Instruction: Generate impression based on findings.

Input: Study is limited due to patient motionMRI BRAIN:Multiple parenchymal brain metastases are overall minimally decreased. A 5-mm left cerebellar lesion is unchanged in size (3001/6). A 5-mm right vermian lesion is unchanged (3001/10). A left frontal lobe lesion measures 1.7 x 1.3 cm (3001/15), previously 2.2 to 1.8 cm. There is susceptibility and hemorrhage within this lesion, which is bright on T1 and T2 sequences, compatible with late subacute hemorrhage. Increased diffusion restriction adjacent to this region of hemorrhage is likely secondary to artifact. Edema surrounding this lesion is slightly decreased. A right inferior frontal gyrus lesion measures 10 x 8 mm (3001/15), previously 10 x 10 mm. Right superior frontal lobe lesion measures 11 x 10 mm (3001/20), previously 14 x 13 mm. Left occipital lobe lesions are decreased in size with decreased associated edema (3001/11). Focus of susceptibility along the peripheral right frontal lobe likely represents old hemorrhage. There is new leptomeningeal enhancement with associated T2 abnormality within the cerebrum, right greater than left, particularly along the frontal lobes.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Mild mucosal thickening within the maxillary sinuses.MRI COMPLETE SPINE:There are superior endplate depressions at T4 and T5 and inferior endplate depressions at T7 and T9 which appears similar to prior exam. There is a superior endplate depression at L4 with associated STIR hyperintensity which is new from the prior CT. Alignment is anatomic. There is no abnormal signal within the cord or conus. There is multilevel disk desiccation. No significant central canal narrowing. Broad-based disk bulges at L3-L4, L4-L5 and L5-S1.

Output: 1.Multiple parenchymal brain metastases are slightly decreased.2.New leptomeningeal enhancement is nonspecific but may be related to leptomeningeal carcinomatosis or meningoencephalitis.3.New subacute hemorrhage within a left frontal lobe lesion.4.No acute cord compression.5.New endplate compression deformity at L4.


Instruction: Generate impression based on findings.

Input: Male, 21 years old. Reason: MRI History: same ACETABULAR LABRUM: The anterior superior labrum is somewhat blunted, with a small tear at the underside of the labrum at this location. The labrum appears otherwise intact.ARTICULAR CARTILAGE AND BONE: Normal bone marrow signal for age. Articular cartilage appears normal, without significant narrowing or focal defect.SOFT TISSUES: The visualized muscles appear normal. ADDITIONAL

Output: Anterior superior labral tear as described above.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: No definite diffusion weighted abnormalities are appreciated. Foci of abnormal signal on DWI in the midbrain are felt to reflect a combination of T2 shine through and artifact without corresponding low ADC signal. There is a moderate degree of periventricular and subcortical punctate and patchy hyperintense white matter lesions present identified on the FLAIR and T2 images. Small focus of encephalomalacia in the peripheral left cerebellar hemisphere. There are unchanged foci susceptibility in the right thalamus, central and left mid brain, and periventricular white matter.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal flow-voids are demonstrated in the major intracranial vascular structures.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA HEAD: Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is redemonstration of approximately 60% stenosis involving the left inferior division M2 MCA segment. There is also mild narrowing of the distal right vertebral artery at the junction with the left vertebral artery. Note is made of an extracranial origin of the right PICA. The superior cerebellar arteries originate from the PCAs. MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion.Both vertebral artery origins are patent. The left vertebral artery is dominant. Suboptimal evaluation of the origins of the vertebral arteries.

Output: 1. There is no evidence for acute ischemic cerebral infarction or hemorrhage.2. Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 3. Multiple microhemorrhages in the midbrain, right thalamus, and periventricular white matter. This was also present on the 9/2016 exam.4. Small focus of encephalomalacia in the left peripheral cerebellar hemisphere.5. There is no evidence for extracranial cerebrovascular occlusive disease.6. Approximately 60% stenosis involving the inferior division M2 segment of the left middle cerebral artery. This is stable


Instruction: Generate impression based on findings.

Input: History of metastatic thyroid cancer with brain metastases status post SRS for surveillance. A lesion has developed within the left inferior parietal lobule measuring 14 x 12 mm with heterogeneous T2 bright signal on a background a strong susceptibility and probable mild rim and speckled enhancement. This lesion is associated with significant new FLAIR signal abnormality. On the prior examination, only a punctate enhancing focus was seen at this location. Anterior to the above lesion within the left superior parietal lobule is an enhancing lesion which measures 7 x 5 mm, previously 7 x 7 mm. There is slightly increased associated FLAIR signal abnormality.The punctate left inferior frontal gyrus enhancing lesion is unchanged. This lesion also demonstrates mild susceptibility effect which is unchanged. The punctate focus of enhancement within the left lateral post central gyrus is also unchanged. The left anterior temporal lobe lesion is decreased in enhancement, and is associated with hemosiderin staining.The right anterior inferior frontal gyrus enhancing lesion measures 6 x 4 mm, previously 6 x 5 mm. The surrounding FLAIR signal abnormality is similar to the prior exam. An additional punctate enhancing lesion noted in the right middle frontal gyrus is unchanged. The lesion along the lateral aspect of the junction between the body and frontal horn of the right lateral ventricle, now measures up to 3 mm, previously 6 mm. There is an associated new focus of susceptibility. There is no definite new lesion. No significant mass effect, midline shift or herniation. There are no extraaxial fluid collections. Incidental note is made of a partially empty sella which is a normal variant. Moderate bilateral ethmoid sinus opacification. Bilateral maxillary mucous retention cysts.

Output: 1. Interval development of a heterogeneous, minimally enhancing lesion containing blood product within the left inferior parietal lobule, the site of a previously seen punctate focus of enhancement. This newly developed lesion could represent a simple intralesional hemorrhage, or perhaps a radiation related cavernoma, with associated significant surrounding edema. A growing metastasis, while on the differential diagnosis, is considered somewhat less likely given the overall stability or improvement of numerous other lesions. 2. An adjacent smaller left superior parietal lobule metastatic lesion with slight increase in the surrounding FLAIR signal, but decreasing enhancement, is favored to reflect treatment effect. 3. Interval decrease in the size of a right lateral ventricle lesion. Interval decrease in enhancement in a left temporal lobe lesion now with hemosiderin staining, perhaps representing treatment effect.3. Stable size of the remaining lesions. No definite new lesions.


