Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: altered mental status, recent seizure, assess for evidence of infection vs lupus cerebritis History: see above There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Minimal scattered high signal intensity lesions on FLAIR imaging periventricular white matter are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal nonspecific small vessel disease as described above.


Instruction: Generate impression based on findings.

Input: Reason: Is there a stress fracture of the cuboid or elsewhere History: lateral foot pain in a runner Bone marrow edema in the anterior talus adjacent to the sinus tarsi representing bone contusion. No distinct fracture line is identified.

Output: Bone contusion of the anterior talus. No definite stress fracture.


Instruction: Generate impression based on findings.

Input: Headache. Suggestion of a colloid cyst on a recent CT scan. The study is limited by artifact from dental braces. This obscures a significant part of the anterior frontal and temporal lobes as well as the posterior fossa on diffusion and susceptibility weighted imaging and causes significant artifact on the other sequences. There is no acute infarct or intracranial hemorrhage in the posterior superior part of the brainIn the very anterior aspect of the third ventricle and just posterior to the fornices, there is question of a subcentimeter T1 isointense, T2-hyperintense (relative to gray matter) structure that is eccentric to the right, but this is not definitively seen. The ventricles are normal in size as well as the other CSF-containing spaces. There are few nonspecific scattered T2/FLAIR-hyperintense foci in the cerebral white-matter. The brain shows no gross abnormality otherwise. There is no mass-effect or midline shift. The major intracranial vascular flow voids are preserved. There is no destructive skull lesion and the mastoid air cells are clear. The paranasal sinuses are obscured.

Output: Limited examination due to patient's braces. There remains a question of a subcentimeter lesion at the foramen of Monro/anterior third ventricle possibly representing a colloid cyst. Due to artifact however the presence of this lesion cannot be confirmed. As such would recommend a follow-up study with gadolinium including 3-D T1 and 3-D T2 sequences at 3 Tesla, preferably without dental hardware if possible. MRI examination of the brain is otherwise unremarkable for age without evidence of intracranial mass effect or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 75-year-old female with recent onset of seizures, possible "cerebral T waves" on EEG. Questionable personality changes. No known falls/head trauma. No prior imaging of brain at this hospital. Evaluate for ischemic injury or mass effect. Many sequences are limited by motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are areas of encephalomalacia in the bilateral thalami and basal ganglia, as well as the left pons. There are punctate areas of susceptibility abnormality in the left thalamus as well as the bilateral basal ganglia, which may indicate prior hypertensive encephalopathy. There is moderate periventricular and subcortical T2 hyperintensity, which is nonspecific, but likely represents chronic small vessel ischemic disease. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid in the mastoid air cells bilaterally, as well as mucosal thickening involving the right maxillary sinus. The skull and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. Chronic lacunar infarcts in the bilateral deep grey nuclei and pons, as well as scattered microhemorrhages, superimposed upon a background of white matter disease, indicate prior hypertensive encephalopathy, but no evidence of acute infarct.2. Diffuse cerebral volume loss. 3. No evidence of intracranial mass.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68 years Male (DOB:9/20/1947)Reason: h/o head and neck cancer, here w/ confusion/agitation/delerium of unknown etiology History: confusion/agitationPROVIDER/ATTENDING NAME: TRACY E CARDIN ANITA N. KALLEPALLI The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is nonenhancing exophytic millimeter diameter focus in the frontal horn of the right lateral ventricle which was also identified on the prior exam and has not changed.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 demonstrate partial opacification right mastoid air cells which is unchanged since prior exam. The visualized portions of the orbits are intact.

Output: An exophytic focus at the frontal horn right lateral ventricle is unchanged since the prior exam. It is too small to characterize. Its clinical significance is uncertain. It does not have imaging features characteristic of neoplasm.No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: MRA Brain:The A1 segment of the left ACA shows irregular multifocal narrowings. The ACOM is normal. The A2 segment of left ACA also shows multifocal luminal narrowings and irregularities. The left pericallosal and calloso-marginal arteries are not clearly delineated.The M1 segment of bilateral middle cerebral arteries show multifocal luminal stenosis. The degree of stenosis is more than 50% in some lesions. However, the distal flow appears to be maintained.There is long segment narrowing and irregularity of the basilar artery which is significantly stenotic, the degree of stenosis appears to be more than 75%.The right distal vertebral artery demonstrates irregular luminal narrowing and the right vertebrobasilar junction is not visualized. The left vertebral artery is not seen.Contrast enhanced neck MRI is non-diagnostic due to arterial bolus of contrast was missed for arterial phase imaging. If clinical concern persists, recommend MRA neck for complete evaluation. This will be performed without additional charge.

Output: Multifocal anterior and posterior circulation luminal narrowing and stenosis compatible with atherosclerotic changes as described.Possible high grade basilar artery stenosis.No intracranial aneurysm was found. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 54 year old female with biopsy proven invasive lobular carcinoma with LCIS in the right breast at two sites presents for breast MRI. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the right breast, there is a large hematoma at 3 o'clock position, measuring 24 x 28 x 27 mm (AP x LR x CC). There is a marker clip at the anterior-superior-lateral aspect of the hematoma. Another clip is identified 1 cm posterior medial from the hematoma.There is a segmental non-mass enhancement in the right inner breast, measuring 49 x 47 x 32 mm, encompassing the hematoma and two clips, corresponding to the proven ILC with LCIS. Distance from the most anterior aspect of non-mass enhancement to the nipple is 15 mm. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Extensive non-mass enhancement in the right breast, corresponding to the proven ILC with LCIS. Large hematoma in the right breast. 2. No abnormal enhancement in left breast. 3. No abnormal lymph nodes are identified in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Right foot swelling There is diffuse subcutaneous edema of the foot particularly along the dorsal aspect of the metatarsals. Overlying the base of the third through fifth metatarsals is lobulated, ill-defined collection of fluid signal intensity. Further evaluation is somewhat limited given lack of intravenous contrast.There are erosions of the midfoot and tarsometatarsal articulation particularly involving the base of the first, third, and fourth metatarsals. Additionally, there is erosion of the head of the first metatarsal with a large associated soft tissue component. There are scattered areas of increased T2 marrow signal particularly in the bases of the metatarsals however there is no corresponding low signal on T1 to suggest osteomyelitis. There is no abnormal joint fluid within the foot.

Output: 1. Scattered erosions of the midfoot and metatarsals with a soft tissue component associated head of the first metatarsal. These findings are more suggestive of an inflammatory arthropathy such as gout. Correlation with radiographs recommended. There is no abnormal T1 signal to suggest osteomyelitis and there is no evidence of abnormal joint fluid to suggest septic arthritis.2. Diffuse subcutaneous edema foot with an ill-defined lobulated collection of fluid along the bases of the third through fifth metatarsals. Evaluation limited given lack of intravenous contrast however these findings may reflect phlegmonous change.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with left leg weakness. Assess for stenosis. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Degenerative endplate signal alteration is seen at L5-S1. Otherwise, no worrisome marrow signal abnormality is detected.The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits.The intervertebral discs demonstrate loss of T2 signal. In addition, there is moderate loss of disc height at L5-S1. Additional level specific findings are as follows:L1-2: No significant spinal canal or neuroforaminal stenosis. L2-3: Minimal bilateral foraminal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Minimal bilateral foraminal disc bulge. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. L4-5: Severe right and moderate left facet hypertrophy. Mild ligamentum flavum thickening. Bulging disc with small superimposed left paracentral and right foraminal protrusions. Mild generalized spinal canal narrowing. Mild right foraminal narrowing. L5-S1: Moderate bilateral facet hypertrophy. Mild bulging disc. No significant spinal canal stenosis. Severe bilateral foraminal narrowing.

