Instruction: Generate impression based on findings.

Input: There are postsurgical changes of pituitary tumor resection via transsphenoidal approach. Please note lack of contrast significantly limits definitive assessment for residual tumor. Small defect is noted in the right aspect of the sella compatible with site of resection. There remains soft tissue within the remainder of the sella and extending superiorly into the suprasellar cistern with isointense T1 signal and hypointense T2 signal, signal features which are similar to the preoperative noncontrast sequences. Susceptibility effect is also noted within the suprasellar component of the lesion which appears to be present preoperatively on outside MRI from 10/16/2015 with differences in technique limiting direct comparison. Residual lesion again abuts the left aspect of the cavernous sinus without gross evidence of invasion. No significant mass effect on the optic chiasm. Normal T1 hyperintensity of the neurohypophysis is again not identified. Remainder of the brain demonstrates no pathologic signal abnormality. The ventricles and sulci are within normal limits. There is no mass effect or midline shift. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the paranasal sinuses with fluid levels consistent with recent surgery.

Output: Postoperative changes of pituitary tumor resection. There is at least partial tumor resection with soft tissue defect noted in the right aspect of the sella. There remains lobulated soft tissue in the suprasellar cistern and left aspect of the sella which is suspected to represent residual tumor but not definitively evaluated in the absence of contrast. Correlate with intraoperative assessment of extent of surgical resection. Alternatively, if patient's GFR is greater than 30 and no other contraindications, would suggest obtaining post gadolinium sequences of the sella with half dose contrast for confirmation.


Instruction: Generate impression based on findings.

Input: Clinical question: Left sciatica, prior L4 -- L5 fusion in 2008 titanium plate. Signs and symptoms: As above. Nonenhanced lumbar MRI:T11 -- T12 is unremarkable.T12 -- L1 demonstrate mild degenerative changes and unremarkable otherwise. Incidental note is made of a small right renal cyst.L1 -- L2 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. No significant change since prior exam.L2 -- L3 demonstrate advanced disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophic changes and mild facet disease. No significant change since prior exam and no evidence of central spinal or neural foraminal compromise/stenosis.L3 -- L4 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral facet and ligamentum flavum hypertrophy and result in moderate central spinal stenosis and bilateral neural foraminal compromise. There is interval progression of findings since prior study progression of findings from 2010.L4 -- L5 demonstrate postoperative changes of fusion of without evidence of central spinal stenosis. Mild to moderate right neural foraminal compromise without significant change since prior study.L5 -- S1 demonstrate mild disk disease and loss of disk height with shallow bulging disk (slightly more prominent on the left) and mild ligamentum flavum and moderate facet hypertrophic changes. There is no evidence of central spinal stenosis. However there is compromise of the lateral recess of the canal bilaterally (left greater than right) with slight interval worsening since prior exam in particular in the left.

Output: 1.Stable postoperative changes of posterior fusion at L4 -- L5 without evidence of spinal stenosis.2.Mild progression of degenerative changes at L3 -- L4 with moderate central spinal stenosis.3.Slight progression of degenerative disease at L5 -- S1 with compromise of the lateral recesses bilaterally.


Instruction: Generate impression based on findings.

Input: 54-year-old male with altered mental status. Again seen are patchy areas of low attenuation in the subcortical and periventricular white matter, which are nonspecific and have progressed since recent MRI. Please refer to the MRI report from 5/22/2009 for further detail. There may be a new focus of low attenuation in the right brainstem (image 8/36, series 2), which may be further evaluated with MRI if clinically indicated.There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid collections. The ventricles are midline, with normal volume and morphology. There is no midline shift or mass effect.The calvaria and other osseous structures are intact, with no fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. New hypoattenuating focus in the right midbrain, which may be further evaluated by MRI if clinically indicated.2. Progression of extensive white matter abnormality, with differential including demyelinating disease versus underlying metabolic abnormality.


Instruction: Generate impression based on findings.

Input: Reason: Left shoulder pain, injured shoulder playing lacrosse, no improvement with 6 months of P.T., left shoulder x-rays normal, evaluate for labral tear History: left shoulder pain. ROTATOR CUFF: The rotator cuff tendons and muscles are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. No labral tear identified. BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Normal examination with no specific finding to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for fluid collection History: 28-year-old female status post gunshot wound 6 wks ago, now with volar swelling Evaluation is slightly limited due to the patient's inability to fully extend her fingers. Bullet fragments from prior gunshot injury are better seen on prior radiographs, although the largest fragment is noted within the subcutaneous soft tissues of the mid palm. The bullet appears to lie within a subcutaneous fluid collection within the mid palm which measures approximately 3.5 cm in the longitudinal dimension and approximately 2 x 1 cm in the transverse dimension. This collection is hyperintense on T2-weighted images and is both iso and hyperintense to muscle on T1-weighted images. There is peripheral and septal enhancement following gadolinium administration. The signal characteristics of this collection are compatible with a hematoma although it is not possible to exclude superimposed infection. The palmaris longus tendon can be followed into the suspected hematoma at which point we can no longer identify its fibers.There is edema within the second metacarpal head, neck, and diaphysis indicating a fracture that is better seen on recent radiographs. There is disruption of the volar plate of the second MCP joint. The A1 pulley of the index finger is also indistinct and likely disrupted. There is edema within the soft tissues surrounding the second metacarpal as well as within the adductor pollicis muscle. The flexor digitorum superficialis tendons of the index finger appear intact, however, just distal to the adductor pollicis, the flexor digitorum profundus tendon of the index finger diverges laterally from the superficialis tendon and appears to terminate at the level of the MCP joint. More distally, however, at the level of the A2 pulley, and distally, the flexor tendon apparatus including both the superficialis and profundus components is grossly intact. The remaining tendons appear intact. There is edema just distal to the thenar musculature within the web space between the thumb and index finger as well as within the soft tissue volar to the index finger.

Output: 1. Fluid collection within the volar soft tissues of the mid palm which has the signal characteristics compatible with a hematoma. Please note we cannot exclude the possibility of an infected hematoma. A bullet fragment is identified within the hematoma.2. Nondisplaced fracture of the second metacarpal.3. Disruption of the volar plate and A1 pulley of the index finger.4. Findings suggestive of a tear of the flexor digitorum profundus tendons of the index finger at the level of the MCP joint.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for structural lesions, ischemia. Signs and symptoms: Comatose decorticate posturing. Nonenhanced brain MRI:Examination demonstrates a focus of restricted diffusion in the right inferior cerebellum measuring at 8 x 12-mm. Additional focus of restricted diffusion involving the left cerebral peduncle and left thalamus measuring at 20 x 10-mm in transaxial dimensions and consistent with acute ischemic strokes.Additionally examination demonstrate fairly extensive bilateral hemispheric cortical restricted diffusion with resultant cortical flair hyperintensity and effacement of adjacent cortical sulci when compared to the prior study. Shunted lateral ventricles demonstrate acute blood product in their trigone and occipital horns as well as acute parenchymal hematoma along the course of right frontal approach ventricular catheter measuring approximately at 17 x 24-mm in size.There is interval decreased size of ventricular system and with maintained midline.Diffuse flair hyperintensity of bilateral hemispheric white matter, bilateral basal ganglia, thalamus and extensively of the pons similar to prior exam and consistent with advanced chronic nonhemorrhagic small vessel ischemic stroke. Revisualization of a chronic left posterior temporal -- occipital ischemic stroke. The signal voids of major intracranial arterial branches are identified. Aneurysm of the basilar tip measures at 9 x 7-mm in transaxial dimensions (axial T2 series 40 on image 14). The aneurysm on prior study from 3 -- 3 -- 15 on axial T2 series measured at 8.8 x 6.4-mm. On coronal T2-weighted images the transverse diameter the aneurysm measures at 8.7 compared to prior study measurement of 7.9-mm. Although not a dedicated vascular imaging the apparent change in size of aneurysm is suggestive of interval expansion of the aneurysm.

Output: 1.Diffusion weighted images demonstrate two distinct foci of restricted diffusion in the right cerebellar and left cerebral peduncle and thalamus without hemorrhage. Diffuse bilateral hemispheric cortical restricted diffusion and with flair hyperintensity and partial effacement of adjacent cortical sulci compared to prior exam. Extensive chronic nonhemorrhagic small vessel ischemic strokes as detailed.2.Interval placement of a right frontal approach ventricular catheter with decreased ventricle since prior. Postprocedural hemorrhage in the ventricular system and a hematoma in the right frontal lobe measuring at 17 x 24-mm.3.The measurements for basilar tip aneurysm both on axial and coronal images suggest subtle interval increased size since prior study as detailed/measured above.