Instruction: Generate impression based on findings.

Input: 70-year-old woman with history of metastatic melanoma status post stereotactic radiosurgery 6 months ago, currently on immunotherapy. In the left cerebellar hemisphere (1001/6), there is a 27 x 26 x 24 mm multilobulated T1 hyperintense mass with surrounding, thick enhancement, particularly along the superior aspect. The central, lobulated portion with high intrinsic T1 signal is stable in size, but the surrounding enhancement has increased in size. Susceptibility artifact corresponding to the lesion represents blood products. Increased T2/FLAIR signal in the white matter of the left cerebellum and vermis has increased from the prior examination. Additionally, there is mass effect on the fourth ventricle and lateral aperture which appears increased from the prior exam. The lateral ventricles appear stable in size and cavum septum is again noted.Encephalomalacia and susceptibility artifact in the right paramedian parietal lobe and left occipital lobe are unchanged. There is a small amount of increased T2/FLAIR signal surrounding these regions.No additional foci of abnormal enhancement are identified. There is no diffusion-weighted abnormality to suspect acute infarct. No extra-axial fluid collections. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. The major intracranial arterial flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Stable size of left cerebellar hemorrhagic lesion. Given the time course of treatment, increasing edema and thickened rim of enhancement surrounding the lesion are suspicious for tumor progression, however, the possibility of radiation necrosis cannot excluded.2.Slightly increased mass effect with effacement of the fourth ventricle.3.Additional areas of encephalomalacia unchanged. No new intracranial foci of metastasis.


Instruction: Generate impression based on findings.

Input: Female 23 years old Reason: eval for meniscal/ligamentous pathology History: L knee pain s/p fall, medial sided MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone island is present in the lateral tibial epiphysis. Bone marrow edema is present near the insertion of the MCL.LIGAMENTS: Complete tear of the MCL near its insertion on the femur (series 501, image 17). Components of the lateral collateral complex are intact. ACL and PCL are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Complete tear of the MCL near its insertion on the femur with adjacent bone marrow edema.


Instruction: Generate impression based on findings.

Input: 27 years Male (DOB:7/2/1988)Reason: disc bulge causing S1 compression History: worsening leg painPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK TARIQ MUSLIM MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a left paramedian broad-based disc protrusion which mildly encroaches on the nerve roots at the left lateral recess more than the right lateral recess. This has not changed substantially compared to the previous exam. There is disc desiccation present at this level and loss of disc space height.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Left paramedian broad-based disc protrusion at L5-S1 mildly encroaches on the nerve roots at the left lateral recess. To a lesser degree there some minor encroachment of the nerve roots at the right lateral recess at this level. Compared to the exam from August this does not appear to have changed substantially.


Instruction: Generate impression based on findings.

Input: Reason: eval knee History: pain MENISCI: There is attenuation of the posterior horn of the lateral meniscus compatible with prior partial meniscectomy. There is increased signal intensity at the interface of the meniscofemoral ligament of Wrisberg with the posterior horn which could represent the remnants of a "Wrisberg rip", but this does not appear to have progressed when compared to the prior study. There is linear increased signal intensity within the body of the lateral meniscus extending to the femoral articular surface, seen on a single image, that has a low likelihood of representing a true tear. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: STIR sequences were substituted for fat-saturated T2-weighted images to reduce metal artifact. This decreases our ability to assess the articular cartilage. Subjectively, the articular cartilage of the patella appears thinned suggesting degeneration, but we see no full-thickness cartilage defects. There is mild edema type signal within the anterior aspect of the proximal tibia that is nonspecific. We see no fracture.LIGAMENTS: The patient has undergone ACL reconstruction. The graft appears intact. There is focal low signal intensity anterior to the intra-articular portion of the graft likely representing focal fibrosis. The PCL appears intact. The patient has undergone MCL reconstruction. The MCL itself appears intact, although thickened, likely reflecting adjacent scar tissue. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Surgical changes of ACL and MCL reconstruction and prior partial lateral meniscectomy.2. Mild nonspecific subcutaneous edema within the anterior and anteromedial aspect of the knee.3. Mild subjective thinning of the patellar cartilage and other findings as described above.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer restaging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastasis. 2. Mild probable chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 12 year old female patient with back pain post lumbar puncture. Evaluate for a pathological reason for the pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign for the patient's age. The conus medullaris is normal in position. There is no abnormal epidural collection or discrete fluid collection to suggest a CSF leak. There is no significant disc disease, spinal canal stenosis, or neural foraminal stenosis at any level. There is increased STIR signal within the posterior spinal musculature and subcutaneous soft tissues consistent with edema.

Output: 1. No evidence of hematoma or fluid collection in the lumbar spine. No spinal canal or neural foraminal stenosis. 2. Edema within the posterior spinal musculature and subcutaneous soft tissues is non-specific and possibly post-procedural.


Instruction: Generate impression based on findings.

Input: 73-year-old female with acute mental status changes evaluate for metastases. Again seen are multiple areas of hypoattenuation in the bilateral cerebellar hemispheres, basal ganglia, and the bilateral parietal lobes consistent with metastatic disease. No new definite metastatic lesions are seen. If there is clinical concern for a new metastatic lesion, contrast enhanced CT or MRI recommended.There are multiple areas of periventricular and subcortical hypoattenuation consistent with small vessel ischemic disease of indeterminate age. There is redemonstration of the low density focus in the brainstem which likely represents a chronic infarction.Hyperdense material in the left globe is evident, compatible with patient's known intra-ocular metastasis with possible hemorrhage.There is no evidence of intra-or extra axial hemorrhage, mass effect, or midline shift. The size of the ventricles remains stable. The visualized mastoid air cells and paranasal sinuses are clear.

Output: 1.No significant interval change in multiple intracranial metastatic lesions. If there is clinical concern for a new metastatic lesion, contrast enhanced CT or MRI is recommended.2. Stable hyperdense material in left globe, compatible with patient's known intra-ocular metastasis with possible hemorrhage.


Instruction: Generate impression based on findings.

Input: A punctate focus of restricted diffusion is seen in the posterior right cerebellum (601/233) with associated T2/FLAIR hyperintensity. This may represent a tiny focus of acute ischemia.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. To lesser degree similar lesions are present in the brainstem and cerebellumA punctate focus of susceptibility signal is seen in the right temporal lobe, most likely representing mineralization versus hemosiderin from microhemorrhage. Also a punctate foci of susceptibility signal are identified in both frontal lobes.A focus of T1 high signal is seen in the right occipital lobe, most likely representing venous lakeThere is mucous retention cyst in the left maxillary sinus.