Output: 1.Mild generalized spinal canal stenosis at L4-5. No other significant spinal canal compromise is identified.2.Severe bilateral foraminal narrowing at L5-S1. Moderate foraminal narrowing on the right at L3-4.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: HIV, recurrent fevers, eval splenic fluid collection (abscess vs hematoma) History: see above ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged. The gallbladder wall is thickened with gallbladder wall edema and some mild pericholecystic fluid. No gallstones are evident. No biliary ductal dilatation. There is a focal mildly T2 hyperintense lesion in segment 5/8 of the liver along its periphery measuring 3.5 x 2.3 cm (image 26/series 601). The lesion shows mild enhancement on portal venous phase imaging. Imaging features are not specific.The hepatic and portal veins are patent.SPLEEN: Spleen is enlarged. Along the posterior aspect of the spleen there is a small fluid collection possibly containing within its capsule measuring 4.1 x 1.7 cm (image 27/series 601). There is a wedge-shaped area of poor perfusion within the splenic parenchyma adjacent to the fluid collection.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcapsular splenic fluid collection possibly representing a peripheral infarction with abscess or hematoma.2.3.5 cm right hepatic lobe lesion with nonspecific imaging features.3.Gallbladder wall edema and associated pericholecystic fluid. Imaging findings are nonspecific but acalculus cholecystitis or cholangiopathy can't have similar features.


Instruction: Generate impression based on findings.

Input: 53 year old with personal history of left breast cancer status post mastectomy. There is heterogeneous amount of fibroglandular tissue in the right breast. The patient is status post left mastectomy. Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast or left chest wall. A few benign right breast foci, including an upper inner breast focus that is compatible with a normal sized intramammary lymph node, are again seen. No abnormal lymph nodes are identified in either axillary region. Post-operative appearance of the left axilla is stable.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 24 year-old woman with history of swelling, pain, and tenderness to palpation over the medial aspect of the joint. Additional history as per patient chart states the patient fell recently. MENISCI: The lateral and medial menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is abnormal, curvilinear signal intensity in the lateral tibial plateau with surrounding edema signal. This likely represents a fracture, however the fracture fragment does not appear significantly displaced. The marrow signal of the distal femur appears normal.The articular cartilage of the patellofemoral and tibiofemoral compartments is intact.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Lateral tibial plateau fracture. This finding was discussed with Lynn Goody-Colamussi in person at 10:05AM.


Instruction: Generate impression based on findings.

Input: 60-year-old woman with left shoulder pain. Evaluate for rotator cuff tear. ROTATOR CUFF: There is a partial tear of the supraspinatus tendon near its attachment at the greater tuberosity. There is no muscle atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Partial tear of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the right maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are clear. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: Negative MRI of the brain and internal auditory canals.


Instruction: Generate impression based on findings.

Input: 76-year-old male with autoimmune sclerosing cholangitis. Evaluate for cholangiocarcinoma or dominant stricture. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular surface contour. No focal hepatic lesions. No biliary ductal dilation. Patent portal and hepatic veins.Stable wall thickening of the common duct just proximal to the biliary enteric anastomosis, which is nonspecific and may be related to postoperative change. MRCP images are limited due to large amount of ascites.SPLEEN: Moderate splenomegaly.PANCREAS: Postoperative changes from modified Whipple's procedure, similar to prior exam. Again, the pancreatic duct is mildly dilated with atrophy of the pancreatic pancreatic parenchyma, compatible with chronic pancreatitis. No focal pancreatic lesions are evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderately enlarged mesenteric and superior trabecular lymph nodes are not significantly changed.RETROPERITONEUM, LYMPH NODES: Postoperative changes from gastrojejunostomy anastomosis. No evidence of bowel obstruction.BOWEL, MESENTERY: Large amount of abdominal ascites, new since prior exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Redemonstration gastrosplenic and paraesophageal varices.

Output: 1.No significant interval change in postoperative findings from modified Whipple's procedure and chronic pancreatitis of the residual pancreas.2.No significant interval change in postoperative changes from biliary enteric anastomosis with stable mild wall thickening of the common duct near the anastomosis, likely related to postoperative change. No biliary ductal dilation.3.Large amount of abdominal ascites, new since prior exam.


Instruction: Generate impression based on findings.

Input: There are numerous (greater than 10) intra-axial heterogeneously enhancing metastases, predominantly in the supratentorial brain and possibly a single 2-mm enhancing nodule in the superior aspect of the left cerebellar hemisphere on series 1300 image 117. A few representative lesions and measurements are as below:1.right temporal/occipital region on series 14 image 18 measuring 16 x 19 mm with moderate surrounding vasogenic edema2.left parietal lobe measuring 13 x 16 mm on series 14 image 11 with mild surrounding vasogenic edema3.left inferior parietal lobule measuring 13 x 11 mm on series 14 image 9 with moderate surrounding vasogenic edema and susceptibility effect suggesting hemorrhagic lesionThere are multiple other lesions scattered in the supratentorial brain with mild to moderate degrees of surrounding vasogenic edema. There is a background of numerous small scattered T2 hyperintensities in the supratentorial brain and in the central pons which are nonspecific. There is no acute infarct, herniation or midline shift.

Output: Numerous intra-axial metastases as described above, the largest in the right temporal/parietal region.


Instruction: Generate impression based on findings.

Input: Male 14 years old Reason: Determine degree of RV-PA conduit obstruction History: S/p truncus arteriosus - 21 mm pericardial valve (Edward's Magna) and PA bifurcation plasty Body surface is 1.8 m2.Left VentricleThe left ventricle is enlarged. The overall LV ejection fraction is 56.9%, the LV end diastolic volume index is 123.9 ml/m2 (normal range: 74+/-15), the LVEDV is 229.8 ml (normal range 142+/-34), the LV end systolic volume index is 53.4 ml/m2 (normal range 25+/-9), the LVESV is 99.07 ml (normal range 47+/-19), the LV mass index is 73.5 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. No ASD is noted after repairRight VentricleThe right ventricle is enlarged. The overall RV ejection fraction is 39.06%, the RV end diastolic volume index is 113.2 ml/m2 (normal range 82+/-16), the RVEDV is 210.3 ml (normal range 142+/-31), the RV end systolic volume index is 69.1 ml/m2 (normal range 31+/-9), and the RVESV is 120.2 ml (normal range 54+/-17). Right AtriumThe right atrium enlarged with no evidence of ASD after repair. Aortic ValveThe aortic/truncal valve opens widely. Trileaflet valve is noted. Significant regurgitant is noted as described below.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta/truncus is enlarged. There is a left sided aortic arch.AORTA MEASUREMENTS: aortic valve ring: 23 mmsinuses of Valsalva: 26 mmsinotubular junction: 24 mmascending aorta: 31 mmaortic arch: 22 mmdescending aorta: 21 mmdiaphragmatic hiatus: 18 mmAORTA FLOW QUANTITATION: Stroke volume in ml: 49.8Forward flow volume in ml: 124.1Backward flow volume in ml: 74.3Regurgitant factor in %: 59.9Pulmonary ArteryThe main pulmonary artery conduit is normal in size with no evidence of strictures or calcifications. The left pulmonary artery appears to be narrowed. PULMONARY ARTERY MEASUREMENTS:MAIN: 28 mmRIGHT: 23 mmLEFT: 19 mm however the narrowest part of the left pulmonary artery adjacent to the main pulmonary activity conduit is 9.4 mm.PULMONARY ARTERIES FLOW QUANTITATION:Main pulmonary arteries flow quantitation values are as follows:Stroke volume in ml: 51.6Forward flow volume in ml: 87Backward flow volume in ml: 35.4Regurgitant factor in %: 40.7Right pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 10.8Forward flow volume in ml: 16.6Backward flow volume in ml: 5.9Regurgitant factor in %: 35.3Left pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 15.9Forward flow volume in ml: 35.7Backward flow volume in ml: 19.8Regurgitant factor in %: 55.5Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening but there is a small effusion.Extracardiac FindingsSternal wires are noted.

Output: 1. Status post truncus repair, VSD closure and placement of Rastelli conduit from RV to PA.2. Right and left ventricle and right atrium dilatation.3. Significant aortic regurgitation as described above.4. Left main pulmonary artery stenosis of approximately 50%5. Mild to moderate main, left and right pulmonary artery regurgitation as described above.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: 12-month-old female, evaluate left lower extremity for congenital anomaly The distal femur is bifurcated/duplicated with the distal epiphyseal ossification center noted along its lateral aspect. The cartilage of the medial aspect of the bifurcated distal femur is situated anteriorly. The quadriceps tendon courses distally around the medial aspect of the distal femur and extends to the cartilage of the proximal fibula which is prominent and may contain a portion of patella cartilage. The tibia is absent. The fibula is slightly bowed and articulates with the lateral femoral epiphysis and distally with the talus. A clubfoot deformity is identified. The soft tissues appear normal. The bone marrow signal is normal for the patient's age. The bladder is moderately distended.