Instruction: Generate impression based on findings.

Input: Clinical question: Prior to TPA and cardiac history, assess for CVD. Signs and symptoms: Concentration problems. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no evidence of acute ischemic stroke is detected.Examination demonstrate periventricular patchy flair hyperintensity in the periventricular and to a lesser degree subcortical white matter of cerebral hemispheres as well as minimally in bilateral basal ganglia which considering patient's stated age of 77 likely representing chronic nonhemorrhagic small vessel ischemic strokes of mild degree. Slight prominence of cortical sulci and ventricular system may be within upper normal range for his stated age. Tiny foci of throughout hyperintensity in bilateral cerebellar hemispheres are suggestive of very small chronic strokes.The signal void of major intracranial vasculature is identified.Calvarium, skull, visualized paranasal sinuses and orbits are unremarkable.

Output: 1.No acute intracranial process.2.Findings of mild chronic small vessel ischemic strokes and tiny chronic bilateral cerebellar ischemic strokes as detailed.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoids.


Instruction: Generate impression based on findings.

Input: Continued pain despite microfracture MFC. MENISCI: The medial meniscus is attenuated, compatible with prior meniscectomy. There is fragmentation and increased signal within the posterior horn of the medial meniscus, which likely reflects a combination of post-surgical changes and tearing and is similar to prior. No tear is identified in the lateral meniscus. ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage in the medial compartment with large areas of full thickness cartilage loss are similar to the prior examination. The subchondral bone marrow edema type signal is persistent, though decreased, and likely represents a combination of post-surgical changes and degeneration. There is mild heterogeneity of the lateral compartment articular cartilage is similar to prior, with slightly decreased subchondral reactive bone marrow changes. No defects are seen in the patellar cartilage. No specific imaging features of osteonecrosis are identified.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Unchanged extensive cartilage degeneration with persistent, though decreased, bone marrow reactive changes which likely reflect a combination of post-surgical changes and degeneration. 2. Attenuation of medial meniscus with increased signal intensity that likely reflects a combination of post-surgical changes and tearing, which is similar to prior.3. No evidence of osteonecrosis, per clinical query.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with chronic low back pain. Image quality is degraded by motion artifact on some sequences. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are diffusely heterogeneous. STIR hyperintensity in the T12 vertebral body, and along the anterior L5-S1 endplates, is favored to be degenerative in nature. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural lesions are suspected. A large left renal cyst is partially visualized.T11-12: Facet arthropathy. Mild disc bulging. No significant spinal canal or foraminal stenosis.T12-L1: Mild disc bulging. No significant spinal canal or foraminal stenosis.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet arthropathy. Ligamentum flavum thickening. Disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy. Ligamentum flavum thickening. Mild disc bulging. No spinal canal stenosis. Mild right foraminal narrowing. L5-S1: Facet arthropathy. Disc bulging. Moderate to severe bilateral foraminal narrowing.

Output: Multilevel degeneration of the disks and posterior elements is seen. No areas of high-grade spinal canal stenosis are detected. Significant foraminal narrowing is seen bilaterally at L5-S1. Edema within the T12 vertebral body and at the L5-S1 endplates is favored to be degenerative in nature.


Instruction: Generate impression based on findings.

Input: Cellulitis Examination is limited by motion artifact and the patient's body habitus.There is diffuse subcutaneous edema with ulceration and skin thickening of the medial soft tissues of the lower leg. There is no focal fluid collection. There is diffuse atrophy of the tibialis anterior muscle with additional areas of atrophy anteriorly.Within the limits of exam, there is no abnormal marrow signal to suggest osteomyelitis.

Output: Marked subcutaneous edema and ulceration of the medial soft tissues without evidence of focal fluid collection or osteomyelitis.


Instruction: Generate impression based on findings.

Input: C-Spine MRI:Craniocervical junction is intact. There is slight straightening of the cervical spine. The alignment is otherwise maintained. There is preservation of the vertebral body heights. There is somewhat heterogeneous bone marrow secondary to degenerative changes but there are no worrisome focal marrow signal abnormalities to indicate myelomatous lesions. There is variable loss of disc height most prominently involving the C5-6 level. There are disc osteophyte complexes involving the C3-4, C4-5 and C5-6 levels and at most mild left neuroforaminal narrowing at C4-5 and C5-6. There is no significant spinal canal compromise and the spinal cord is of normal caliber and signal.T-Spine MRI: Examination of the thoracic spine is limited by motion.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body heights are well maintained. There is multilevel degenerative disc height loss and endplate degenerative signal change most notably involving T4-5 and T5-6. Endplate edema is also demonstrated at T7-8. There are no worrisome focal marrow signal abnormalities to indicate myelomatous lesions. The spinal cord is of normal caliber and signal.The upper thoracic levels from T1-T2 through T3-T4 are unremarkable.At T4-5 through T7-8, there are small disc bulges without neural foraminal narrowing or spinal canal compromise.At T10-11, there is a prominent disc bulge asymmetric and ligamentum flavum hypertrophy which contributes to moderate left and mild right neuroforaminal narrowing. There is mild to moderate spinal canal stenosis at this level.At T11-12 is a minimal disc bulge and minimal facet hypertrophy without neural foraminal narrowing or spinal canal compromise.L-Spine MRI: There is lordotic curvature of the lumbar spine with anatomic alignment. There is preservation of the vertebral body heights. The disc spaces demonstrate variable mild disc desiccation most prominently involving the lower lumbar levels. No worrisome focal marrow signal abnormality to suggest myelomatous lesions is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. Multiple renal cystic lesions are partially visualized.At T11-12 and T12-L1 are minimal disc bulges and minimal facet hypertrophy without neural foraminal narrowing or spinal canal compromise.At L2-L3, there is a mild disc bulge, facet arthropathy and ligamentum flavum thickening. There is mild spinal canal stenosis and mild foraminal narrowing.At L3-4, there is a small disc bulge, facet arthropathy and ligamentum flavum thickening which results in mild bilateral neural foraminal narrowing but no significant spinal canal stenosis.At L4-5, there is a small disc bulge, moderate facet arthropathy, and ligamentum flavum thickening, with mild spinal canal stenosis but no significant foraminal narrowing.At L5-S1, there is a minimal disc bulge, moderate facet arthropathy and right greater than left, and ligamentum flavum thickening, which contributes to moderate right and mild left neural foraminal narrowing. There is no significant spinal canal stenosis.

Output: 1. No evidence of osseous myelomatous disease.2. Multilevel spondylotic changes with at most moderate spinal canal stenosis and scattered areas of mild to moderate neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Reason: 53 yo F paraplegic, h/o L hip osteomyelitis now with recurrent drainage from L hip sinus; rule out tract; rule out active osteo History: see above. Again seen is skin ulceration and sinus tract overlying the left greater trochanter with surrounding soft tissue edema. Previously seen fluid and gas collection overlying the greater trochanter has decreased in size compared to prior, measuring approximately 2.7 x 1.6 cm, previously 4.9 x 2.4 cm. The previously seen discrete overlying gas collection is no longer visualized. No definite evidence of acute osteomyelitis.Previously seen fluid collection overlying the right greater trochanter measures 2.8 x 1.4 cm, previously 2.5 x 1.6 cm.Diffuse muscle atrophy. Edema within the left gluteal musculature has slightly decreased compared to prior. Edema within the left upper thigh musculature has resolved.Foley catheter in place. Gas within the bladder likely related to recent instrumentation. Small bilateral pelvic lymph nodes again noted, likely reactive.

Output: 1.Interval decrease in fluid collection likely representing abscess overlying the left greater trochanter with surrounding inflammatory changes and overlying skin ulceration. No definite evidence of underlying osteomyelitis. 2.Fluid collection overlying the right greater trochanter is not significantly changed. Enhancement cannot be assessed on the current examination without intravenous contrast. This collection was previously described as suggestive of trochanteric bursitis due to lack of rim enhancement.


Instruction: Generate impression based on findings.