Output: 1. A punctate focus of restricted diffusion in the right cerebellum, may represent acute microinfarction.2. Periventricular and subcortical white matter punctate lesions as well as punctate lesions in the brainstem and cerebellum of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 54 years, Male, Reason: biliary strictures? History: elevated alk phos. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic liver morphology. No suspicious hepatic lesions. Focal decreased T1 signal within the caudate likely reflects iron deposition.Status post cholecystectomy. Prominent common bile duct measuring up to 1.1 cm with dilatation of the cystic duct stump. The common bile duct tapers to the ampulla which may represent a benign structure. Mild intrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left upper pole cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Esophageal varices.OTHER: Mild perihepatic ascites.

Output: 1.Mild intrahepatic and extrahepatic biliary ductal dilatation with tapering of the common bile duct to the ampulla, which may represent a benign stricture.2.Cirrhotic liver with splenomegaly, esophageal varices and mild perihepatic ascites. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: 63 year old female status post right lumpectomy and sentinel lymph node biopsy (negative nodal biopsy) in January 2009 for multifocal infiltrating ductal carcinoma. Patient is status post radiation and hormonal therapy. Patient has a strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Postsurgical changes with volume loss identified in the right upper outer quadrant. Stable enhancing intramammary lymph node identified in the lateral left breast. Stable low T2 nonenhancing lesion in the left breast 6:00 position is also noted.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of glioblastoma on treatment with Avastin/TMZ and repeat radiation therapy. Postoperative changes from prior right frontoparietal craniotomy and partial tumor resection. Again seen are areas of heterogeneous enhancement and restricted diffusion in the right frontal lobe, insula, basal ganglia, temporal, and parietal lobes as well as extending into the right aspect of the corpus callosum. This surrounds a stable central cystic cavity. Ill-defined tumor enhancement extends 20 mm anterior to the cystic collection, previously 20 mm. There is associated vasogenic edema as well as mild mass effect in the adjacent right lateral ventricle which is stable. Relative cerebral blood volume generated from perfusion data demonstrates no significant perfusion increase adjacent to the treatment cavity to correspond with areas of enhancement.Numerous scattered small foci of susceptibility predominantly within the right cerebral cortex compatible with posttreatment changes/microhemorrhages. The ventricles and basal cisterns are stable. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Stable examination with post treatment changes as described.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion. The lumbar spine is in normal alignment, with straightening of the normal lumbar lordosis. The vertebral body and disk heights are stable, with mild-moderate disc narrowing at L4-L5 and moderate disc narrowing at L5-S1. Mild disc narrowing is present at L1-L2. Disc desiccation is again present from L3-L4 through L5-S1, and to a lesser degree at L1-L2. No worrisome focal marrow signal abnormality is appreciated, with redemonstration of severe endplate degenerative changes at L4-L5. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level. There is developmental narrowing of the lumbar spinal canal due to shortened pedicles and prominence of dorsal epidural fat.At T12-L1, there is persistent bilateral facet arthropathy and ligamentum flavum thickening.At L1-L2, there is persistent bilateral facet arthropathy and ligamentum flavum thickening.At L2-L3, there is prominent bilateral facet arthropathy and ligamentum flavum thickening. There is mild developmental narrowing of the central spinal canal.At L3-L4, there appears to be slight decreased crowding of the cauda equina nerve roots within the thecal sac. There is bilateral facet arthropathy and ligamentum flavum thickening with overall mild-moderate central spinal canal stenosis.At L4-L5, there has been interval complete resolution of previously seen left paracentral disc protrusion. There is a residual mild disc bulge. Postoperative changes are again seen from remote right-sided laminotomy. The left lateral recess is now patent. There is mild-moderate developmental central spinal canal stenosis remaining at this level, with improved visualization of the CSF within the thecal sac. There is stable mild right foraminal narrowing. There remains right greater than left facet arthropathy as well as left ligamentum flavum thickening.At L5-S1, there is a stable shallow central/left paracentral disc protrusion which abuts the descending left S1 nerve root. There is moderate bilateral facet arthropathy and left ligamentum flavum thickening. There is again slight encroachment upon the left lateral recess. There is mild left foraminal narrowing. Right-sided postoperative changes from previous laminotomy are again noted.

Output: 1.Interval resolution of previously seen left paracentral disc protrusion at L4-L5 with decreased mass effect upon the thecal sac, as there is only a mild residual disc bulge with mild-moderate developmental central spinal canal stenosis at this level. Also associated decreased crowding of cauda equina nerve roots at L3-L4.2.Stable minimal central/left paracentral disc protrusion at L5-S1 which continues to abut the descending left S1 nerve root.


Instruction: Generate impression based on findings.

Input: Seizure disorder and likely mitochondrial disorder with new focal neuro deficits. Focal right posterior parietal/occipital lobe seizures. There are scattered gyriform areas of T2 hyperintensity in the right parietal and occipital lobes. There has been interval cavitation of the expanded bilateral medullary olives with associated peripheral enhancement. There are T2 hyperintense lesions in the bilateral thalami, right larger than left. The caudate nuclei appear to be slightly T2 hyperintense diffusely. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right superior frontal gyrus developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Scattered gyriform areas of T2 hyperintensity in the right parietal and occipital lobes, persistent abnormalities in the bilateral thalami and basal ganglia, and interval cavitation of the medullary olives. Overall, the findings may represent stigmata of a mitochondrial disease, particularly Leigh and Leigh-like syndromes, with associated seizure activity and hypertrophic olivary degeneration.


Instruction: Generate impression based on findings.

Input: Clinical question: History of breast cancer in right breast. Signs and symptoms: Evaluate for progression of disease. Nonenhanced head CT:Examination demonstrates diffuse subtle subcortical and periventricular foci of low attenuation which are nonspecific although concern patient's age are highly suspected for minimal small vessel ischemic disease of indeterminate age.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. This non-infused examination demonstrate no evidence of any findings to suggest metastatic lesions however lack of intravenous contrast significantly reduces the sensitivity of the exam for detection of small metastatic disease to the brain or leptomeninges. Falloff in infuse the study or an enhanced MRI should be considered.The cortical sulci, ventricular system and CSF cisterns remain already normal.Visualized mastoid air cells and paranasal sinuses are unremarkable.Images through the orbit demonstrate evidence of prior cataract surgery.Calvarium is intact.