Output: Duplicated/bifurcated distal femur, absent tibia, and clubfoot deformity as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Altered mental status. Nonenhanced head CT:There is no detectable intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white differentiation remains within normal.Calvarium is intact. Paranasal sinuses and mastoid air cells are unremarkable. Limited views of the orbits demonstrate thickening of the extraocular musculature on the left and crowding of the retro-orbital space. There is also suspected increased density of the retro-orbital fat. Correlate weighted physical exam. Recommend enhanced MRI or dedicated CT of orbit with enhancement.

Output: 1.No evidence of intracranial abnormality.2.Apparent thickening of the extraocular musculature on the left side with crowding of the retro-orbital space and poor visualization of retro-orbital fat. Recommend dedicated MRI or CT of orbits.


Instruction: Generate impression based on findings.

Input: Reason: meniscal or ligamentous damage? History: limited ROM to flexion and extension, pain in fossae and lateral joint line Patient motion artifact results in suboptimal image quality on multiple sequences.MENISCI: There is branching linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the periphery of the meniscus as well as to the tibial and femoral articular surface indicating a complex tear with a large longitudinal component. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Evaluation of the patellofemoral articulation is limited due to the aforementioned patient motion artifact. There is linear decreased signal abnormality within the articular cartilage along the lateral facet of the patella which may represent an articular cartilage fissure. Increased bone marrow signal abnormality within the posterior aspect of the lateral tibial plateau and medial femoral condyleLIGAMENTS: There is complete disruption of the ACL through its mid substance fibers. The PCL appears intact. The MCL and LCL appear intact given the aforementioned limitations due to patient motion artifact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Patient motion artifact limits examination. 1. Complex tear of the posterior horn of the medial meniscus.2. Rupture of the ACL through its midsubstance fibers.3. Bone contusions of the lateral tibial plateau and medial femoral condyle.


Instruction: Generate impression based on findings.

Input: 54-year-old female with metastatic uveal melanoma status post embolization and RFA of liver metastases, now status post 4 cycles of therapy. Evaluate liver for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Immediately anterior to the ablation cavity, there is an arterially enhancing and washing out lesion in the caudate lobe measuring approximately 1.4 x 1.1 cm (series 9, image 59), previously measuring 0.6 x 0.6 cm. There is a segment 6 T2 hyperintense lesion with peripheral nodular discontinuous enhancement, which measures 1.8 x 1.8 cm (series 3, image 23), compatible with a hemangioma. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Anterior to the caudate lobe ablation cavity, there is an arterially enhancing and washing out lesion, which is increased in size.2.Segment 6 hemangioma.


Instruction: Generate impression based on findings.

Input: Female 44 years old with right shoulder pain and limited range of motion. Evaluate for rotator cuff tear, labral tear, adhesive capsulitis. ROTATOR CUFF: There is thinning of the supraspinatus tendon just proximal to its insertion with irregularity of the undersurface fibers indicating partial thickness tearing involving less than 50% of the tendon thickness. Although we see no discrete full-thickness tear, there is mild diffuse increased signal intensity within the distal 1 cm supraspinatus tendon anteriorly with a small amount of gadolinium in the overlying subdeltoid bursa suggesting a full-thickness perforation of the tendon that is below the resolution of this study. We see no tendon retraction. The supraspinatus muscle appears normal. The infraspinatus, teres minor and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. Again seen is a small amount of gadolinium in the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There may be a tiny articular cartilage defect along the anterior glenoid but this is equivocal. We see no labral tear.BICEPS TENDON: The tendon of the long head of the biceps is perhaps slightly perched on the lesser tubercle but otherwise appears normal. ADDITIONAL

Output: 1.Although we see no discrete full-thickness rotator cuff tear, increased signal intensity in the distal supraspinatus tendon along with gadolinium in the subdeltoid bursa suggests a perforation that is beneath the resolution of this study. There is also partial-thickness tearing of the undersurface supraspinatus tendon fibers more proximally.2.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 33 years old, with history of AIDS, off HAART, presenting with headache for about one year and worsening vision. The sulci and ventricles are more prominent than expected for a patient of this age. Prominence of the CSF space along the posterior left cerebellum is also seen. No additional abnormal fluid is detected. No evidence of intracranial hemorrhage is seen.Two small foci of parenchymal T2 hyperintensity are evident, one within the right middle frontal gyrus and one within the right superior frontal gyrus. These are associated with no mass effect or pathologic enhancement. In fact, no evidence of pathologic parenchymal or extra-axial enhancement is identified anywhere. No significant parenchymal edema or mass effect is seen.Paranasal sinus mucosal thickening is evident in the right maxillary sinus and right ethmoid air cells. A mucus retention cyst is seen in the left maxillary sinus. The orbits as visualized are unremarkable though this is a nondedicated exam.

Output: 1.Cerebral volume loss greater than expected for the patient's age likely representing sequela of HIV infection.2.Two small nonspecific parenchymal lesions are seen. No evidence of parenchymal edema or pathologic parenchymal or extra-axial enhancement is detected. No findings are seen to suggest intracranial tumor or opportunistic infection.3.Normal variant cisterna magna or perhaps an arachnoid cyst within the left posterior fossa.4.Sinus mucosal inflammatory disease.


Instruction: Generate impression based on findings.

Input: Reason: eval for chronic tenosynovitis History: swelling/pain at wrist LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No evidence of tenosynovitis of the flexor tendons. Extensor tendons are involved in the diffuse swelling of the soft tissue, which limits evaluation of tenosynovitis.BONES: No significant abnormality noted.ADDITIONAL

Output: 1.Diffuse soft tissue swelling and inflammatory changes.2.No evidence of tenosynovitis of the flexor tendons.Extensor tendons are involved in the diffuse swelling of the soft tissue, which limits evaluation of tenosynovitis.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE: The cervical spine is in normal alignment. The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. C2-C3: No significant disc bulge, herniation, spinal canal or foraminal stenosis.C3-C4: Bilateral uncovertebral spurs contributing to mild bilateral, worse on the left, foraminal stenosis. No significant disc bulge, herniation, or spinal canal stenosis.C4-C5: Mild disc bulge and uncovertebral spurs contributing to mild right foraminal stenosis. No significant spinal canal or left foraminal stenosis.C5-C6: Mild disc bulge and uncovertebral spurs contributing to mild spinal canal stenosis and mild right greater than left foraminal stenosis. C6-C7: Disc bulge with superimposed right foraminal disc protrusion and uncovertebral spurs, contributing to mild spinal canal stenosis and moderate bilateral foraminal stenosis. C7-T1: Mild disc bulge and uncovertebral spurs, contributing to mild left foraminal stenosis. No significant spinal canal or right foraminal stenosis.THORACIC SPINE: The spinal cord is of normal caliber and signal. The thoracic spine is in normal alignment. The vertebral body heights are well-maintained. There are foci of T1 hyperintense signal at T7 and T9, which likely represent fat-containing hemangiomas. No worrisome focal marrow signal abnormality is appreciated. There is mild loss of disc height at T8-T9 and T9-T10 and mild disc bulge at T8-T9. No significant spinal canal or foraminal stenosis within the thoracic spine. There is a 2.0 x 2.7 cm right thyroid mass. There are multiple enlarged mediastinal lymph nodes. There is a large left adrenal mass measuring 5.2 x 3.8 cm.