Input: Radicular pain in the left upper extremity. Sagittal alignment is notable for straightening. In addition, there is 3 mm anterior subluxation of C3 on C4. The vertebral bodies are preserved in height. Marrow signal is notable for mild type I degenerative change subjacent to an intrabody herniation through the superior endplate of C5 and the right C3-C4 facet, which also shows a subchondral cyst. There is desiccation of all cervical discs. There is moderate height loss at C5-C6 and C6-C7. Spinal canal narrowing is mild at C3-C4, C5-C6 and C6-C7 levels as described below. There is no cervical spinal cord signal abnormality. Included posterior fossa structures are grossly unremarkable.C2-C3: Very shallow ventral indentation of the thecal sac by disc-osteophyte complex but no significant spinal canal stenosis. Uncovertebral and right more than left facet arthropathy result in mild right foraminal stenosis.C3-C4: Disc-osteophyte complex and ligamentum flavum thickening in addition to mild bilateral uncovertebral and severe right and moderate left facet arthropathy result in mild spinal canal stenosis and moderate bilateral foraminal stenoses.C4-C5: Left more than right uncovertebral and facet arthropathy result in moderate bilateral foraminal stenoses but no significant spinal canal stenosis.C5-C6: Disc-osteophyte complex in addition to bilateral uncovertebral and facet arthropathy are associated with mild spinal canal stenosis and moderate bilateral neural foraminal stenoses.C6-C7: Disc-osteophyte complex in addition to bilateral uncovertebral and facet arthropathy are associated with mild spinal canal stenosis and moderate bilateral neural foraminal stenoses.C7-T1: Eccentric to the left disc-osteophyte complex is present but no significant spinal canal or neural foraminal stenosis.

Output: Multilevel degenerative cervical spondylosis associated with mild C3-C4, C5-C6 and C6-C7 spinal canal stenoses but no spinal cord signal abnormality. There is also moderate bilateral neural foraminal stenoses at C3-C4 through C6-C7.


Instruction: Generate impression based on findings.

Input: 66 years, Male, GBM. Left-sided weakness and neglect. Again seen are postsurgical changes of right-sided craniotomy for tumor resection. Again seen is a heterogeneously enhancing right cerebral hemisphere mass with surrounding FLAIR hyperintensity centered in the deep white matter of the right frontal lobe. Compared to 6/17/2016 there is increase in size of the enhancing solid mass particularly medially with increased extension into the right thalamus and into the right midbrain. Increased involvement of the right anterior basal ganglia is also noted. Necrotic components and hemorrhagic components within the tumor are again seen. No evidence of infarct or new discrete hematoma. Mass effect including effacement of the right lateral ventricle has worsened. Leftward midline shift measured at the level of the foramen of Monro measures 14 mm, previously approximately 9 mm measured similarly. There is also mild interval increase in size of the left lateral ventricle with surrounding FLAIR hyperintensity indicating entrapment. Uncal herniation is also worsened since prior.

Output: Compared to 6/17/2016, there is evidence of further progression of right cerebral hemispheric glioblastoma with particular increasing solid components involving the right anterior basal ganglia and thalamus, with slight extension into the right midbrain. Associated mass effect has also progressed as described above including worsened leftward midline shift and uncal herniation with entrapment of the left lateral ventricle.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder pain, s/p labral repair, assess healing/re-tear History: right shoulder pain, s/p labral repair, assess healing/re-tear ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. There may be mild undersurface fraying of the supraspinatus at the level of the myotendinous junction. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid is identified within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is minimal posterior translation of the humeral head relative to the glenoid.There is heterogeneity and branching linear increased signal abnormality traversing the superior and posterior superior labrum which fills with intra-articular gadolinium indicating a tear. There is additional linear signal abnormality traversing the articular cartilage of the posterior glenoid which extends through the posterior labrum and fills with intra-articular gadolinium. This likely represents a combination of post surgical change, degeneration and re-tearing. There is a tiny subcentimeter paralabral cyst along the posterior aspect of the glenoid. There is heterogeneity and increased signal abnormality within the anterior glenoid labrum likely representing a combination of postsurgical change and degeneration. No fluid-filled tear is evident.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is intermediate signal intensity within the intra-articular portion of long head of the biceps indicate mild tendinosis.

Output: Postsurgical and degenerative changes of the glenoid labrum with new tears involving the superior and posterior labrum as described above.


Instruction: Generate impression based on findings.

Input: 85-year-old female with pancreatic cystic neoplasm ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst in the left lobe of the liver are unchanged. No new focal hepatic lesions. Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Largest cystic pancreatic lesion in the uncinate process with demonstrable connection to the main pancreatic duct measures 6 mm, previously 7 mm (series 5, image 55). Additional smaller cystic pancreatic lesions with demonstrable connection to the main pancreatic duct compatible with side branch IPMN. No pancreatic ductal dilatation is present. Small probable sidebranch IPMN at the tail of the pancreas is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts are unchanged. No hydronephrosis.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.No significant change in multiple side branch IPMNs.


Instruction: Generate impression based on findings.

Input: Metastatic, Stage IV breast cancer, 1 week of N/V, dizziness, double vision. There are multiple supratentorial and infratentorial lesions with associated vasogenic edema. The largest of these is located in the posterior right temporal lobe and occipital lobe and measures approximately up to 3 cm, although assessment is limited by the lack of intravenous contrast. There is effacement of the right lateral ventricle trigone and a portion of the fourth ventricle, but no obstructive hydrocephalus. There are a few scattered foci of nonspecific cerebral white matter T2 hyperintensity. There is no evidence of acute infarct or gross hemorrhage, although some of the sequences are limited by patient motion. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The right parietal skull lesion suggested by the bone scan is not discernible.

Output: 1. Multiple supratentorial and infratentorial lesions with associated vasogenic edema are compatible with metastatic disease, although assessment is limited by the lack of intravenous contrast.2. No midline shift or herniation. 3. The right parietal skull lesion suggested by the bone scan is not discernible, although assessment is limited by the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with right flank pain. Assess for cord compression. Spinal alignment is anatomic. Vertebral body heights are preserved. Mild endplate edema is seen at C5, C6 and C7, with mild edema extending to the left C7 pedicle.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormality is suspected.The intervertebral discs are diffusely degenerated with loss of disc height and endplate irregularity. Additional level specific findings are as follows:C2-3: Right greater than left facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild bilateral foraminal narrowing. C3-4: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C4-5: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Severe bilateral foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. C7-T1: Facet hypertrophy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Diffuse disc degeneration with loss of disc height and endplate irregularity at every level.2.Disc osteophyte formation is seen but this results in at most a mild spinal canal stenosis at several levels. Variable foraminal narrowing is seen ranging from mild to severe.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial abnormality. Signs and symptoms: Gait disturbance, tremor in LE. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates numerous periventricular foci of hyperintensity in bilateral cerebral hemispheres, minimal similar signal changes in the subcortical white matter of the hemispheres are also present. Tiny foci of flair hyperintensity in bilateral external capsules and pons are also identified. Findings are nonspecific however considering patient's stated age of 72 the likely represent chronic microvascular ischemic changes. These findings demonstrate no susceptibility signal changes. No detectable signal abnormality of cerebral cortex, cerebellum or vermis detected.Slight generalized prominence of hemispheric cortical sulci are noted. Correlate with history and neurological evaluation. Ventricular system remains within normal and with maintained midline. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Post enhanced images are negative for any abnormal enhancement of brain parenchyma, leptomeninges, calvarium, soft tissues of the scalp or the orbits.Unremarkable signal intensity of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: 1.No acute intracranial process.2.Findings of mild chronic nonhemorrhagic small vessel ischemic strokes more prominent in the periventricular white matter and minimally in the subcortical, bilateral external capsules and pons.3.Mild generalized prominence of cortical sulci without signal abnormality and unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Left arm paresthesia Note that a routine shoulder protocol was performed followed by axial T1 and T2 images of the proximal arm.ROTATOR CUFF: There is no evidence of full-thickness rotator cuff tear. There are scattered areas of susceptibility artifact which suggesting prior surgical intervention. There is mild atrophy of the supraspinatus muscle.SUPRASPINATUS OUTLET: There is nonvisualization of the coracoclavicular ligament and also the subcoracoid fat pad suggesting the presence of adhesive capsulitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild degenerative changes of the anterior labrum and mild glenohumeral arthritis. Subchondral cystic change noted in the humeral head.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Findings suggestive of adhesive capsulitis and moderate synovitis of the shoulder.2. Area of possible focal subcutaneous inflammation involving the ulnar portion of the arm however this does not approach the neurovascular bundle. What is seen of the ulnar nerve appears grossly unremarkable.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right knee was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 20 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 17 seconds.