Output: 1.Negative non-infused head CT for metastatic disease. Recommend further studies will an enhanced CT or an enhanced MRI is recommended.2.Small vessel disease of indeterminate age.3.Negative calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Question of rotator cuff tear, pain. ROTATOR CUFF: The supraspinatus appears thickened, though intact fibers appear to insert onto the humerus. The insertional site appears slightly edematous. These findings are consistent with at least a moderate tendinopathy. Further, a mild tendinopathy of the subscapularis is also appreciated. SUPRASPINATUS OUTLET: Supraspinatus tendinopathy as above.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is grossly intact.BICEPS TENDON: The long head of the biceps is not visualized on this examination, of unclear clinical significance. The short head of the biceps is well visualized.ADDITIONAL

Output: Moderate tendinopathy of the supraspinatus and mild tendinopathy of the subscapularis. Nonvisualization of the long head of the biceps tendon of unclear clinical significance.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, status post T1 corpectomy and fusion. Postoperative findings are seen compatible with interval T1 corpectomy with anterior instrumented fusion from C7 through T2. Evidence of more remote laminectomy is also seen involving the cervicothoracic junction. The previously seen left ventral epidural enhancing lesion at T1 has been resected and there is no evidence of any residual intraspinal enhancing tissue at this location. Previously seen spinal canal narrowing and mass effect upon the spinal cord have also been relieved. The cord remains chronically thinned at this location and there may be minimal residual cord T2 hyperintensity though this is equivocal.Nodular, T2 hypointense and mildly enhancing soft tissue remains evident within the left lateral paraspinal tissues at C7 and T1. This tissue measures up to 30 x 25 mm (image 21 series 12), showing no significant change from the prior exam.No new epidural lesions are suspected. The spinal canal is patent throughout. Elsewhere, the spinal cord shows normal morphology and signal characteristics.Spinal alignment is anatomic. Outside of the operative region, vertebral body height and morphology are within normal limits. No new or concerning marrow signal abnormality is detected.

Output: 1.Interval resection of the previously seen plaque-like ventral epidural enhancing lesion at the T1 level. Spinal canal narrowing and mass effect on spinal cord at this level have been relieved. No definite evidence of any residual intraspinal lesion is seen.2.Nodular soft tissue remains evident within the left lateral paraspinal tissues contiguous with the C7 and T1 vertebral bodies. This tissue has not significantly changed in size from the prior examination and may represent an extraspinal component of the original intraspinal lesion.


Instruction: Generate impression based on findings.

Input: 60-year-old male with Gleason 6 adenocarcinoma on active surveillance PELVIS:PROSTATE:Prostate Size: 5.6 x 3.6 x 5.7 cm.Peripheral Zone: Previously seen T2 hypointense focus with restricted diffusion in the right midgland peripheral zone has decreased in size and may reflect focal scarring. Previously noted wedge shaped left paracentral peripheral zone T2 hypointense lesion with diffusion restriction is not significantly changed. Mild capsular retraction around this focus. Central Gland: Mild degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Decrease in size of right midgland peripheral zone lesion which may reflect focal scarring. 2.No change in left paracentral peripheral zone lesion.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma of the left floor of mouth. There is an enhancing mass centered the left floor of mouth that measures up to approximately 50 mm. The tumor has eroded into the lingula aspect of the left mandible and extends into the left submandibular space with mass effect upon the glossotonsillar sulcus. The tumor does not extend across the midline. There are denervation changes in the left tongue, but there is no evidence of perineural tumor in the region of the skull base. There is an enlarged left level 1B lymph node that measures 12 x 19 mm in axial section. The right submandibular gland and bilateral parotid glands are unremarkable. There is a right palatine tonsillary crypt retention cyst. The thyroid gland is unremarkable. The imaged orbits and intracranial structures are unremarkable. There is mucosal thickening in the bilateral ethmoid and maxillary sinuses. There is multilevel degenerative cervical spondylosis.

Output: 1. The adenoid cystic carcinoma of the left floor of mouth measures up to approximately 50 mm and has eroded into the lingula aspect of the left mandible and extends into the left submandibular space. 2. An enlarged left level 1B lymph node may represent metastatic disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Ocular pain, right eye Aneurysm of unspecified siteClinical question: r/o mass or aneurysmSigns and Symptoms: HA MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the right maxillary sinus which is new since the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is mild asymmetry in the size of the eyeballs the right is slightly larger than the left. This is unchanged since prior exam.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for intracranial mass or other intracranial abnormality.4.Asymmetry in the size of the size of the eyes is stable.


Instruction: Generate impression based on findings.

Input: 50-year-old female with fever of unknown origin, evaluate liver and kidneys for ring enhancing lesions ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly. Bilobar hepatic cysts measuring up to 1.6 cm. The hepatic vasculature is patent. No intrahepatic biliary ductal dilatation. The gallbladder and common bile duct are normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas and main pancreatic duct are normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal mass or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval and upper abdominal lymph nodes. Small retroperitoneal lymph nodes.BOWEL, MESENTERY: The visualized bowel is without significant abnormality.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatomegaly and enlarged portacaval / upper abdominal lymph nodes of unknown etiology.2.No hepatic or renal collections as clinically queried.


Instruction: Generate impression based on findings.

Input: 54 years, Female, Reason: 3 t scanner moyamoya unilateral History: headache and tingling in upper extremities. MRI BRAIN