Output: 1. Mild degenerative changes in the cervical spine without high grade spinal canal stenosis. No cord signal abnormality. Individual levels as detailed above.2. Mild degenerative changes in the thoracic spine without significant spinal canal or foraminal stenosis. No cord signal abnormality.3. Please note postgadolinium sequences could not be obtained due to patient tolerance despite 2 attempts.4. There is a 2.0 x 2.7 cm right thyroid mass. There are multiple enlarged mediastinal lymph nodes. There is a large left adrenal mass measuring 5.2 x 3.8 cm. Consider dedicated CT evaluation.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with headache and known brain tumor. Evidence of prior right parietotemporal craniotomy is again seen. The previously demonstrated extensive, irregularly marginated and infiltrative enhancing lesions involving the right parietal lobe as well as the right periatrial white matter and posterior medial temporal lobe have significantly decreased in size. The quantity of enhancement is much reduced with only minimal speckled enhancement seen through most of the lesion. The degree of adjacent T2 hyperintensity and mass effect have also improved. A focus of susceptibility along the right precentral gyrus likely represents a biopsy marker. Ill-defined bilateral periventricular T2 hyperintensity is unchanged. The size and morphology of the ventricles are also unchanged. No new lesions are seen.

Output: Since the prior examination, the size of a previously quite extensive, infiltrative enhancing lesion involving the right parietal lobe and the periatrial white matter has substantially decreased in size. Associated T2 signal abnormality and edema have also improved.


Instruction: Generate impression based on findings.

Input: altered mental status, left temporoparietal ICH Redemonstration of the left temporoparietal ICH with surrounding edema.In addition, there are variable sized multiple susceptibility artifacts on bilateral hemispheres as well as bilateral thalami, brain stem and cerebellar hemispheres. These lesions indicate possible multifocal various aged hemorrhagic foci or possibility of cerebral amyloidosis.The left lateral ventricle occipital horn appears to be obliterated due to mass effect. However, there is no evidence of midline shift or herniation.There is focal restricted diffusion, on the right mesial thalamus indicating acute ischemic infarction. There is no evidence of ventriculomegaly. There is no evidence of abnormal enhancement.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin. Vertebrobasilar system appears to be normal.

Output: 1. Re demonstration of the left temporo-parietal ICH with minimal surrounding edema and mass effect.2. Multifocal variable sized susceptibility artifact lesions indicate possible cerebral amyloidosis or multiple various aged hemorrhagic foci.3. Focal ischemic stroke on the right thalamus.4. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 37 years Male (DOB:9/1/1978)Reason: hx of astrocytoma, evidence of progression or meningeal enhancement History: chin numbnessPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY There is redemonstration of a nonenhancing mass located in the midbrain and centered in the right posterior paramedian aspect measuring 18 x 21 mm axial dimensions and 19 x 22 mm coronal dimensions. On the prior exam measured 18 x 21 mm coronal dimensions this mass is well-circumscribed. It has a cerebral blood volume characteristics and are similar to white matter on the current exam.. The aqueduct of Sylvius appears to be narrowed, however, the lateral ventricles do not appear to be significantly enlargedThere is redemonstration of a tract of T2 signal hyperintensity emanating from a burr hole through the right frontal lobe into the right lateral ventricle which mostly represents a prior surgical tractNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right A1 segment appears to be very small.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The right midbrain mass appears stable compared to prior exam. It is known to represent a low grade astrocytoma. No ventriculomegaly is appreciated on the current exam.


Instruction: Generate impression based on findings.

Input: View for soft tissue swelling. Status post fall after dad was assaulted while holding the patient. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No evidence of epidural hematoma. Ligamentous structures are intact. No appreciable edema in the prevertebral or paraspinous soft tissues.

Output: Unremarkable cervical spine MRI.


Instruction: Generate impression based on findings.

Input: 36-year-old male with history of Crohn's disease presents with fevers, chills, pain; evaluate for abscess. Status post recent fistula repair (on 2/5/2010) with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable hypodense lesions within the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Marked thickening of the terminal ileum and multiple loops of bowel appearing have resolved since the prior exam. The ileosigmoid fistula seen on the prior exam has been resected. There are post-op changes in the right lower quadrant from recent endocsopic procedure. Small amount of intraperitoneal fluid and subcutaneous / intraperitoneal gas are attributed to post-op changes. Contrast is present in the terminal ileum, but not the sigmoid, suggesting that the fistula has been repaired. BONES, SOFT TISSUES: No significant abnormality notedOTHER: New fluid collections with gas bubbles in the rectus muscles near the midline bilaterally, seen best on axial image 93/163 of series 12 and coronal image 67 have enhancing rims, compatible with abscess. These are new since the prior exam. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Prominent bladder.LYMPH NODES: Borderline enlarged inguinal nodes. No other significant abnormality.BOWEL, MESENTERY: Rectal intramural fistula tract extending to the scrotum is reidentified and is subtle; however, this is incompletely evaluated by CT and may be better seen with MRI, if indicated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Ileitis with narrowing of the terminal ileum and fistula between the ileum and the sigmoid colon have resolved since the prior exam. 2. A rectal intramural fistula to the scrotum is less prominent on this exam; however, it is incompletely evaluated on CT and MRI is recommended, if indicated.3. New abscess in the rectal sheath bilaterally.


Instruction: Generate impression based on findings.

Input: Known right breast cancer, MRI #4 on I-SPY 2 protocol. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Again, the index lesion in the right breast 3:00 position posteriorly or the biopsied satellite lesion are not visualized on post-contrast images. Other satellite lesions are not seen above the level of background enhancement. Few scattered nodular enhancements are likely background parenchymal enhancement.The axillary biopsy clip is present. All right axillary nodes are normal in morphology. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in left axillary region.

Output: Complete imaging resolution of known right breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: dysphasia with muscular dysfunction and Atrial fibrillation. No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal diffuse brain atrophy with prominent ventricular system.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 on this scan.No abnormal Gad enhancement.


Instruction: Generate impression based on findings.

Input: Blurry vision. Follow up ADEM. There is interval decrease in the T2 signal of the right anterior medulla involving the pyramid with trace residual signal. This is not associated with mass effect. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass effect, or acute infarct.2. Interval decrease in T2 signal intensity of the right anterior medulla. No new lesions are identified.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: oligodendroglioma. S/p RT and PCV. Please compare to prior MRI and older MRIs.Signs and Symptoms: oligodendroglioma.Comments: Oligodendroglioma s/p surgery, RT, and now PCV. Please compare to prior MRI and earlier MRIs. | The patient is status post right frontal craniotomy for removal of a predominantly nonenhancing right frontal lobe mass known to represent oligodendroglioma. There is contrast enhancement along the surgical margins . Some susceptibility effect is present along the resection margins in the right frontal lobe which was also present on the prior exam. Some T2 signal changes present along the brain parenchyma adjacent to the resection margins remains.A focus of diffusion restriction present present in the right half the genu of the corpus callosum no longer displays diffusion restriction and is smaller on the current exam. There is now ex vacuo effect of the frontal horn of the right lateral ventricle adjacent to the site of this previously noted focus of diffusion restriction.There is confluent signal change present adjacent to the frontal horns of the lateral ventricles bilaterally which is increased since the prior exam.Since the prior exam there postoperative changes have regressed.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 mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no convincing evidence for recurrent tumor at this time.2.There is some periventricular white matter signal change present which is suspected to be treatment related.


Instruction: Generate impression based on findings.

Input: Ms. Wilson is a 67-year-old female presenting with mammographically detected pleomorphic calcifications in a segmental distribution with sonographic correlates in the left breast. Of note, she is scheduled for a two-site ultrasound guided biopsy of the left breast immediately following the MRI examination. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left lower outer breast, there is a 7.8 x 4.1 cm span of segmentally distributed clumped nonmass enhancement. The nonmass enhancement extends up to the nipple base. Within this clumped nonmass enhancement are several discrete irregular masses, the largest of which measures approximately 1.2 cm at the posterior-most extent. This suspicious area of clumped nonmass enhancement corresponds in location and distribution to the 7cm span of segmentally distributed pleomorphic calcifications identified on the diagnostic mammogram. No additional abnormal enhancement is identified in the left breast. Specifically, there is no abnormal enhancement at the site of mammographically detected 0.4 cm cluster of calcifications in the left upper outer breast.Several normal axillary lymph nodes are identified in the left axillary region.In the right breast, there is no abnormal enhancement identified. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: (1) Segmental distribution of clumped nonmass enhancement in the left lower outer breast, measuring approximately 7.8 cm, corresponding in location and distribution to the mammographically detected pleomorphic calcifications. A two-site ultrasound guided biopsy was performed on the same day as the MRI with clip placement. Of note, the two Hydromark clips (placed at the anterior and posterior extent of suspected disease) are separated by approximately 4.7 cm in the AP dimension.(2) Mammographically detected cluster of calcifications in the left upper outer breast with no associated abnormal MR enhancement. A 6 month mammographic follow-up is recommended in order to confirm stability of these calcifications. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Left knee pain and swelling, prior MPFL reconstruction and microfracture surgery Note that images are suboptimal secondary to the patient's body habitus and inability to use the appropriate knee coil.MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Again seen is susceptibility artifact within the medial femoral condyle relating to prior MPFL repair with thickening/scarring along the medial femoral condyle. An additional area of susceptibility artifact is noted within the patella centrally which is also postsurgical in nature. There is mild heterogeneity of the articular cartilage of the patella but otherwise there are no full-thickness defect. The femoral trochlea appears shallow suggesting dysplasia and there is mild lateral translation of the patella with respect to the femoral trochlea. This appears unchanged from the prior exam. The articular cartilage of the lateral and medial compartments is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Limited exam demonstrating surgical changes of prior MPFL reconstruction with intact graft and scarring. There is otherwise no acute intra-articular pathology.