Output: Successful fluoroscopic-guided right knee arthrogram.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is a small, peripheral, intrasubstance tear of the posterior horn of the medial meniscus which is superimposed on intrasubstance degeneration. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: A small focus of near full-thickness cartilage loss is seen along the medial femoral condyle anteriorly (series 3 image 14/33). The remaining articular cartilage of the medial, lateral, and patellofemoral compartments is otherwise preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small intrasubstance tear of the posterior horn of the medial meniscus.2. Small focus of near full-thickness cartilage loss of the medial femoral condyle. The remaining articular cartilage is otherwise relatively preserved.3. Mild soft tissue signal abnormality along the knee medially which may represent resolving contusion/hematoma.


Instruction: Generate impression based on findings.

Input: Male, 4 years old, with tethered cord and syrinx, status post tethered cord repair. Yearly evaluation. Prominence of the central canal of the spinal cord is again seen in the low cervical and upper thoracic regions. Frank syringohydromyelia begins at approximately the T7 level and continues down to the conus. The craniocaudal extent of this abnormality is unchanged. Likewise, the maximal caliber of the syrinx is also not significantly changed, measuring approximately 4 x 4 mm at the T11 level, previously 5 x 4 mm.As on the prior examination, cerebellar tonsillar fullness at the level of the foramen magnum is again seen on the sagittal counting sequence. The conus tip terminates at the L1 level which is normal. Findings are again seen compatible with surgical tethered cord release at the L2-3 level. No intraspinal fatty material is observed. The nerve roots of the cauda equina disperse evenly through the distal thecal sac. On prone imaging, there is clear evidence of anterior displacement of the conus and cauda equina.Spinal alignment is anatomic. A normal complement of vertebral bodies is observed. Apart from surgical alterations in the lumbar spine, no abnormalities of vertebral body morphology or signal characteristics are seen. No significant spinal canal or foraminal stenosis is detected. As on the prior examination, the urinary bladder is fluid distended.

Output: 1.No significant change in the caliber or craniocaudal extent of thoracic syringohydromyelia.2.No evidence of spinal cord re-tethering.


Instruction: Generate impression based on findings.

Input: Asymptomatic 30-year-old female with a known orbital vascular lesion and a right tentorial lesion. MRI Brain:Redemonstrated is a small 3 mm extra-axial, T1 bright lesion along the right tentorial leaf with susceptibility effect which may suppress on fat suppressed images. This lesion is unchanged compared to previous exams. In the vicinity of this lesion there is an increased number of prominent venous structures when compared to the contralateral side. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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. Small left maxillary sinus mucous retention cyst or polyp. The paranasal sinuses and mastoid air cells are otherwise unremarkable. The skull, and scalp soft tissues are grossly unremarkable.MRI Orbits:Redemonstrated is a lobular right intraconal space mass located between the right lateral rectus muscle and optic nerve with mild lobulation measuring 1.3 x 1.4 cm compared to 1.5 x 1.7 cm previously. On early postcontrast images, the lesion demonstrates heterogeneous and complete enhancement. On delayed postcontrast imaging, the lesion enhances nearly uniformly. No new lesions are identified. The globes are intact. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact.MRI Face/ Neck:There is no evidence of measurable mass lesions or significant lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged portions of the lungs are clear.

Output: 1.Slight overall decrease in size of the enhancing right intraconal space mass compared to the prior exam. The imaging features, and particularly the pattern of early and late enhancement, favor the diagnosis of cavernous hemangioma.2.Stable small 3 mm extra-axial, T1 bright lesion along the right tentorial leaf demonstrating susceptibility and possible fat suppression. The increased number of prominent venous structures in the vicinity of this lesion is of uncertain significance.


Instruction: Generate impression based on findings.

Input: Female 29 years old with dysmenorrhea and inability to penetrate vagina with finger or tampon. Evaluate for vaginal septum and other uterine abnormality (ie didelphys). PELVIS:UTERUS, ADNEXA: The lower vagina is unremarkable in appearance. The upper vagina is collapsed limiting evaluation. Smooth mucosal enhancement is seen throughout the vagina. The upper vagina courses to the left and the uterine fundus is displaced to the right. The uterine contour smooth and normal in appearance. There is a single cervix. No evidence of congenital uterine abnormality. There are no findings to suggest endometriosis.Both ovaries contain multiple follicles. No suspicious adnexal lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of vaginal lesion or congenital uterine abnormality.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:12/16/1944)Reason: s/p transphenoidal hypophysectomy 2/5/16, s/p resection of pituitary tumor History: 6 week post-op follow up; s/p resection of pituitary tumorPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI pituitary:The patient is status post transsphenoidal pituitary surgery. Since the prior exam postoperative changes have regressed.There is an 11 x 14 mm coronal dimension pituitary mass. Present which is eccentric towards the left side and has suprasellar extension. The suprasellar extension is just anterior to the optic chiasm.The optic nerves and chiasm are atrophic.The cavernous sinuses are intact bilaterally.There is redemonstration of an extra-axial mass adjacent to the left superior frontal gyrus measuring 27 x 12 mm coronal dimensions and associated with a daughter extra-axial nodule just anterior to it measuring 10 mm in diameter. There is associated thickening of the calvarium immediately adjacent to this lesion.

Output: 1.Since the prior exam, postoperative changes involving the pituitary fossa have regressed. There is a pituitary fossa mass present as detailed above which is associated with suprasellar extension. Certainly it is significantly smaller than the preoperative lesion. It could represent residual pituitary adenoma.2.There is redemonstration of an extra-axial mass most likely representing a meningioma adjacent to the left superior frontal gyrus.3.The patient is status post transsphenoidal surgery.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis with pancreatic neuroendocrine tumor and renal angiomyolipoma status post partial nephrectomy and distal pancreatectomy. Status post prior splenectomy. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again are multiple small hepatic T2 hyperintense lesions which demonstrate signal dropout on fat-suppressed imaging compatible with small hepatic angiomyolipomas, unchanged. No suspicious liver lesion. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: Postsurgical changes from a distal pancreatectomy without specific evidence of residual or recurrent tumor.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal masses are again seen and mostly demonstrate partial or complete macroscopic fat signal intensity and avid contrast enhancement compatible with angiomyolipomas. Status post partial nephrectomy of the previously seen left lower pole angiomyolipoma. The dominant right angiomyolipoma involves the anterior cortex measuring 4.9 x 4.0 cm, minimally increased in size from 4.4 x 3.9 cm previously. There is a T2-weighted hypointense right posterior cortex superior pole lesion demonstrating avid enhancement which is unchanged measuring 2.5 x 1.9 cm and is more compatible with an angiomyolipoma. None of the larger lesions demonstrate typical signal characteristics of a renal cell carcinoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A fatty lesion adjacent to the left ventricle is again seen and is unchanged.

Output: 1.Postsurgical changes from partial left nephrectomy, distal pancreatectomy and splenectomy.2.Bilateral renal masses are again noted and are most compatible with angiomyolipomas including a 4.9 cm right renal angiomyolipoma which is slightly increased in size from the prior.3.Stable multiple hepatic lesions are compatible with angiomyolipomas.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with paresthesias. There is no significant change in the numerous (greater than 10) white matter lesions, accounting for differences in technique. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. However, there is degenerative spondylosis and kyphotic angulation of the upper cervical spine with apparent mild indentation upon the spinal cord.

Output: 1. No significant interval change in the demyelinating lesions, accounting for differences in technique. 2. Degenerative spondylosis and kyphotic angulation of the upper cervical spine with apparent mild indentation upon the spinal cord. Dedicated cervical spine imaging may be useful for further evaluation, if clinically warranted.


Instruction: Generate impression based on findings.

