reason for Study: CT evidence of acute ischemic stroke on the right temporal lobe. There is restricted diffusion on the left posterior aspect of the middle and inferior temporal lobe as well as left parietal lobe precuneus indicating acute to subacute ischemic infarction. On gradient echo images, the lesions show susceptibility artifacts indicating hemorrhagic transformation.There are other subtle restricted diffusion lesions including right frontal lobe middle frontal gyrus, right temporo-occipital gyrus, and left cerebellar hemisphere indicating subacute ischemic infarctions. Underlying brain show multifocal tissue defects on the right parietal lobe superior lobule, left thalamus and left cerebellar hemisphere indicating age indeterminate likely chronic ischemic infarction.There are mild non specific small vessel ischemic disease on FLAIR images.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The sphenoid sinus shows mucosal thickening.The right eyeball lens appears to be very thin indicating possible post-cataract surgery and the right eyeball shows elongated appearance indicating possible staphyloma.3D 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.No intracranial arterial aneurysm was seen.No significant arterial luminal stenosis.

Output: 1. Left temporal and parietal lobes acute or subacute ischemic infarctions with hemorrhagic transformation involving left middle and inferior temporal gyrus, left parietal lobe precuneus.2. Multifocal bihemispheric subacute ischemic infarctions as described above.3. Underlying brain shows multifocal chronic ischemic infarctions and non specific small vessel ischemic disease. 4. No intracranial arterial aneurysm. No intracranial arterial luminal stenosis or occlusion.5. Possible post cataract surgery status on the left eye lens and staphyloma on the right eyeball.


Instruction: Generate impression based on findings.

Input: 13073 IRB MRI screening There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Few small cysts noted in the right breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 72-year-old female with small cell lung cancer. Evaluate for metastasis. There are at least 12 enhancing lesions seen within the bilateral cerebral hemispheres and cerebellum. Many of these are very close to the or at the cortical surface concerning for involvement of the subarachnoid space. There is no definite cranial nerve enhancement. The lesions are all small with the largest along the medial aspect of the right middle cerebellar peduncle measuring 11 x 10 mm (series 10, image 54). Some of these lesions demonstrate mild surrounding T2 signal abnormality and 1 or 2 of these lesions produce very mild edema. There is no evidence of acute intracranial hemorrhage or hemorrhagic involvement of any of the lesions. Extensive underlying periventricular and subcortical white matter T2/FLAIR hyperintensity is seen most likely related to chronic small vessel ischemic disease. 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: Numerous, at least 12, enhancing intracranial lesions are seen compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: 77-year-old maleDiagnosis: Ataxia, unspecifiedClinical question: h/o cerebellar ataxiaSigns and Symptoms: preop planning for DBS The CSF spaces are appropriate for the patient's stated age with no midline shift. Redemonstrated is a mild degree of periventricular and subcortical hyperintense white matter lesions present identified on the T2 images. A high signal focus on T2 imaging is present in the pons. No abnormal mass lesions or foci of abnormal enhancement are appreciated intracranially. No edema is identified within the brain parenchyma. Normal vascular flow voids are present in the distal carotid and left vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery demonstrates a small focus of signal within the flow void which is also apparent as a filling defect on enhanced technique within the cisternal portion at the level of the foramen magnum. Mucosal thickening is again noted within a posterior right ethmoid air cell. The remaining visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities, unchanged. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Stable white matter changes of a mild degree are nonspecific, most likely vascular related, unchanged in appearance. 2.The right vertebral artery demonstrates a small focus of signal within the flow void which is also apparent as a filling defect on enhanced technique within the cisternal portion at the level of the foramen magnum. This may represent focal plaque or residua from prior occlusion. The T2 appearance is unchanged.


Instruction: Generate impression based on findings.

Input: New onset headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are punctate foci of high T2 signal in the subcortical white matter of the anterior right superior frontal gyrus and right inferior frontal gyrus. The brain parenchyma otherwise appears 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a left sphenoid sinus retention cyst.

Output: Nonspecific punctate foci of high T2 signal in the subcortical white matter of the anterior right superior frontal gyrus and right inferior frontal gyrus. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are mammogram dated 5/12/2016 and breast MRI 7/13/2016 performed at Rush University Medical Center. For comparison,mammogram 5/11/2015 is available. Mammogram 5/12/2016:The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. MRI breast 7/13/2016:Uploaded on DYNACADHeterogenously dense breast density noted. Mild parenchymal enhancement noted in both breast. There is a 6 x 4 x 6 mm circumscribed benign morphology enhancing lesion with T2 correlate within the posterior depth at the 12:00 position within the right breast. This most likely represents a benign etiology such as complicated enhancing cyst or lymph node.No abnormal area of enhancement noted in both breasts or axillary regions.

Output: Given the benign morphology lesion within the posterior depth at the 12:00 position of the right breast, MR directed ultrasound is recommended to confirm benign etiology. If lesion is occult by ultrasound, short term MR follow-up is recommended in 6 months.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 43 year old with known left breast cancer. Evaluation of left axilla and left breast findings from MRI is requested. A targeted left ultrasound was performed for the areas of concern. Three suspicious left axillary nodes are seen. The largest of these measures 1.3 x 1.3 cm. One of the nodes retains a fatty hilum, but it has some non-hilar blood flow. In the left outer breast there are numerous simple and complicated cysts, however no suspicious morphology mass to correlate to the enhancement on MRI in the outer breast is present. In the left upper inner breast anterior to the index mass (which is well seen with internal biopsy clip artifact), there is a small 6 mm hypoechoic lesion located 1.3 cm anterior to the index mass that could be a correlate to the anterior satellite on MRI. Please note that the presence of innumerable cysts throughout the breast is somewhat of a limitation of this study.

Output: 1. Suspicious left axillary lymph nodes would be amenable to ultrasound guided biopsy.2. No suspicious morphology mass seen sonographically in the left outer breast to correlate to the enhancement on MRI. 3. Subtle potential correlate to the small satellite seen on MRI in the left inner breast anterior to the index lesion. If breast conservation is planned, then the following is suggested:A. Presuming a left axillary ultrasound guided biopsy will be done, also perform an ultrasound guided biopsy for the anterior satellite lesion.B. Subsequently, perform MRI biopsy for the left outer breast area of enhancement and at that time ensure that the biopsy clip from the satellite lesion correlates positionally to the finding on MRI. If it does not correlate, then perform an additional MR guided biopsy for the satellite. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:10/19/1942)Reason: CCM brain please do with CCM protocol on the 3 T scanner, headaches History: CCM brainPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM The temporal horns of lateral ventricles are mildly dilated. This appearance was previously present. Biventricular diameter at the level of the foramen of Monro on coronal imaging is 34 mm on the current exam and the same on the 6/9/2016 exam.On susceptibility weighted imaging there is signal loss along the surface of the brainstem and cortex compatible with cirrhosis. There is a hemorrhagic lesion present in the third ventricle anteriorly and inferiorly which was also present on the prior exam.No abnormal enhancing 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 mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Stable cerebral cavernous malformation located in the third ventricle. This is stable compared to previous exams.2.Mild ventriculomegaly remains stable.3.Siderosis suggests prior subarachnoid bleeding.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with a single brain metastasis, planning for stereotactic radiosurgery. An enhancing nodule is evident within the left inferior cerebellum measuring 14 x 11 mm. It does not appear that this lesion induces significant local edema. No intracranial hemorrhage is suspected. No abnormal extra axial fluid collections are seen. The ventricles are normal in size and morphology.

Output: A solitary nodule is evident within the left inferior cerebellum.