Instruction: Generate impression based on findings.

Input: Left sided arm and leg weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild patchy T2 hyperintensity in the cerebral white matter bilaterally. The ventricles and basal cisterns are normal in size and configuration. The pituitary gland is unchanged. 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 minimal fluid within the bilateral mastoid air cells.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild patchy T2 hyperintensity in the cerebral white matter bilaterally is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: assess for new stroke History: dysphagia Multifocal restricted diffusion lesions involving right middle frontal gyrus precentral gyrus postcentral gyrus right side insular cortex right temporal lobe as well as left occipital lobe indicating acute/subacute ischemic infarct involving left MCA and the right PCA territories.. There is no evidence of hemorrhagic conversion.Scattered several T2/flair high signal intensity lesions are seen on bilateral periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings with the retention cysts are seen on bilateral maxillary sinus.

Output: 1. Left MCA and right PCA territorial acute/subacute ischemic infarct without evidence of hemorrhagic conversion.2. Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: There is bone marrow edema within the posterior lateral humeral head along with some flattening , consistent with a Hill-Sachs deformity. ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the anterior inferior glenoid labrum consistent with a cartilaginous Bankart defectBICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Hill-Sachs deformity and Bankart deformity, both consistent with previous anterior dislocation


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with history of cavernoma and seizures. A lesion is evident centered on the left amygdala and hippocampal head showing bubbly internal T2 hyperintensity with a rim of susceptibility effect. This lesion measures up to 21 x 14 mm on the axial T2 weighted sequence (image 11 series 401). The lesion contacts the temporal horn of the left lateral ventricle. There is only minimal associated mass effect. The left basal vein of Rosenthal is somewhat prominent, but apart from this, there is no clear evidence of an associated developmental venous anomaly.No additional susceptibility inducing foci are seen within the brain. A developmental venous anomaly is, however, present within the right superior frontal gyrus. No pathologic parenchymal or extra-axial enhancement is observed.Diffusion-weighted images are unremarkable. A few scattered small foci of T2 hyperintensity are demonstrated in the cerebral white matter, the basal ganglia on the left thalamus, a nonspecific finding. No parenchymal edema or significant mass effect is observed. No abnormal extra-axial fluid collections are identified. The ventricular system is normal in size and morphology.Opacification of the right mastoid air cells is seen. Bone marrow signal characteristics are unremarkable.

Output: 1.Cavernous malformation of the left medial temporal lobe with involvement of the amygdala and hippocampal head. Although the adjacent left basal vein of Rosenthal is slightly prominent, no definite evidence of an associated developmental venous anomaly is seen.2.No additional susceptibility inducing lesions are seen in the brain. Incidental note is made of a developmental venous anomaly in the right superior frontal gyrus.


Instruction: Generate impression based on findings.

Input: 34-year-old male with stiffness of the left ankle. Rule out syndesmotic lower tib-fib ligament tear. TENDONS: The flexor tendons appear intact. Extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is unremarkable.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized portions of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the lateral aspect of the talar dome and posterior aspect of the tibial plafond. There is partial-thickness articular cartilage degeneration along the lateral aspect of the tibial plafond. There is no evidence of an osteochondral defect. No full thickness or near full thickness articular cartilage defects are identified.ADDITIONAL

Output: Bone contusions within the talar dome and posterior tibial plafond as described above.


Instruction: Generate impression based on findings.

Input: Reason: h/o right frontal meningioma s/p cyberknife and left intraventricular tumor History: surveillance Images are somewhat limited by patient motion, especially postcontrast imaging. There is a stable slightly heterogeneously enhancing mass in the expanded left ventricular trigone, which measures 3.0 x 3.2 cm in greatest axial dimensions, essentially unchanged from previous measurement of 2.9 x 3.2 cm when allowing for differences in technique. Is is also similar to remote measurements from May 2013.There has been no significant increase in size of a smaller right frontal convexity dural based extra-axial mass, which measures 15 x 11 mm compared to previous 14 x 11 mm in April 2015. However compared to the more remote May 2013 exam, there has been interval increased in size from prior measurement of 12 x 8 mm. There is an additional more caudally located tiny enhancing extra-axial dural based nodule along the inferior frontal lobe measuring 6 x 6 mm on 12/99, slightly increased in size from 5 x 5 mm in April 2015, and 4 x 4 mm in May 2013.The ventricles and sulci are otherwise within normal limits. The cisterns remain patent. There is no midline shift. A few stable small scattered foci of T2/FLAIR hyperintensity within the white matter remain nonspecific. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. There is slight focal prominence of extra-axial space along the left lateral posterior fossa with questioned mild flattening of the adjacent cerebellar parenchyma, which could relate to a small arachnoid cyst.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a stable enhancing focus along the right parietal bone which is nonspecific.

Output: 1.Stable presumed left intraventricular meningioma.2.Stable smaller presumed right frontal convexity meningioma when compared to the most recent prior exam, although slightly increased in size since May 2013.3.Progressive slight increased size of a subcentimeter right anterior cranial fossa floor presumed meningioma when compared back to 2013.


Instruction: Generate impression based on findings.

Input: Recurrent adenoid cystic carcinoma, status post radiation and surgery. There is no evidence of intracranial hemorrhage or infarction. There are scattered hypoattenuating foci in bilateral cerebral white matter, which may represent small vessel ischemic changes.Extensive post-treatment changes are again present involving the left orbit, maxillary region and upper neck. Again noted are enhancing soft tissue lesion involving the left orbit, extending to the orbital apex, superior and inferior orbital fissure. There is extension into the region of the left pterygopalatine fossa and left cavernous sinus. There is lesion involving the left nasopharyx and sphenopalatine foramen, with bony destruction at the floor of the sphenoid sinus and bone destruction of the left basisphenoid. There is soft tissue lesion overlying and lateral to the ramus of the left mandible. The lesion at the left lacrimal fossa measures slightly larger as 21 x 7 mm (image 12, series 3) compared to prior measurement of 19 x 5 mm (image 33, series 10). There is increased erosion of the lateral wall of the left orbit, with soft tissue lesion involving also the left temporalis muscle. The lesion overlying the ramus of the left mandible is also slightly increased.The enhancing lesions involving the anterior pole of the left temporal lobe, and enhancement in the left foramen ovale seen on prior MRI are not as well appreciated on this CT study and may be related to technical difference.There is patchy opacity in the right lung apex, which may represent inflammatory change. Degenerative disease of cervical spine is noted.

Output: 1. Enhancing lesions involving the left maxillary region and left orbit with extension into the left nasopharynx, left masticator space, sphenoid sinus, skull base, and left cavernous sinus as described above. There is subtle interval increase of the lesions as evident at lateral aspect of the left orbit and left masticator space.2. Enhancing lesion in anterior pole of the left temporal lobe seen on prior MRI study is not well-visualized and may be related to technical difference. This could potentially represent post radiation necrosis versus tumor brain parenchymal involvement. This can be further evaluated with MRI brain using skull base protocol.


Instruction: Generate impression based on findings.