Output: 1. No evidence of acute infarct. Chronic infarct involving the left frontal corona radiata with mild extension into the basal ganglia. There are additional mild chronic small vessel ischemic changes.2. Cystic lesion involving the right aspect of the sella which also appears to present on remote CT from 2009. Further delineation with pituitary MRI can be considered as clinically warranted.3. The left internal carotid artery is moderately diminutive developmentally with suspected superimposed high-grade stenosis/occlusion involving the left distal supraclinoid ICA extending into the left M1 and to a lesser degree proximal left A1 segments. There are mildly prominent left-sided lenticulostriate collateral vessels. Overall findings are consistent with a moyamoya pattern. 4. Left parieto-occipital scalp defect.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, with left frontotemporal GBM status post biopsy then radiotherapy which was completed in 6/2016. Evaluate for progression/response. Postoperative findings are seen compatible with a left parietal approach stereotactic biopsy. Again seen is an irregularly marginated enhancing lesion which spans the left frontal operculum, insula, sylvian fissure and perhaps the temporal. Since the pretreatment evaluations, the superior portion of the lesion has become more centrally necrotic while the enhancing medial rim seems to have thickened. The overall size of this component has increased with an AP dimension of up to 5 cm, previously 3.5 cm. The more inferior portion of the lesion which involves the insula and temporal lobe has also become centrally necrotic and perhaps minimally larger. There may be some subarachnoid spread from the lesion into the sylvian fissure. The enhancing portions of the lesion correlate with clear elevated rCBV.Surrounding T2 hyperintensity within the left cerebral hemisphere has increased in geographic extent. The degree of generalized mass effect has also increased with progressive effacement of the left lateral ventricle and a midline shift to the right of 11 mm, previously about 6 mm. The right lateral ventricle has increased in caliber suspicious for entrapment.Periventricular T2 hyperintensity is seen on the right along with a few scattered nonspecific foci of FLAIR hyperintensity. No definite evidence of contralateral tumor spread is seen. The core of the tumor demonstrates susceptibility compatible with blood product. However, no frank intracranial hematoma is identified.

Output: Since the prior pretreatment examinations, the overall size of the patient's left frontotemporal tumor has increased. While this at least partly represents development of central necrosis, which could reflect response to treatment, areas of progressively thicker rim enhancement are also seen. There is also a generalized increase in mass effect with progressive midline shift to the right and developing entrapment of the right lateral ventricle. Overall, the findings are concerning for progressive tumor with perhaps a minor component of treatment effect.


Instruction: Generate impression based on findings.

Input: 68-year-old female with SLE, HTN, CAD with episodes of hallucination with facial weakness and limited upgaze. A moderate or vasculitis or vascular pathology. CT of brain without infusion.No evidence of hemorrhage, cortical stroke, mass effect, edema or midline shift is detected. Previously reported small muscle disease on MRI examination is not visible on this study.The bony density of calvarium, pneumatization of paranasal sinuses and mastoid air cells are also unremarkable.CTA of intracranial circulation.CTA of the carotid system demonstrates patent bilateral intracranial portions of the carotid arteries with no abnormality in particular no evidence of vasculitis. There is also good visualization of bilateral anterior and middle cerebral arteries and all of their branches. Within the limitation of CTA no evidence of vasculitis of the left middle or anterior cerebral arteries or their branches is detected.CTA of vertebral basilar system demonstrates patent bilateral intracranial components of the vertebral arteries with no pathology. There is good visualization of bilateral PICAs. The basilar artery is also well visualized and demonstrates no pathology. There is normal visualization of bilateral posterior cerebral arteries and superior cerebellar arteries with no evidence of pathology in particular no evidence of vasculitis.Within the limitation of CTA no evidence of vasculitis of the branches of the posterior cerebral arteries or superior cerebellar arteries is detected.

Output: Unremarkable CTA of intracranial circulation.Within the limitation of CTA for detection of small vessel vasculitis this is study is unremarkable.


Instruction: Generate impression based on findings.

Input: 34-year-old female status post Chiari decompression experiencing headache, subjective balance issues, as well as pressure in head Redemonstrated are changes from previous suboccipital craniectomy for treatment of Chiari malformation. A previously demonstrated extradural fluid collection has resolved, resulting in resolution of mass effect upon the adjacent dura, with commensurate increase in the CSF space at the distal aspect of the tonsils. As before, there is biphasic CSF flow at the level of the cerebellar tonsils. Redemonstrated is straightening cervical spinal may be positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Unremarkable and unchangedC3/4: Unremarkable and unchangedC4/5: Unremarkable and unchangedC5/6: Unremarkable and unchangedC6/7: Mild disc bulge and bilateral uncinate hypertrophy. There is mild bilateral neural foraminal stenosis. These findings are unchanged.C7/T1: Unremarkable and unchanged

Output: 1.Redemonstrated are changes from previous suboccipital craniectomy for treatment of Chiari malformation. A previously demonstrated extradural fluid collection has resolved, resulting in resolution of mass effect upon the adjacent dura, with commensurate increase in the CSF space at the distal aspect of the tonsils. As before, there is biphasic CSF flow at the level of the cerebellar tonsils.2. C6/7: Mild bilateral neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: Biopsy proven pineocytoma WHO I status post repeated endoscopic stereotactic 3rd ventriculostomy for obstructivehydrocephalus: surveillance. There are postoperative findings related to right transfrontal endoscopic third ventriculostomy and biopsy of a pineal tumor. There is no significant change in size of the pineal tumor, which measures up to approximately 25 mm. There is also unchanged dilatation of the third and lateral ventricles, as well as the confluent periventricular white matter T2 hyperintensity. There is no evidence of acute infarct or hemorrhage. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: No significant interval change in the size of the residual pineocytoma and triventricular hydrocephalus associated with transependymal cerebrospinal fluid flow, which may indicate third ventriculostomy failure.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:3/25/1950)Reason: Hx of colon cancer, pain in neck, radiating to arm and numbness in hands History: Hx of colon cancer, pain in neck, radiating to Arm and numbness in handsPROVIDER/ATTENDING NAME: MARK F KOZLOFF MARK F KOZLOFF The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disc space height this desiccation and diffuse disc bulge associated with endplate reactive changes as well as endplate and uncovertebral osteophytes and ligamentum flavum hypertrophy. There is effacement of the spinal fluid surrounding the spinal cord at this level resulting in the mild to moderate degree of spinal stenosis. There is narrowing of the neural foramina bilaterally at this level with encroachment of the left exiting nerve roots within the neural foramina bilaterally. There is mild posterior subluxation of C3 on C4. These findings are stable compared to the prior examAt C4-5 there is no significant compromise to the spinal canal. There is bilateral facet hypertrophy at this level which is worse on the left compared to the right side. There are small uncovertebral osteophytes at this level. There is narrowing of the neural foramina with encroachment of the exiting nerve roots bilaterally at this level. These findings are stable relative to the prior examAt C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes at this level associated with loss of disc space height and a disc bulge and bilateral uncovertebral osteophytes. There is narrowing of the neural foramina bilaterally at this level with encroachment of the exiting nerve roots within the neural foramen bilaterally. There are endplate reactive changes at this level which are hyperintense on T2, hypointense on T1 and enhance following gadolinium and administration. The subacute endplate reactive changes were not present on the prior exam.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C3-4 and encroachment of exiting nerve roots bilaterally at C3-4, on the left-sided C4-5 and bilaterally at C7-T1. Since the prior exam subacute endplate reactive changes have developed at C7-T1.2.No evidence for metastases to the cervical spine.