Input: 69 year old female with a history of apical hypertrophy, question of hypertrophic cardiomyopathy who is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated and normal systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 103 ml/m2 (normal range: 65+/-11), the LVEDV is 151 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is apical hypertrophy, however the hypertrophy is not confined to the apical segments. The mid anterior and anteroseptal walls are hypertrophied: lateral wall 10 mm, mid septum/anteroseptum 19-20.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 92 ml/m2 (normal range 69+/-14), the RVEDV is 135 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 51 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation. Pulmonic ValveNot well visualized.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine great vessel pattern. There is aneurysmal dilation of the brachiocephalic vessel (above and beyond the pseudo bovine pattern). The aortic root is dilated (37x40 mm at Sinus of Valsalva)Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function (LVEF 70%).2. The right ventricle is normal in size and systolic function (RVEF 62%). 3. There is apical hypertrophy, however the hypertrophy is not confined to the apical segments. The mid anterior and anteroseptal walls are hypertrophied.4. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.5. The main pulmonary artery is severely dilated. 6. There is a left sided aortic arch with a pseudo-bovine great vessel pattern. There is aneurysmal dilation of the brachiocephalic vessel (above and beyond the pseudo bovine pattern). The aortic root is dilated (37x40 mm at Sinus of Valsalva)I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of retroperitoneal liposarcoma. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There is minimal diffuse parenchymal signal loss in the out of phase images which suggest mild hepatic steatosis. No suspicious focal hepatic lesions.No intrahepatic or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODESThere is redemonstration of a large retroperitoneal mass which demonstrates heterogeneously increased T2 signal and enhancement extending from the level of the duodenal sweep inferiorly into the upper pelvis, overall increased in size from prior.The component of the mass immediately anterior to the infrarenal aorta at the level of the bifurcation (series 14, image 80) now measures approximately 2.9 x 18 cm, previously 2.7 x 6.4 cm and is now confluent with the previously described additional mass anterior to the left psoas muscle. The previously described partially enhancing nodule anterolateral to the right psoas muscle (series 14, image 91) measures approximately 2.5 x 2.7 cm, previously 1.9 x 2.0 cm.BOWEL, MESENTERY: Postoperative changes from an end to side anastomosis in the descending colon.BONES, SOFT TISSUES: Diastases of the rectus muscles.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Heterogeneously decreased signal within the prostate peripheral zone is nonspecific but could reflect prostatitis.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Post surgical changes in the rectosigmoid colon and tumor extension into the pelvis as described above.BONES, SOFT TISSUES: Fat-containing right inguinal hernia.OTHER: No significant abnormality noted.

Output: Extensive retroperitoneal tumor involvement extending from the level of the duodenal sweep into the upper pelvis, overall increased in size from prior.


Instruction: Generate impression based on findings.

Input: Hearing loss and developmental delay. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Interval Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or ventriculomegaly. 2. No evidence of cochlear nerve deficiency or internal auditory canal tumors.


Instruction: Generate impression based on findings.

Input: Male, 38 years old, history of grade 2 oligodendroglioma status post radiation and chemotherapy. T2 hyperintensity of the left frontal white matter and cortex is again seen with mild associated cortical thickening. The central region of this tissue demonstrates cystic degeneration. There has been no significant interval change in the appearance of this tissue, and no pathologic enhancement is appreciated.Ill-defined bilateral periventricular T2 hyperintensity is unchanged as well, likely related to treatment. No new parenchymal signal abnormality is detected. No significant mass effect or edema is seen. The ventricles are stable in size and configuration. Enhancement and osseous thickening along the right orbital roof is unchanged possibly representing a site of fibrous dysplasia.

Output: No change in the appearance of the treated left frontal lesion.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with history of non-Hodgkin lymphoma with a CSF protein of 200, moderate stenosis noted on an outside nonenhanced MRI at L3-4. Assess for enhancing nerve roots. Sagittal alignment is grossly anatomic with mild straightening of the lumbar lordosis. Vertebral body heights are preserved. Loss of intervertebral disc height is seen at L4-5 and L5-S1. Advanced endplate degenerative signal abnormality with edema is seen at L4-5. Elsewhere, no significant marrow edema or marrow replacement is seen. No pathologic marrow enhancement is observed.The visualized distal spinal cord and conus are within normal limits. The nerve roots of the cauda equina are likewise unremarkable except where influenced by spinal canal stenosis (discussed below). No pathologic spinal cord or nerve root enhancement is seen.L1-2: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L2-3: Mild facet arthropathy with perhaps a small extracanalicular synovial cyst on the left. Mild disc bulging with a superimposed right foraminal/far lateral protrusion. No significant generalized canal stenosis. Mild right foraminal narrowing. L3-4: Moderate facet arthropathy with facet effusions. Ligamentum flavum thickening. Disc bulging. Moderate to severe generalized spinal canal narrowing with crowding of the cauda equina nerve roots and near complete exclusion of CSF. Mild left foraminal narrowing. L4-5: Facet arthropathy. Ligamentum flavum thickening. Bulging disc asymmetric to the right. Mild generalized spinal canal narrowing. Severe right and moderate left foraminal narrowing. L5-S1: Facet arthropathy with a synovial or ligamentum flavum cyst on the right. Disc bulging. No significant generalized spinal canal stenosis. Severe bilateral foraminal narrowing with possible nerve root impingement.

Output: 1.No evidence of pathologic spinal cord or nerve root enhancement is seen.2.Multilevel degeneration of the disks and posterior elements is noted. This results in a moderate to severe generalized spinal canal stenosis at L3-4. Severe foraminal narrowing is also evident bilaterally at L5-S1 and on the right at L4-5.


Instruction: Generate impression based on findings.

Input: There is a large bilobed lesion centered in the right caudate head, that measures 31 x 12 mm (601/17). This mass has heterogenous signal on T2/FLAIR and has a complete peripheral T2 hypointense rim of hemosiderin. The mass has prominent popcorn like T1 intrinsic hyperintensity, with mild superimposed enhancement. There is prominent blooming on the susceptibility images, and several areas of blood-fluid levels. Small lobular component of the mass extends just beyond the midline with slight mass effect on the anterior third ventricle. The mass exerts minimal mass effect on the anterior horn of the right ventricle. The mass abuts the right A1 segment. There is no surrounding FLAIR hyperintensity to suggest recent hemorrhage.No evidence of diffusion abnormalities. There is normal ventricular size with no midline shift. Basal cisterns are patent.

Output: Prominent right caudate head cavernous angioma with several tiny blood-fluid levels, but with no evidence of surrounding edema to suggest recent hemorrhage.


Instruction: Generate impression based on findings.

Input: 51 years, Female, Reason: Abnormal MRCP, biliary stricture on MRCP, jaundice History: Jaundice. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a stent within the distal common bile duct. The proximal common bile duct is mildly dilated through 11 mm with mild intrahepatic biliary ductal dilatation. The stent appears patent. No stones or obstructing biliary lesions are evident.SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct is dilated with numerous dilated outpouchings. There is a structure within the body of the pancreas (500/5) which measures approximately 11 mm. There is also multi-focal stricturing within the distal pancreatic duct in the head of the pancreas with areas of narrowing and dilatation. A distinct communication with the duodenum is not evident, likely due to stricturing. Overall these findings are compatible with chronic pancreatitis.An accessory pancreatic duct is seen only on secretin stimulated images, corresponding to findings on prior ERCP. Response to secretin is within normal limits.There is low T1 signal within the pancreas and increased peripancreatic T2 signal which suggests an acute component of pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney.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.Acute on chronic pancreatitis with regions of multifocal stricturing, including a dominant stricture detailed above.2.Patent common bile duct stent with mild intrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: 69-year-old man with history of prostate cancer status post prostatectomy, now with rising PSA. Please note that this examination was mildly limited by patient discomfort.PELVIS:PROSTATE: The patient is status post prostatectomy. There is an 18 x 16 mm area of enhancing soft tissue in the left pelvic sidewall adjacent to the obturator internus (series 801, image 24).BLADDER: There is a 7 mm left lateral bladder diverticulum.LYMPH NODES: No lymphadenopathy is identified.BONES, SOFT TISSUES: Heterogeneous signal in the bone marrow of the pelvis is noted, please correlate with bone scan. Bilateral hip prostheses noted. Fat-containing inguinal hernias are seen bilaterally.OTHER: Colonic diverticulosis without diverticulitis.

Output: Soft tissue mass in the left pelvic sidewall which, although somewhat atypical in location, has imaging features highly suspicious for recurrent adenocarcinoma.


Instruction: Generate impression based on findings.