Input: History of uterine fibroids status post uterine fibroid embolization. History of myomectomy. PELVIS:UTERUS, ADNEXA: Anteverted and mildly retroflexed uterus. No evidence of a congenital mullerian duct abnormality.The uterus measures 8.2 x 5.1 cm in the sagittal plane. There are several well-defined hypoattenuating intramural masses compatible with fibroids with the largest measuring 2.4 x 1.9 cm in the right uterine body. The fibroids demonstrate no significant postcontrast enhancement. There are approximately 3 additional smaller fibroids.The inner myometrium/junctional zone is poorly defined and thickened in the uterine fundus suspicious for diffuse adenomyosis. No significant cystic or hemorrhagic changes are noted in the uterus.The myometrium is normal in thickness. The cervical stroma and parametrial soft tissues are unremarkable.The bilateral adnexa are heterogeneously enlarged with the right measuring approximately 5.5 x 4.0 cm in the axial plane and the left measuring approximately 4.8 x 3.0 cm. They contain complex cystic lesions which demonstrate air-fluid levels, foci of hemorrhage and T2-weighted shadowing suspicious for endometriosis. This is progressed from the prior study.BLADDER: Note is made of a urethral diverticulum without evidence of complication.LYMPH NODES: No enlarged pelvic lymphadenopathy.BOWEL, MESENTERY: There is asymmetric marked thickening of the rectosigmoid junction which demonstrates peripheral enhancement and intrinsic mild hyperintensity. This was noted on prior CT examination dated 4/6/2014. Given the stability this is suspicious for endometriosis of the sigmoid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant enhancement of several small uterine fibroids the largest of which measures 2.4 cm.2.Findings suspicious for diffuse adenomyosis. Bilateral heterogeneous ovarian enlargement with findings suspicious for endometriosis.3.Suspected rectosigmoid junction large focus of endometriosis.


Instruction: Generate impression based on findings.

Input: 65-year-old male with history of prostate cancer PELVIS:PROSTATE:Prostate Size: 5.0 x 3.5 x 4.3 cm.Peripheral Zone: There is a large anterior left base peripheral zone lesion with measuring at least 4.2 x 2.4 cm transaxially. This lesion demonstrates early enhancement on DCE. Additional T2 hypointense lesions in the left mid gland and right base.Central Gland: Extension of left apical gland lesion into the left transitional zone.Seminal Vesicles: No specific evidence of seminal vesicle invasion.Extracapsular Extension: There is evidence of extracapsular extension anteriorly and on the left at the base. BLADDER: There is extension of the transitional zone into the bladder base. A component of the predominant left base lesion extending into the base of the bladder cannot be entirely excluded.LYMPH NODES: No significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large anterior left base peripheral zone lesion with extracapsular extension as described above. Tumor involvement of the portion of bladder extending into the bladder base cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: r/o bleeding History: dizziness, nystagmus, hypertensive Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.Confluent patchy high signal intensity lesions on FLAIR/T2 on bilateral periventricular white matter as well as bilateral cerebellar hemispheres including right side of lower pons (best seen on T2) indicate possibility of demyelinating disease such as multiple sclerosis.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. There is no evidence of intracranial arterial aneurysm. No evidence of intracranial arterial luminal stenosis.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Patchy and confluent high signal intensity lesions distributed mainly on bilateral periventricular white matter as well as posterior fossa likely indicating demyelinating disease such as multiple sclerosis.2. Normal brain MRA and MRV.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with bitemporal hemianopsia, status post transsphenoidal hypophysectomy Findings are seen compatible with recent transsphenoidal hypophysectomy including inflammation and fluid within the sphenoid sinuses. Lobular T1 hyperintense material along the floor of the sella and adjacent sphenoid bone may represent blood product and/or surgical packing material. The previously seen large sellar and suprasellar mass has been significantly debulked. Suprasellar extension is much reduced compared to prior. Residual enhancing tumor measures up to 17 mm in the craniocaudal dimension, previously 29 mm; and up to 14 mm in the transverse dimension, previously 22 mm.The native pituitary gland is not well visualized. However, the pituitary stalk passes behind and to the right of the residual tumor which may indicate the location of the native pituitary parenchyma. The pre-chiasmatic right optic nerve and the chiasm itself appear to be chronically thinned.

Output: Expected findings are seen status post transsphenoidal hypophysectomy. The previously seen large sellar and suprasellar mass has been significantly debulked with much reduced encroachment on the suprasellar cistern.


Instruction: Generate impression based on findings.

Input: 83 year old female with history of breast cancer, diabetes and heart failure admitted with acute decompensated heart failure. CMR ordered to evaluate for etiology of left ventricular dysfunction, including infiltrative processes. Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 124 ml/m2 (normal range: 65+/-11), the LVEDV is 220 ml (normal range 109+/-23), the LV end systolic volume index is 87 ml/m2 (normal range 18+/-5), the LVESV is 154 ml (normal range 31+/-10), the LV mass index is 82 g/m2 (normal range 67+/-11), and the LV mass is 146 g (normal range 114+/-24). The left ventricular systolic dysfunction is global. There is diffuse late gadolinium enhancement predominately in the bases in a pattern atypical for myocardial infarction to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The T1 times were elevated at 1250ms. There is no left ventricular thrombus. Left AtriumThe left atrium is moderately-severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 150 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is at least trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation. Mild thickening anterior leaflet.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 a small circumferential pericardial effusion.Extracardiac FindingsBilateral small, left greater than right, pleural effusions with subsegmental atelectasis left lower lobe and lingula. Fluid noted in superior esophagus suggestive of reflux. Nonspecific T2 high signal focus in mid thoracic vertebral body, incompletely characterized. With the history of breast cancer, comparison to outside imaging recommended. In absence of such comparison, consider further cross sectional imaging.Evidence of previous left rotator cuff repair and deformity of left humeral neck, better visualized on radiograph 12/24/15.

Output: 1. The left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 30%. The left ventricular systolic dysfunction is global. 2. There is diffuse late gadolinium enhancement predominately in the bases in a mid and epicardial distribution atypical for myocardial infarction. Additionally, there is increased T1 times, in combination, these findings are consistent with infiltrative disease, such as myocardial amyloidosis.3. The right ventricle is normal in size and function. 4. Nonspecific T2 high signal focus in mid thoracic vertebral body. With the history of breast cancer, consider further cross sectional imaging (such as with spin echo MRI of spine).


Instruction: Generate impression based on findings.

Input: Clinical question: Bilateral lower extremity weakness and numbness. Signs and symptoms: Bilateral lower extremity weakness and numbness. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.Unremarkable lower most visualized thoracic spine and thoracic cord from T11 inferiorly.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild disc desiccation, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease and bilateral facet effusion. Mild bilateral neural foraminal and central spinal stenosis is noted.L4-L5 demonstrate mild disc disease, mild bilateral ligamentum flavum hypertrophy and mild facet disease with suspected bilateral facet effusion. No evidence of central spinal stenosis however mild right neural foraminal compromise is noted.L5-S1 demonstrate minimal degenerative changes without spinal stenosis or neural foraminal compromise.Partially visualized kidneys demonstrate small cysts on the right.

Output: 1.Mild degenerative changes of lumbar spine as detailed.2.Mild central spinal stenosis only at L3-L4 is noted.3.Mild neural foraminal compromise as detailed per level.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other convulsions Multiple sclerosisClinical question: H/O MS, NEW SEIZURE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular white matter lesions as well as lesions in the internal capsules, brainstem and cerebellum hemisphere and subcortical white matter which to a large degree were present on the previous exam and have not changed substantially in extent.No abnormal enhancing lesions are appreciated 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.There is redemonstration of a moderate to marked degree of periventricular, subcortical, internal and external capsule, brainstem and cerebellar lesions which are compatible the patient's diagnosis of a demyelinating disorder. There is not appear to be a substantial change in the extent or distribution of these lesions when compared to the prior exam from last year.2.No abnormal enhancing lesions are appreciated intracranially to suggest acute demyelinating plaque at this time.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter. There is encephalomalacia in the right occipital lobe, right corona radiata, right cerebellar hemisphere, left pons, and bilateral thalami. There are scattered punctate foci of susceptibility effect, consistent with hemosiderin deposition. There is T1 hyperintense signal within the right centrum semiovale and medial right basal ganglia, which may be due to mineral deposition. There is a small enhancing focus in the left medial thalamus, which is likely related to a small developmental venous anomaly. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a faintly enhancing extra-axial hypointense mass along the left frontal convexity without significant mass effect upon the adjacent brain parenchyma. The skull and extracranial soft tissues are otherwise unremarkable.  MRA HEAD: There is irregularity of the circle of Willis, particularly the bilateral cavernous internal carotid arteries and the mid basilar artery. The intracranial internal carotid arteries, middle and anterior cerebral arteries are otherwise patent. The right vertebral artery and posterior cerebral arteries are patent. The left vertebral artery is diminutive, which may be an anatomic variant. There is no evidence of aneurysm. MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are patent. The left vertebral artery is diminutive, which may be an anatomic variant. There is otherwise no evidence of flow-limiting stenosis or occlusion.