Instruction: Generate impression based on findings.

Input: Tremor, unspecified [R25.1] / Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: etiology for seizure History: seizure, AMS, intermittent tremulousness No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickenings on bilateral maxillary sinuses, ethmoid sinuses, and sphenoid sinus. Partial opacifications of the left mastoid air cells.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal signal intensity of brain parenchyme. No tumor or space occupying lesion.


Instruction: Generate impression based on findings.

Input: History of abdominal pain and anemia status post Roux-en-Y gastric bypass. Outside CT showed 1.9 cm mass lesion in the duodenal bulb of the excluded stomach. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from Roux-en-Y gastric bypass. There is no enhancing mass lesion at the duodenal bulb at the site of abnormality reported on outside hospital CT. This likely represented fluid within peristalsing bowel.The bowel is otherwise normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small uterine fibroids and ovarian cysts.BLADDER: No significant abnormality noted.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 enhancing mass lesion at the duodenal bulb. Abnormality seen on CT likely represent peristalsis and intraluminal fluid. 2.Postsurgical changes from Roux-en-Y gastric bypass without evidence of complication or acute abnormality.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left parietal craniotomy for resection of a subjacent mass. There are multiple foci of susceptibility effect within and adjacent to the resection cavity which extends to the atria of the left lateral ventricle. There is unchanged area with punctate enhancement along the anteromedial cavity margin. There is no evidence of intracranial 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.

Output: Unchanged postoperative findings with a non-specific area of signal abnormality along the anteromedial margin of the resection cavity, but no evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Clinical question: known DJD, worsened pain. Signs and Symptoms: as above Nonenhanced lumbar MRI:Lower most visualized thoracic spine demonstrate advanced disc disease at T11-T12 level with mild bulging disc resulting in subtle flattening deformity of the ventral aspect of the cord however without spinal stenosis. This finding demonstrate mild interval progression since prior study.T12-L1 demonstrate mild disc disease and loss of disc height, mild bulge of the disc, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L1 -2 demonstrate minimal disc desiccation and unremarkable otherwise.L2-L3 demonstrate mild disc desiccation, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease, mild to moderate ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however mild to moderate left neural foraminal compromise is present.L4-L5 demonstrate mild disc disease with loss of disc height, diffuse broad-based bulging disc, moderate to significant bilateral ligamentum flavum hypertrophy and mild to moderate bilateral facet hypertrophy changes. There is also grade 1 anterolisthesis at this level. Constellation of changes results in significant central spinal stenosis and moderate left and mild right neural foraminal compromise. There is slight interval progression changes at this level since prior exam from 2003.L5-S1 demonstrate mild disc disease, moderate bilateral ligamentum flavum and mild bilateral facet hypertrophic changes are present. No spinal stenosis or neural foraminal compromise.No detectable paraspinal soft tissue abnormalities.

Output: 1.At L4-L5 extensive degenerative changes and including mild grade 1 anterolisthesis results in significant central spinal stenosis and moderate left neural foraminal compromise. Progression since 2003 exam is mild.2.There is evidence of mild interval progression of degenerative changes however without evidence of spinal stenosis or significant neural foraminal compromise at any other level. Please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: A 35 year old male with hypertension, systolic aortic murmur, alcohol abuse. Noted to have irregular hear beats, frequent PVC's on holter, a recent echocardiography showed left ventricular ejection fraction of 35-40%. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 242 ml (normal range 142+/-34), the LV end systolic volume index is 72 ml/m2 (normal range 25+/-9), the LVESV is 152 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 116 g (normal range 164+/-36). There is global hypokinesis with regional variation. Considerable breathing artifact on short axis views reducing the diagnostic accuracy of these views, however there is no evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process on long axis views or on post contrast short axis T1 views. T2-weighted images showed no signs of active inflammation. Normal native T1-times. No intracavitary thrombus.Left AtriumThe left atrium is normal in size (79ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 171 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).No evidence of myocardial fatty infiltration. No regional wall motion abnormalities or aneurysms in the RV free wall. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely, is trileaflet and there is no significant aortic regurgitation or flow acceleration.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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 moderately reduced systolic function, the LVEF is 36%. There is global hypokinesis with regional variation. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process based on long axis views and post contrast short axis T1 views.3. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. No evidence of myocardial fatty infiltration. No regional wall motion abnormalities or aneurysms. 4. The aortic valve opens widely, is trileaflet and there is no significant aortic regurgitation or flow acceleration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: meniscus tear History: knee pain MENISCI: The lateral meniscus appears intact. Intra-articular gadolinium enters the tibial surface of the posterior horn of the medial meniscus extending to involve both the root and body of the meniscus in a complex but predominantly horizontal fashion, indicating a new tear. The anterior horn appears intact. There is also blunting and deformity of the posterior horn and body of the meniscus presumably reflecting postsurgical change from prior partial meniscectomy, degeneration, and prior tearing.ARTICULAR CARTILAGE AND BONE: There is subjective thinning of the articular cartilage along the weightbearing surface of the medial femoral condyle anteriorly. There is subjective thinning of the lateral tibiofemoral compartment articular cartilage. No near full-thickness or full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is mild increased signal abnormality within the proximal fibers of the patellar tendon which may reflect a mild tendinosis.ADDITIONAL

Output: 1. Complex tear of the medial meniscus as described above.2. Minimal articular cartilage degeneration affecting the tibiofemoral articulation. Other findings as described.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of right temporo-parietal craniotomy for resection of metastasis at the right temporo-occipital junction. There are susceptibility changes along the margin of the treatment cavity as well as left temporal lobe, consistent with blood products, unchanged from prior. There is confluent T2 signal changes surrounding the resection cavity in the right temporal and occipital lobes, similar to previous. There is interval increased nodular enhancement along the right temporo-occipital lobe resection cavity with nodular enhancement superiorly and posteriorly to the treated cavity. These changes while may be in part related to posttreatment effects, remain highly suspicious for local tumor recurrence.In addition, there are 2 ring-enhancing lesions measuring 9 mm and 6 mm in the right frontal lobe (series 2401, image100, image 104), with mild associated edema, consistent with metastases. There is an additional focus of enhancement measuring 9 x 7 mm in the right occipital lobe abutting the superior sagittal sinus (series 2401, image 92) compatible with metastasis. Superior sagittal sinus, however, remains patent.There is an apparent focus of enhancement in the right cerebellum (image 9, series 2201) seen on post gadolinium spin echo sequences, which is not seen in other sequences and not associated T2 signal changes, and therefore most likely artifactual.There are a few scattered periventricular and subcortical white matter hyperintensity, which are nonspecific but compatible with mild chronic small vessel ischemic changes, unchanged. There is no significant intracranial mass effect, midline shift or uncal herniation. Normal flow-voids are demonstrated in the major intracranial vascular structures. No destructive lesions in the calvarium are appreciated.