Input: 34 year old male with a history of D-transposition of the great vessels s/p Mustard procedure at 18 months, sinus node dysfunction, recurrent SVT, s/p CTI for atrial flutter who was admitted for persistent junctional rhythm and atypical chest pain. He was referred for cardiac MRI for further evaluation. Overall AnatomyD-TGA. There is a Mustard baffle that connects the SVC and IVC to the sub-pulmonic ventricle (i.e. morphologic left ventricle) via the mitral valve. The morphologic left ventricle communicates with main pulmonary artery. The pulmonary venous flow returns to the systemic ventricle (i.e. morphologic right ventricle) via the common atrium that surrounds the baffle via the tricuspid valve. The morphologic right ventricle communicates with the aorta.Systemic Venous ReturnThere is a baffle that connects the SVC and IVC to the sub-pulmonic ventricle (i.e. morphologic left ventricle) via the mitral valve. There is significant tubular narrowing within the the SVC and IVC baffle limbs. The SVC limb is ~8 mm at its narrowest transverse dimension. The IVC limb is ~10 mm at its narrowest transverse dimension. The common portion of the baffle limb is ~6 mm at its narrowest dimension. There is no evidence of flow acceleration within the baffle. The IVC is dilated. The SVC is normal in size. There is no obvious baffle leak noted. Systemic Ventricle (i.e. Morphologic Right Ventricle)The right ventricle is significantly dilated and hypertrophied with moderate to severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 206 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17). There is late gadolinium enhancement noted at the anterior and inferior insertion points of the right ventricle. Pulmonary Venous ReturnThere are four pulmonary veins which drain into the common atrium and then through the tricuspid valve. There are no obvious obstructions of the pulmonary veins.Sub-Pulmonary Ventricle (i.e. Morphologic Left Ventricle)The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 106 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 40 ml (normal range 47+/-19). The interventricular septum bows into the sub-pulmonic left ventricle causing systolic anterior motion of the mitral valve leaflets and flow acceleration in the outflow tract below the pulmonary valve. Common AtriumThe interatrial septum has been resected resulting in a common atrium. The common atrium is significantly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. There is systolic anterior motion of the mitral leaflets causing sub-pulmonic outflow obstruction as described above. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.Great VesselsThe aorta is located anterior and to the right of the pulmonary trunk. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm or thoracic aortic dissection. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. D-Transposition of the Great Vessels status post Mustard atrial switch procedure. 2. There is significant narrowing within the SVC and IVC baffle. No obvious baffle leaks were detected.3. Significantly dilated and hypertrophied systemic right ventricle. RV systolic function is moderate to severely reduced (RVEF 30%).4. The subpulmonic ventricle (left ventricle) is normal in size with normal systolic function (LVEF 63%). 5. The interventricular septum bows into the sub-pulmonic left ventricle causing systolic anterior motion of the mitral valve leaflets and flow acceleration in the outflow tract below the pulmonary valve.6. Moderate tricuspid regurgitation associated with significant atrial dilation. 7. IVC is dilated. When compared to the prior study, the systemic ventricle has a slightly lower ejection fraction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 63-year-old female with a family history of pancreatic carcinoma. Dilated pancreatic duct on previous MRCP. ABDOMEN:LIVER, BILIARY TRACT: No intra- or extra-hepatic biliary ductal dilation is identified. There is mild dilation of the main pancreatic duct measuring up to 6 mm in diameter. No focal mass lesions are identified. SPLEEN: No significant abnormality noted.PANCREAS: There is mild dilation of the main pancreatic duct measuring up to 6 mm in diameter. No focal mass lesions are identified. 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: There is mild dilation of the main pancreatic duct which is of uncertain etiology but may be related to stricture/narrowing at or adjacent to the level of the ampulla, however, there is no focal mass lesions identified. Clinical correlation and follow-up examination is recommended.


Instruction: Generate impression based on findings.

Input: 60 year old female with seizure. Diffuse white matter hypodensity in the left parietal lobe consistent with persistent vasogenic edema that appears increased compared to prior. Mass-effect compresses the posterior horn of the left lateral ventricle and effaces the sulci on the left side. There is a question of a mass within the region of the edema. For further evaluation consider MRI or CT with contrast. Postsurgical changes are noted in the left parietal calvarium.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Increased vasogenic edema in the left parietal lobe. No acute hemorrhage. Postsurgical changes are again noted. Question mass within the edema region. For further evaluation consider MRI or CT with contrast.


Instruction: Generate impression based on findings.

Input: Left hip infection Note that evaluation of the bones and soft tissues is limited secondary to metallic susceptibility artifact from the left hip arthroplasty.The previously described fluid collection along the posterior and inferior ischium is no longer seen. In its place is a large soft tissue defect involving the subcutaneous fat of the medial left buttock which contains packing material. A rind of abnormal signal surrounding the defect is seen which likely reflects a combination of granulation tissue and edema. This abnormal signal extends to the left ischium but there is no abnormal signal within the ischium itself to confirm the presence of osteomyelitis.Inflammatory changes surround the sciatic nerve and proximal hamstring tendons however we see no frank edema of the musculature of the upper thigh. There is atrophy of the proximal hamstring musculature. There is atrophy of the iliopsoas and gluteal musculature. There is scarring traversing the posterolateral subcutaneous fat which is likely the result of the prior total hip arthroplasty. A small fluid collection is seen immediately posterior to the greater tuberosity which is essentially unchanged in appearance and may represent a seroma. Although evaluation of the left hip is limited due to the susceptibility artifact, there are no specific imaging features of septic arthritis identified.There is mild osteoarthritis of the right hip and mild degenerative disc disease of the lower lumbar spine. A small amount of fluid is noted within the sacroiliac joints which is of uncertain clinical significance. A renal transplant is noted in the left iliac fossa and the urinary bladder is distended.

Output: Limited examination secondary to metallic susceptibility artifact. A large left posterior buttock wound is noted with extension to the ischium however there is no abnormal signal within the ischium to confirm osteomyelitis. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: 62-year-old male with prostate cancer and elevation to previous PSA baseline. PSA was 11.83 ng/mL on 11/21/2016 and was 7.4 ng/mL on 9/11/2015. Biopsy from March 2015 showed benign tissue in all 12 cores. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.5 cm in transverse, 4.3 cm in AP, and 5.8 cm in the craniocaudal diameter.Peripheral Zone: No target lesion in the peripheral zone.Central Gland: In the mid gland transitional zone, there are bilateral ADC and T2 hypointense foci with intermediate suspicion for malignancy measuring 2.2 x 1.4 cm on the left (series 403 image 224) and 1.7 x 1.2 cm on the right (series 403 image 244).Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Bilateral fat-containing inguinal hernias, and the left inguinal hernia also contains the left anterior bladder wall (series 301 image 65).OTHER: No significant abnormality noted.

Output: 1.In the mid gland transitional zone, there are bilateral ADC and T2 hypointense foci with intermediate suspicion for malignancy measuring 2.2 x 1.4 cm on the left and 1.7 x 1.2 cm on the right (PI-RADS 3).2.Fat and bladder containing left inguinal hernia.PI-RADS™ v2 Assessment Categories:PI-RADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2 – Low (clinically significant cancer is unlikely to be present)PI-RADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PI-RADS 4 – High (clinically significant cancer is likely to be present) PI-RADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Diagnosis: Transient cerebral ischemic attack, unspecifiedClinical question: 87M with concern for TIA vs ischemic eventSigns and Symptoms: word finding difficulty MRI of the brainNo diffusion weighted abnormalities are appreciated.There are small T2 hyperintense and T1 and FLAIR hypointense lesions in the right basal ganglia.There is 5-10 periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is a high-grade stenosis present along the distal right M1 segment of the middle cerebral artery with approximately 70% stenosis proximal to the bifurcation. This was also present on the 3/30/2012 exam and has not progressed significantly.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery. The left posterior communicating artery is medium-sized. The right posterior communicating artery is small. The anterior communicating artery appears to be fenestrated. The left internal carotid artery is larger than the right internal carotid artery. The left A1 segment is larger than the right A1 segment.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery.

Output: 1.There is a high-grade stenosis present at the distal right M1 segment of the right middle cerebral artery proximal to the bifurcation. This was also present on the 3/30/2012 exam and has not progressed significantly.2.A couple small lesions in the right basal ganglia may be attributable to old right-sided lacunar infarcts. There is no evidence for acute ischemic cerebral infarction.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. Their number is relatively small and likely this is of little clinical consequence.


Instruction: Generate impression based on findings.