Output: 1. Chronic right occipital lobe, right corona radiata, right cerebellar hemisphere, left pons, and bilateral thalami infarcts superimposed upon a background of probable chronic small vessel ischemic disease, but no evidence of acute infarct.2. Irregularity of the circle of Willis, particularly the bilateral cavernous internal carotid arteries and the mid basilar artery, is likely related to atherosclerosis. 3. Diminutive left vertebral artery diffusely, but otherwise patent cervical arteries.4. A small faintly enhancing extra-axial hypointense mass along the left frontal convexity may represent a meningioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Redemonstrated is diffuse volume loss without specific lobar predominant atrophy, unchanged in extent. There are no findings of ventricular obstruction or hydrocephalus. T2 hyperintense abnormality is present in periventricular and subcortical white matter locations as well as within the pons which do not have associated mass effect or restricted diffusion and do not enhance. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is again noted within the inferior left maxillary sinus. Otherwise the remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Stable diffuse volume loss without a specific lobar predominant atrophy pattern.2.Stable chronic small vessel ischemic disease.


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 hippocampi are symmetric and normal in appearance. The midline structures and craniocervical junction are within normal limits. 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 unremarkable.

Output: Normal MRI without evidence for mass, structural abnormality, or mesial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Brain: There are numerous, greater than 10, T2 hyperintense lesions in the supratentorial and infratentorial white matter. Many of the lesions also display T1 hypointensity. There is no discernible associated enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There are multiple areas of T2 hyperintensity in the cervical spinal cord without appreciable associated enhancement or spinal cord expansion. The thoracic spinal cord appears unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foramen stenosis. However, there are multiple subcentimeter perineural cysts within the cervical neural foramina. The paravertebral soft tissues are unremarkable.

Output: Numerous intracranial and spinal cord white matter lesions are compatible with demyelinating disease.


Instruction: Generate impression based on findings.

Input: Presents with reported left lower quadrant abdominal pain. Carcinoma in situ on prior cone biopsy. Previous MRI concerning for locally invasive cervical cancer status post hysterectomy. No mass on histopathology. PELVIS: Susceptibility artifact from right hip arthroplasty limits evaluation.UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy. No evidence of a residual or recurrent mass lesion. No free fluid or loculated fluid collection.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis without diverticulitis.BONES, SOFT TISSUES: Previously seen nodule in the right gluteal/labial soft tissues has decreased in size, only seen on coronal images.OTHER: No significant abnormality noted.

Output: Status post hysterectomy without residual or recurrent mass. No specific findings to account for the patient's abdominal pain.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, history of small pituitary adenoma now with persistent headache. Assess for growth of lesion. A lesion in the right posterior aspect of the pituitary gland seen on the 2011 examination remains much reduced in size and similar to that noted on the more recent examination from 2014. No discretely measurable lesion is seen. Rather, the right posterior aspect of the pituitary is mildly heterogeneous in T2 signal and pattern of enhancement.The remainder of the pituitary gland is within normal limits. The pituitary stalk sits at midline and enhances normally. No suprasellar lesions are detected. No abnormalities of the visualized optic apparatus are seen.

Output: Stable appearance of the pituitary gland with residual heterogeneity of the right posterior aspect of the gland representing the site of a previously larger lesion.


Instruction: Generate impression based on findings.

Input: 29-year-old female with left invasive ductal carcinoma, for evaluation of response to neoadjuvant chemotherapy. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Left breast: At the 2:00 position, in the posterior left breast, there is an ovoid homogenously enhancing mass with central clip artifact which has decreased in size measuring 13 x 12 x 12 mm (AP X ML X CC), previously 18 x 16 x 17 mm. There is no evidence of pectoralis invasion. At the 3:00 position in the left breast, there is an irregular heterogeneously enhancing mass that has also slightly decreased in size, measuring 16 x 7 x 16 mm (AP X ML X CC), previously 21 x 15 x 16mm, with biopsy clip artifact. This mass is located inferior to the index mass at 2:00.Additional satellite lesions located more posteriorly at 3:00, and have also decreased in size, with the largest measuring 6 x 7 x 6 mm (AP X ML X CC), previously 9 x 8 x 10 mm. There is non-mass enhancement, which extends anteriorly, but has decreased laterally and medially. The total extent now measures 5.0 x 2.4 x 5.0 cm (AP X ML X CC), previously 5.6 x 3.6 x 6.5 cm. The intensity of the non mass enhancement has also decreased.Right breast: No abnormal enhancement is identified. No abnormal lymph nodes are identified in either axillary region.

Output: Mild to moderate response to neoadjuvant treatment, with decreased size of the index and satellite lesions, and decreased extent of non-mass enhancement.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain metastases. Please compare with prior exam. Signs and symptoms: Not. Pre and post enhanced brain MRI:No acute intracranial process. A previously known enhancing metastatic lesion in the high convexity right frontal lobe measures at 4.8 x 7.4 mm compared to prior study remeasurement of 4.1 x 6.4 mm.A right frontal cortical enhancing metastatic lesion measuring 4 x 3.4 mm in transaxial dimensions compared to prior study which was barely identified.A left occipital metastatic lesion measuring at 3.8 mm in transaxial dimensions compared to prior study measurement of 1.8 mm is noted.There is no significant surrounding edema with tumors and none with evidence of mass effect.Diffusion weighted images are negative and findings of mild chronic nonhemorrhagic small vessel ischemic strokes are present only in the subcortical and periventricular white matter of cerebral hemispheres without change since prior exam.Ventricular systems remain within normal size and with maintained midline. There is no detectable calvarial metastatic lesions.Unremarkable images through the orbits including axial fat sat postcontrast enhanced series.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized.

Output: 1.Multiple small metastatic lesions all measure minimally larger since prior and without necrosis as measured above.2.Negative diffusion weighted images and findings of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate pituitary gland given the concern for hypopituitarism. Signs and symptoms: Low cortisol level there Pre-and post-enhanced pituitary MRI:The pituitary gland is uniformly small in size and measuring approximately at 1.7-mm in height. There is a tiny cyst like lesion along the superior aspect of pituitary on the left without enhancement and measuring approximately 2 mm in size. This finding is best appreciated on coronal T2 weighted series on image 14.Pituitary stalk is in midline and demonstrate normal expected enhancement. The caliber of pituitary stalk however appears also small. There is no detectable abnormal signal morphology or enhancement of the hypothalamic region.Bilateral cavernous sinuses are unremarkable.Pre-and post-enhanced brain MRI:Unremarkable diffusion weighted images.Examination demonstrate mild periventricular foci of flair hyperintensity which considering patient's stated age likely representing chronic small vessel ischemic strokes. Slight prominence of cortical sulci and ventricular system likely within normal range for age. The signal void of major intracranial arterial branches are identified. There is no detectable abnormal parenchymal or leptomeningeal enhancement.Mild sinus disease and unremarkable orbits.

Output: 1.MRI of pituitary demonstrated uniformly smaller size of pituitary gland and measuring maximum of 1.7-mm in height. It is uncertain what this morphology is pathologic for patient's stated age of 78. Pituitary stalk is in midline and the suggestion of decreased caliber however with expected enhancement. Suspected two minute nonenhancing cyst as detailed.2.Pre-and post-enhanced brain MRI demonstrate no acute intracranial process. Findings suggestive of mild chronic non-hemorrhagic small vessel ischemic strokes and unremarkable otherwise.