Output: 1. Compared to 6/8/2015, there is evidence of progression of metastatic disease. There are two new subcentimeter right frontal and one new right occipital enhancing lesions consistent with metastases. There are also new nodular areas of enhancement along the superior and posterior aspect of the right temporo-occipital resection cavity, which has been recently treated with radiation; while these changes may be in part treatment related, they remain highly suspicious for local tumor recurrence given their nodular appearance and new metastases elsewhere.2. No significant intracranial mass effect associated with the above lesions.


Instruction: Generate impression based on findings.

Input: 63-year-old male with prostate cancerAdditional history from EPIC: 62 year-old gentleman who was recently noted to have a rise in his PSA to 2.5 ng/mL (was 2.15 before) This prompted a transrectal ultrasound and biopsy of the Prostate which revealed adenocarcinoma, Gleason score 6 (3+3) Located at the right apex, involving a single core with less than 1mm (<5%) involvement. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.0 x 3.1 cmPeripheral Zone: No significant abnormality noted.Central Gland: There is a lesion along the anterior aspect of the right apex measuring approximately 0.9 x 0.7 cm which is intermediate signal on ADC and T2, bright on DWI and demonstrates early enhancement with washout, suspicious for prostate cancer.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the right anterior apex is suspicious for cancer.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Interval tumor resection (central neurocytoma). There has been interval right frontal craniotomy with scattered areas of pneumocephalus and right frontal lobe leptomeningeal enhancement and vasogenic edema, as well as diffuse areas of scalp swelling. There is residual tumor within the body of the right lateral ventricle with areas of high and intermediate T1 signal and susceptibility effect. Overall, the residual tumor measures approximately 15 x 30 mm in axial cross-section. There is persistent susceptibility effect and high T1 signal in the glomus of the right lateral ventricle choroid plexus with high T1 signal, as well as a small amount of layering susceptibility effect in the right lateral ventricle with intermediate T1 signal. There are two right transfrontal ventricular catheters in unchanged positions. There is persistent dilatation of the right lateral ventricle posterior to the mass, with deviation of the septum pellucidum 15 mm to the left. The rest of the ventricular system is not dilated. There is a mild degree of vasogenic edema and susceptibility effect related to hemorrhage in the left frontal lobe along the paths of the catheters. There is no evidence of acute territorial infarct. The major cerebral flow voids are intact.

Output: 1. Postoperative findings related to partial resection of a right lateral ventricle central neurocytoma with acute upon subacute intratumor hemorrhage, as well as subacute hemorrhage in the glomus of the right lateral ventricle and acute hemorrhage layering in the right lateral ventricle. 2. Persistent dilatation of the right lateral ventricle posterior to the mass due to obstructive hydrocephalus. The rest of the catheterized ventricular system is not dilatated.


Instruction: Generate impression based on findings.

Input: Reason: ruleout nmo, demyelinating disorder History: vision loss, changes MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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 right vertebral artery appears be hypoplasticThe visualized portions of the paranasal sinuses demonstrates partial opacification of the ethmoid air cells, mucosal thickening in the maxillary sinuses and frontal sinuses and partial opacification of the sphenoid sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. 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 .MRA brain:Antegrade flow is present in the distal internal carotid arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The vertebral arteries were not included on this exam. There is fenestration of the anterior communicating artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.

Output: 1.MRI of the brain and orbits is within normal limits.2.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. The vertebral arteries were not included on the MRA exam.3.Inflammatory changes are present in the paranasal sinuses.


Instruction: Generate impression based on findings.

Input: Reason: Please evaluate C1 lesion and if there are other paraspinal masses History: mass in right neck. MRI Cervical Spine:There is a soft tissue abnormality of the left C3 nerve root that is hyperintense on STIR images, causing expansion of the left C2-C3 neural foramen, extending to the C1-C2 level, representing neurofibroma. The lesion extends also posteriorly into the deep neck musculature. There is subtle neural foraminal asymmetry on STIR images, left greater than right, at the C4-C5, C5-C6, and C6-C7 levels, without evidence of discrete measurable mass.The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. There is no evidence of abnormal enhancement of the spinal cord.There are partially imaged plexiform neurofibromas of the right lateral supraclavicular fossa region. Redemonstrated are T2 hyperintense foci in the cerebellum, left greater than right, which is better demonstrated on prior MRI.MRI Thoracic Spine:There is normal thoracic kyphosis. The vertebral bodies, marrow and end plates demonstrate a normal MR appearance. The epidural space, and thecal sac, are preserved with no evidence of spinal canal narrowing. Normal signal of the spinal cord is noted throughout. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable. No evidence of kyphoscoliosis or discrete masses. The conus terminates at L1-L2.

Output: 1.There is a soft tissue abnormality of the left C3 nerve root that is hyperintense on STIR images, causing expansion of the left C2-C3 neural foramen, extending to the C1-C2 level, representing neurofibroma.2.Subtle left greater than right asymmetry of the neural foramina level C4-C5, C5-C6, C6-C7 on STIR images, without evidence of discrete measurable mass.3.There are partially imaged plexiform neurofibromas of the right lateral supraclavicular fossa region. 4.Redemonstrated are T2 hyperintense foci in the cerebellum, left greater than right, which is better demonstrated on prior MRI.


Instruction: Generate impression based on findings.