Input: Unspecified atrioventricular block [I44.30] / Other speech disturbances [R47.89] / Atrioventricular block, complete [I44.2], Reason for Study: ^Reason: Eval for structural changes, hemorrhage/ischemia/necrosis History: Suspected TIA and 2nd degree heart Brain MRIThere are multiple scattered restricted diffusion lesions on the left frontal, temporal and parietal lobes indicating acute ischemic stroke without evidence of hemorrhagic conversion.Scattered FLAIR high signal intensity lesions on the periventricular white matter and especially on the left side centrum semiovale indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Small lipoma on the right temporal area.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate decreased in-flow signal enhancement on the left ICA, however, there is no evidence of luminal stenosis. Otherwise the right ICA, bilateral MCAs and bilateral ACAs appear to be normal. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate sever luminal stenosis of the left proximal extracranial ICA, about 25mm above the left CCA bifurcation.Otherwise, 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 right common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Left hemispheric acute ischemic infarctions without evidence of hemorrhagic conversion as described above.2. Significant luminal stenosis of the left extracranial ICA about 25mm above the bifurcation.3. Normal brain MRA with evidence of either slow or decreased flow through the left ICA. Discussed and informed findings to Dr Brandt of Cardiology team.


Instruction: Generate impression based on findings.

Input: 49-year-old male patient with pain after pedestrian versus car. Question of chondral injury. MENISCI: The lateral meniscus is intact. Internal signal within the posterior horn of the medial meniscus does not reach an articular surface and no discrete medial meniscal tear is identified. ARTICULAR CARTILAGE AND BONE: There is marked thinning of the articular cartilage of the anterior medial femoral condyle with generalized thinning anteriorly, though full thickness defect. There is generalized thinning of the weightbearing portion of the lateral femoral condyle articular cartilage. There is fissuring of the medial facet patellar articular cartilage with minimal subchondral edema within the bone. Bone marrow signal is otherwise within normal limits. LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Chondromalacia without full thickness defect.2. Intact meniscal and ligamentous structures.


Instruction: Generate impression based on findings.

Input: Left parotid mass. There is an unchanged well-defined, lobulated cystic lesion with multiple septations in the deep lobe of the left parotid gland, which measures up to 16 mm. The rest of the left parotid gland and other salivary glands are unremarkable. There is no significant lymphadenopathy in the imaged portions of the neck. There is scattered mucosal thickening in the ethmoid sinuses. There is partially-imaged periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is a partially-empty sella. The orbits are unremarkable. There is a small left maxillary sinus retention cyst. There is degenerative spondylosis of the imaged portions of the cervical spine.

Output: Unchanged cystic lesion in the deep lobe of the left parotid gland.


Instruction: Generate impression based on findings.

Input: 66 year old female with altered mental status and memory loss x 10 days Examination demonstrates a large suprasellar mass a well-demarcated round appearance measuring approximately 31.7 mm times 31.6-mm. Mass applies mass effect on the third ventricle with superior elevation and causes hydrocephalus bilaterally. No transependymal exudate of CSF is detected. There is possibility of some hemorrhage within the mass at its base. The epicenter of the tumor appears to be in the basal cistern. There is however subtle enlargement of the sella. Further evaluation with an MRI for better evaluation and etiology is recommended.

Output: Large likely partially hemorrhagic suprasellar mass.Obstructive hydrocephalus.


Instruction: Generate impression based on findings.

Input: Again noted are postoperative findings related to left retrosigmoid craniotomy. Postoperative extra-axial collection with flattening of the left lateral aspect of the cerebellum is unchanged. There is persistent intermediate T2 signal with enhancement on postcontrast T1 images within the left internal auditory canal with adjacent dural thickening, which measures about 1 cm in length, as seen on image 11 of series 17, unchanged when compared to prior exam. Stellate areas of low signal in the left prepontine area minimally distorting the left trigeminal nerve and extending caudally is again noted and perhaps represents scarring from previous surgery, similar to prior exam. There is diminished normal T2 signal associated with left inner ear structures which appears less conspicuous as compared to the contralateral side, likely postoperative.Scattered foci of T2/FLAIR hyperintensity in the periventricular white matter is nonspecific but suggestive of chronic microvascular ischemic changes. There is mild symmetric smooth diffuse pachymeningeal thickening. Previous smooth pachymeningeal enhancement was seen along the ventral skull base at the level of surgery. The ventricles and sulci are normal in size. There is no significant mass effect or midline shift. No diffusion-weighted abnormalities are identified. Flow voids are present within the major vessels indicating patency. The left maxillary sinus and nasopharyngeal retention cysts are unchanged.

Output: 1.Postoperative findings with persistent intermediate T2 signal and enhancement within the left internal auditory canal, stable when compared to exam from 1/6/2016. This may represent posttreatment changes and/or residual tumor. 2.Diffuse symmetric pachymeningeal thickening which is nonspecific, but may be related to recent lumbar puncture or can be seen with idiopathic hypertrophic pachymeningitis.3.Scattered foci of T2/FLAIR hyperintensity in the periventricular white matter, which is nonspecific but suggestive of chronic microvascular ischemic changes.


Instruction: Generate impression based on findings.

Input: Clinical question: Headaches, history of GBM, post radiation. Signs and symptoms: As above Non-enhanced head CT:The examination demonstrates new area of low attenuation in the right basal ganglia measuring 13.9 x 14.5-mm on axial image 10. This finding could represent a lacunar infarct however possibility of tumor cannot be excluded. A smaller second similar lesion more posteriorly with extension into the thalamus is also present. Follow-up with an MRI is recommended. There is also a large area of CSF density well-demarcated collection measuring 33.5 x 33.6-mm in transaxial dimension and approximately 44 mm in cranial -- cephalad access. This is suspected for a cyst formation at the surgical site and or cystic tumor.The combination of above findings results in effacement of adjacent cortical sulci and subtle mass effect on the third ventricle and right lateral ventricle which appears a slightly smaller than before. There is also midline shift of approximately 4.6 mm to the left at the level of septum pellucidum.There is a small extra-axial collection likely subdural in the right frontal region anterior to the anterior edge of right frontal craniotomy flap which measures approximately 36 mm in length and 8.3 -mm in thickness which is measured on axial image 13.New since prior exam there is also a cortical based low attenuation of the left anterior frontal lobe that is suspected for a small cortical stroke. This finding is appreciated on axial images 13 to 15.A punctate size calcification at the anterior aspect of third ventricle is this could represent a small colloid cyst which was also noted before and report change.

Output: 1.Suspect a small left frontal cortical stroke, local nor stroke of right basal ganglia as detailed above.2.Large cyst formation at the surgical site in the right temporal lobe measuring approximately 32.5 x 33 x 44-mm concerning for a cyst or a cystic tumor.3.Well-demarcated a small low-attenuation lesions in the right basal ganglia concerning for strokes and or tumor.4.A small CSF density subdural in the right frontal region measuring 36-mm in length and 8.3-mm in thickness.5.Combination of above findings results in further subtle increase in mass effect on the right lateral ventricle and midline shift of approximately 4.6 mm.6.Constellation of all these new findings require further evaluation with a dedicated MRI examination.


Instruction: Generate impression based on findings.

Input: Images were obtained for surgical stereotactic localization purposes. Postoperative changes are seen from previous occipital craniectomy. There is redemonstration of a large cystic lesion in the midline posterior fossa, slightly greater to the left side, with areas of enhancing mural nodularity and small serpentine flow-voids. It measures 4.5 cm transverse x 5.0 cm AP x 3.9 cm CC. When allowing for differences in technique, it appears slightly increased in size compared to prior outside MRI. There is mild increased degree of mass effect upon the fourth ventricle, with persistent areas of T2 hyperintensity extending outward into the cerebellar parenchyma, slightly progressed and representing vasogenic edema. A linear area of T2 hyperintensity the right frontal lobe is likely postprocedural gliosis.Areas of solid nodular enhancement associated with the dominant lesion as well as other scattered foci of nodular enhancement elsewhere in the cerebellum bilaterally appear grossly similar. There is a rounded area of nodularity along the dorsal aspect of the right posterior body of the corpus callosum, measuring 7 x 7 mm in greatest axial dimensions.In addition, along the upper cervical spinal canal at the C1-C2 level, there is an irregular enhancing intradural extra medullary nodule along the left ventral thecal sac on 4/9 measuring 6 x 7 mm, with slight thickening of the adjacent dural margin just caudally. Coronal and axial T2-weighted images appear to suggest mild heterogeneous T2 hyperintense signal within the right greater than left atrophic cord along the visualized upper cervical spine. Previous spine imaging suggested myelomalacia at these levels with associated volume loss.The ventricles and sulci are otherwise within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal opacification of posterior ethmoid air cells.