Instruction: Generate impression based on findings.

Input: 37-year-old female with EtOH cirrhosis. Screening exam for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver, and splenic varices are noted. No arterially enhancing lesions with washout are identified. Cholelithiasis is present, and there is anterior midline orientation of the gallbladder (axial series 6 image 20). Mildly dilated common bile duct measuring 12 mm in diameter (coronal series 5 image 11). No definite intrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly measuring 15.8 cm in craniocaudal diameter.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild thoracolumbar scoliosis.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic morphology.2.No suspicious hepatic lesions.3.Dilated common bile duct measuring 12 mm.


Instruction: Generate impression based on findings.

Input: Status post right frontal craniotomy for recurrent brain neoplasm. There are postoperative findings related to recent right craniotomy for resection of a larger portion of the right frontal lobe air and fluid with in the resection cavity and deep to the craniotomy flap. There are also multiple areas of restricted diffusion and susceptibility effect along the surgical margins. There is also susceptibility effect within the ventricular system. There are residual areas of confluent high T2 signal surrounding the resection cavity, with extension into the left cerebral hemisphere. There are mildly prominent vessels and dural enhancement in the vicinity of the resection cavity, as well as patchy mild enhancement in the right basal ganglia that may attributable to hyperemia. Otherwise there is no evidence of residual enhancing tumor components. The ventricles are unchanged in size and configuration and there is unchanged slight midline shift to the right.

Output: Recent postoperative findings with scattered areas of intracranial hemorrhage, but no definite evidence of residual enhancing tumor components.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with two days of slurred speech, history of prior stroke. Image quality is reduced by motion artifact on several sequences.A subcentimeter focus of restricted diffusion is seen within the left centrum semiovale just inferior to the precentral gyrus. Very mild restricted diffusion is also seen at the level of the precentral gyrus.In addition to the above lesions, there are a number of scattered small foci of nonspecific white matter T2 hyperintensity. A small chronic infarct of the right cerebellum is also seen.No significant parenchymal edema or mass effect is detected. There is no evidence to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.The middle nasal turbinates appear thickened which may represent mucosal edema, secretions or polyps.

Output: 1.Foci of acute ischemia are seen within and just inferior to the left precentral gyrus.2.Scattered small foci of T2 hyperintensity are nonspecific but may reflect chronic microvascular ischemic disease. A small chronic infarct of the right cerebellum is seen.3.No evidence of any significant generalized mass effect is detected.


Instruction: Generate impression based on findings.

Input: 73-year-old female with stage IV lung cancer, bilateral arm pain and numbness with upper back pain. ROTATOR CUFF: There is mild thickening and increased signal intensity of the distal supraspinatus tendon indicating mild tendinosis with a small linear focus of increased signal intensity in the distal fibers which may represent a small interstitial tear. There is perhaps mild bursal surface fraying as well but we see no full thickness tear. Small degenerative cysts are seen in the underlying humeral head. The infraspinatus, teres minor, and subscapularis muscles and tendons appear normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is minimal enhancement of the subdeltoid bursa which is probably of no clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is minimal enhancement of the synovium of the glenohumeral joint which is not necessarily of any clinical significance. There is increased signal intensity of the superior labrum which may represent mild degenerative fraying/tearing but overall the labrum appears normal for age.BICEPS TENDON: Given the limitations of a non-arthrographic study the biceps appears normal. ADDITIONAL

Output: Mild supraspinatus tendinosis and additional degenerative arthritic changes as described above. No findings to suggest metastatic disease to the shoulder.


Instruction: Generate impression based on findings.

Input: status migranosus There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.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. Acom artery and bilateral Pcom arteries are patent.The distal right vertebral artery appears to be hypoplastic. No intracranial aneurysm. No intracranial arterial luminal significant stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. 3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, internal cerebral veins, vein of Galen and straight sinus.The left transverse sinus appears to be hypoplastic and the left sigmoid sinus is also smaller than that of the right side. On T2 coronal scan, the left transverse sinus shows high signal intensity and those show some enhancement on Gad, thus indicating age indeterminate thrombus or very slow flow. Considering there is no MR evidence of venous congestive encephalopathy, this lesion is likely represent subclinical and no clinical significance.There are some filling defects within the right transverse and sigmoid sinuses, however, the forward flow appears to be well maintained. Thus those can represent prominent arachnoid granulation or flow related artifacts.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Normal intracranial and extracranial arterial system.3. Hypoplastic left transverse and sigmoid sinuses, otherwise unremarkable brain MRV.


Instruction: Generate impression based on findings.

Input: BRCA 2 mutation carrier. High risk breast screening MRI requested. History of breast cancer in sister and maternal great aunt. Minimal parenchymal enhancement is noted bilaterally. Heterogenously dense breast parenchyma noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of partial gastrectomy and Billroth II complicated by pancreatico-cutaneous fistula with bile duct dilatation on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size measuring 16 cm in craniocaudal dimension.It is normal signal intensity. There is marked extrahepatic biliary ductal dilatation with the common bile duct measuring 2.1 cm with moderate intrahepatic biliary duct dilatation. The common bile duct tapers smoothly at the level of the ampulla without an obstructing stone or mass evident.Distended gallbladder without acute inflammation.Small perihepatic fluid collection adjacent to segment 6 is unchanged.SPLEEN: Normal splenic size and morphology without focal lesion.PANCREAS: The pancreatic duct is irregularly dilated up to 8 mm and narrowed, with a moderate stricture at the body tail junction. The dilated main pancreatic duct extends anteriorly and does not clearly communicate with the common bile duct which inserts into the major papilla. The main pancreatic duct appears to merge with a smaller duct in the uncinate process and extends anteriorly where it enters the more proximal duodenum at the minor papilla and communicates with the complex fistulous tract. On postcontrast imaging there is a persistent complex fistulous network deep to the incision site compatible with patient's known pancreatico-cutaneous fistula with no discrete fluid collection is evident.Moderate parenchymal atrophy with decreased intrinsic T1 signal intensity and postcontrast enhancement compatible with parenchymal dysfunction.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Tortuous abdominal aorta with infrarenal aneurysmal dilatation better evaluated on the recent prior CT.BOWEL, MESENTERY: Postsurgical changes from Billroth procedure.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large bilateral pleural effusions with compressive atelectasis.

Output: 1.Marked extra and moderate intrahepatic biliary ductal dilatation to the level of the ampulla without a discrete stone or obstructing mass evident.2.Irregular beaded appearance of the pancreatic duct likely related to chronic pancreatitis. The main pancreatic duct appears to merge with a smaller duct in the uncinate process and extends anteriorly where it may enter the more proximal duodenum at the minor papilla (possible pancreas divisum) and communicates with the complex fistulous tract, compatible with the patient's known pancreatic-cutaneous fistula. No discrete fluid collection.3.Large pleural effusions.


Instruction: Generate impression based on findings.

Input: 45 year old man with a history of sarcoid, hypertension, and alcoholism. He presents with acute decompensated heart failure and is referred to evaluate for etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 8%, the LV end diastolic volume index is 193 ml/m2 (normal range: 74+/-15), the LVEDV is 332 ml (normal range 142+/-34), the LV end systolic volume index is 177 ml/m2 (normal range 25+/-9), the LVESV is 305 ml (normal range 47+/-19), the LV mass index is 139 g/m2 (normal range 85+/-15), and the LV mass is 239 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 14%, the RV end diastolic volume index is 135 ml/m2 (normal range 82+/-16), the RVEDV is 231 ml (normal range 142+/-31), the RV end systolic volume index is 115 ml/m2 (normal range 31+/-9), and the RVESV is 198 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated..Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 a trace pericardial effusionExtracardiac FindingsThere is a small mediastinal lymph node noted. Large right 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. Severe LV dilation with severely reduced systolic function (LVEF 8%). No evidence of underlying myocardial fibrosis, inflammation, or infiltration. This favors hypertension or alcohol as an etiology for the cardiomyopathy over sarcoidosis.2. Moderate RV dilation with severely reduced systolic function (RVEF 14%).3. Significant biatrial dilation.4. Moderate mitral regurgitation.