Output: 1. Slight interval increased size of dominant cerebellar hemangioblastoma with increased mass effect although without significant interval ventricular size change.2. Similar pattern of other scattered smaller predominantly cerebellar enhancing nodules as well as one posterior to the posterior body of the corpus callosum on the right side, also likely hemangioblastomas.3. Findings suggestive of upper cervical cord myelomalacia of the incompletely assessed, with the possibility of intrinsic cord lesion entirely excluded on the basis of this exam. Small nodular area of enhancement along the left ventral thecal sac at the C1-C2 level, likely representing an additional hemangioblastoma perhaps along the cervical nerve root. Grossly, this appears similar to prior outside MRI of the spine from May 2012.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: assess for stroke, other pathology History: headache, increased BP 24 years Female (DOB:3/10/1992)Reason: assess for stroke, other pathology History: headache, increased BPPROVIDER/ATTENDING NAME: DAVID G. BEISER Brain MRINo evidence of acute ischemic or hemorrhagic lesion. A couple of high signal intensity on FLAIR/T2 images involving periventricular white matter at the left frontal lobe and right periventricular white matter are seen which are nonspecific.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.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. No evidence of acute ischemic or hemorrhagic lesion.2. A couple of nonspecific FLAIR/T2 high signal intensity lesions on white matter of left frontal lobe and right periventricular white matter.3. Normal brain MRV.


Instruction: Generate impression based on findings.

Input: Reason: new onset episodes of loss of consciousness in setting of history of stroke and seizures; eval for structural cause History: loss of consciousness. No evidence of true restricted diffusion is seen. Multiple areas of encephalomalacia with surrounding T2 hyperintensity are seen, for example in the left greater than right high frontal lobes, the right inferior occipital lobe, the left anterior temporal lobe and the right lateral cerebellar lobe, compatible with chronic infarcts. These do not appear significantly changed compared to prior CT scan. There is patchy hyperintense signal within the periventricular and frontal white matter on FLAIR, which is consistent with chronic small vessel ischemic disease. There are numerous scattered foci of susceptibility, compatible with old microhemorrhage.The ventricles and sulci are normal in size, with prominent frontal horns, which is unchanged. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Hyperostosis frontalis, as seen on prior CT.

Output: 1. Extensive encephalomalacia involving the cerebellum, right occipital lobe, left anterior temporal lobe, and bilateral frontal lobes compatible with multiple prior infarcts. No evidence of acute ischemia, hemorrhage, or intracranial mass. These correspond to the lesions seen on prior CT without interval change.2. Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB:5/3/1962)Reason: 3 t scanner ccm protocol qsm permeability History: headaches evaluate for aneurysmPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is a serpiginous lesion present along the junction of the left lingual gyrus, fusiform gyrus and left parahippocampal gyrus and within the left collateral sulcus which extends to the periventricular white matter at the temporal horn which is low signal on T2 and associated with susceptibility effect. There is associated contrast enhancement with this lesion extending from the subarachnoid space into the gyrus. Associated with a somewhat caput medusa appearance. There is a CT from 4/7/2 6003 which suggested this was smaller at that time.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Lesion present within the left collateral sulcus and adjacent brain parenchyma is present which could represent a developmental venous anomaly associated with venous varix or small cavernoma. A coincidental small extra-axial mass such as a meningioma along the tentorium cannot be excluded. A follow-up exam would help further evaluate for this possibility.


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:11/28/1954)Reason: eval for stroke, and assess right ventricular mass History: Left sided weaknessPROVIDER/ATTENDING NAME: RAYMOND A ROOS RAYMOND A ROOS There is redemonstration of status post transsphenoidal pituitary surgery. There is a sellar and suprasellar mass present associated with some extension into the left cavernous sinusA small focus of encephalomalacia is present in the right cerebellar hemisphere. Another small focus of encephalomalacia is present in the right pons. Punctate lesion is redemonstrated in right globus pallidus several other punctate lesions are present in the left thalamus and external and internal capsules. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to the prior exam.Incidental note is made of cavum septum pellucidum and vergae. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left A1 segment appears to be small. The right vertebral artery smaller than the left vertebral artery.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is somewhat degraded due to patient motion.

Output: 1.There is a pituitary fossa mass present which in general appear similar in dimensions compared to the prior exam, however, this is not a pituitary study and subtle changes in size would not be readily appreciated on the current exam.2.Small foci of encephalomalacia in the right cerebellar hemisphere and pons related to prior foci of infarction now on chronic stage.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 13-week-old male status post trauma; evaluate for subdural hematoma There is prominent CSF density surrounding the cerebral hemispheres bilaterally with multiple small hyperdense foci suspicious for blood product. These hyperdense foci are best visualized on: the left frontal parafalcine region (image 12 and 13), the right frontal lobe (image 21), the left frontal lobe (image 30), the right parietal lobe (image 34), and the left parietal lobe (image 29). These findings are suspicious for posttraumatic subdural hemorrhage/hematoma of indeterminate age and should be followed up with with an MRI to evaluate the extent of parenchymal injury.There is also a area of low density consistent with edema in the posterior frontal lobe best seen on axial images 25 through 27. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base show no fractures. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Multiple hyperdense foci within a prominent CSF density surrounding the cerebral hemispheres, as described above, highly suspicious for posttraumatic subdural hematoma/hemorrhage. Recommend MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: Left leg pain history of lumbar decompression 3 years ago. There is multilevel degenerative spondylosis. At T12-L1, there is a slight disc bulge without significant spinal canal or neural foraminal stenosis. At L1-L2, there is there is a slight disc bulge, mild facet hypertrophy, and thickening of the ligamentum flavum, with minimal spinal canal and bilateral neural foraminal narrowing. At L2-L3, there is a disc bulge, mild facet hypertrophy, and thickening of the ligamentum flavum, with moderate spinal canal narrowing and mild bilateral neural foraminal narrowing. At L3-4, there is a disc bulge, mild facet hypertrophy, and thickening of the ligamentum flavum, with moderate spinal canal and bilateral neural foraminal stenosis. At L4-5, there is a disc bulge, mild facet hypertrophy, and thickening of the ligamentum flavum, with mild spinal canal narrowing and bilateral neural foraminal narrowing. At L5-S1, there is a disc bulge, mild facet hypertrophy, and thickening of the ligamentum flavum, with mild spinal canal narrowing and moderate to severe right and severe left neural foraminal narrowing. There is mild convex left scoliosis, but no spondylolisthesis. There are intravertebral disc herniations via the inferior endplates of T11 and T12. The vertebral body heights are otherwise preserved. There is a subcentimeter area of focal fat or hemangioma in the T11 vertebral body, as well as scattered areas of fatty infiltration within the lumbar spine bone marrow. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative lumbar spondylosis, which is most pronounced at the L2-3, L3-4, and L5-S1 levels.


Instruction: Generate impression based on findings.

Input: Newly diagnosed squamous cell carcinoma of the lung; need to complete staging with brain imaging History: newly diagnosed squamous cell carcinoma of the lung; need to complete staging with brain imaging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of cerebral white matter T2 hyperintensity in the bilateral cerebral hemispheres. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: No evidence of intracranial metastases. Scattered foci of cerebral white matter T2 hyperintensity in the bilateral cerebral hemispheres are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of proctitis with persistent rectal bleeding and pain. Transrectal ultrasound showing a 2 mm perianal fistula. Evaluate extent of disease prior to surgical treatment. PELVIS:PROSTATE/SEMINAL VESICLES: Prostate is normal in size.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a fistula arising from the 1:00 position of the anal verge distal to the sphincter and extending through the medial left gluteal soft tissues and exiting the skin along the inferior aspect of the major gluteal fold (series 1202 images 21 through 11). No involvement of the sphincter is identified. The tract appears well granulated. No associated abscess is identified.BONES, SOFT TISSUES: Fat containing left inguinal lymph node. Edema and ill-defined enhancement in the right vastus lateralis muscle; correlate with history of trauma (series 1202 image 12).OTHER: No significant abnormality noted.

Output: 1.Perianal fistula arising distal to the sphincter at the anal verge extending into the left gluteal soft tissues as described. No associated underlying abscess is identified.


Instruction: Generate impression based on findings.

Input: Ms. Brill is a 36-year-old female with a family history of breast cancer in mother, diagnosed at the age of 34. She is BRCA1 positive. This is the 10th module of the study. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is 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.