Input: Pain. Rotator cuff injury? ROTATOR CUFF: The supraspinatus tendon and muscle appear normal. There is mild intermediate signal intensity within the insertional fibers of the infraspinatus tendon suggesting mild tendinosis with mild edema-type signal in the underlying humeral head, but I see no fluid-filled rotator cuff tear. The infraspinatus muscle appears normal. The teres minor muscle and tendon appear normal. The subscapularis tendon appears slightly thickened, but I suspect this is due to internal rotation of the humerus; I see no tear, and the subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. I see no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Mild osteoarthritis affects the glenohumeral joint with a small subchondral cyst in the superior aspect of the glenoid. Mild intermediate signal intensity within the superior labrum and blunting of the anterior inferior labrum suggests degeneration, but I see no fluid-filled labral tear.BICEPS TENDON: Given the limitations of a nonarthrogram study, the tendon of long head of the biceps appears normal.

Output: 1.Mild insertional tendinosis of the infraspinatus, but no rotator cuff tear is evident.2.Mild osteoarthritis of the acromioclavicular and glenohumeral joints with other findings as above.


Instruction: Generate impression based on findings.

Input: The question: Patient with a 5 month history of headache worst when upright, better while lying down. Signs and symptoms: As above. Weight loss and dysphasia. Pre-and post enhanced brain MRI:No diffusion weighted abnormalities identified.There is normal anatomical morphology of brain and with normal signal intensity on all MRI sequences.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is within normal. The signal voids of major intracranial arterial branches are identified. Post enhanced images demonstrate no detectable abnormal enhancement or brain parenchymal, leptomeninges, calvarium or the orbits.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.Calvarium and soft tissues of the scalp demonstrate no abnormalities.Mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Paranasal sinuses are well pneumatized and there is a small right inferior maxillary sinus retention cyst.

Output: 1.Negative pre-and post enhanced brain MRI.2.Unremarkable paranasal sinuses, well pneumatized mastoid air cells and middle ear cavities.3.Unremarkable calvarium, soft tissues of the scalp and orbits.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with altered mental status. Assess for worsening brain metastases versus edema. Diffuse ependymal nodularity and enhancement is redemonstrated involving the entire ventricular system. The enhancement pattern of some of the nodules has changed in that they appear more rim-enhancing rather than solidly enhancing. Some of the nodules have increased in size, for example along the left ventricular atrium and within the third ventricle. A nodule along the floor of the right frontal horn appears to be slightly smaller. Leptomeningeal enhancement along the ventral surface of the brainstem is also perhaps slightly increased in prominence. T2 hyperintensity surrounding the ventricular system shows variable interval changes. For example, extent of the signal abnormality has slightly increased along the left frontal lobe, but has improved along the right frontal horn. The ventricles remain generally prominent, but the caliber of the lateral ventricles has decreased. The third ventricle is unchanged in size and the fourth ventricle appears slightly more prominent. No evidence of acute intracranial hemorrhage is seen.

Output: Findings are demonstrated compatible with diffuse ependymal and leptomeningeal metastatic disease. On comparison with the prior examination, the overall impression is of slightly worsening disease though in some areas tumor nodularity has decreased in size.


Instruction: Generate impression based on findings.

Input: Cognitive deficits and expressive aphasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral and pontine white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and sulci are prominent diffusely due to to cerebral volume loss. 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 are secretions in the left posterior ethmoid sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarction.2. White matter signal abnormality is nonspecific but may represent chronic small vessel ischemic disease.3. Mild diffuse cerebral volume loss.


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 hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 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: 16 seconds

Output: Successful fluoroscopic guided right hip arthrogram for MRI.


Instruction: Generate impression based on findings.

Input: Clinical question:? Intracranial hemorrhage. Signs and symptoms: Seizures. CT of brain without infusion:Large area of vasogenic edema is noted in the right frontal lobe causing significant effacement of adjacent cortical sulci. A subtle mass effect on the right lateral ventricle. Within the area of vasogenic edema a partially cystic and partially solid mass is present. The larger cystic component of the mass measures 28 mm x 32-mm in transaxial dimensions (axial image 14. This finding is highly suspect of a neoplasm. There is no evidence of hemorrhage associated with this finding. There is a single small focus of low attenuation in the subcortical white matter of left posterior frontal (axial image 18). This finding is nonspecific and may represent an additional foci of neoplasm/metastases or a small foci of ischemic change. Further evaluation with an infused MRI examination is recommended. There is no evidence of hemorrhage, midline shift or hydrocephalus.Calvarium, limited paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Large area of vasogenic edema containing a partially cystic and partially solid mass highly concerning for malignancy. Follow-up with an MRI examination with infusion is recommended.2.Small foci of subcortical low attenuation is nonspecific however it may represent a second foci of malignancy or small vessel disease.3.No areas of hemorrhage, midline shift or hydrocephalus.4.Calvarium is intact.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized)Unspecified psychosis The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate lesions are also present in the basal ganglia, thalami and brainstemNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Lesions in the thalami, basal ganglia and brainstem are also likely vascular related.3.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: 64-year-old male with metastatic brain tumor with bleeding in the right frontal. Follow-up Multiple foci of vasogenic edema are consistent with peritumoral edema from patient's known metastatic lesions. A small hemorrhagic and necrotic tumor superficially within the high convexity left frontal lobe measuring 9.6-mm times 9-mm on axial image 22 is noted. A second solid hemorrhagic tumor in the right frontal lobe measures 12.2-mm x 9.7-mm on axial image 18. Both of these lesions were present on the prior MRI exam and demonstrates no definitive interval change.

Output: Multiple foci of vasogenic edema with two hemorrhagic METs as detailed above.


Instruction: Generate impression based on findings.

Input: Achilles tendon tear, status post repair TENDONS: The least tendon demonstrates complete rupture and retraction of approximately 3 cm approximately 5 cm above the calcaneal attachment. Interposed fluid and suspected hemorrhage is observed with associated surrounding immediate subcutaneous and additional inflammatory changes in Kager's triangle. Abnormal thickening and mild signal abnormalities otherwise observed in the more proximal Achilles tendon compatible with associated degenerative changes proximally.The remaining tendons otherwise unremarkable and intact.LIGAMENTS: No significant abnormality noted, visualized ligaments are intact throughout the ankle and midfoot.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Specifically the mortise remains intact and symmetric. The more distal visualized foot is also unremarkable without superimposed additional acute or subacute abnormalities. Marrow signal unremarkable. ADDITIONAL

Output: Interval recurring tear through the mid Achilles tendon with associated moderate retraction approximate 5 cm from the distal calcaneal attachment. Overlying acute and subacute changes and suspected hematoma


Instruction: Generate impression based on findings.

Input: Female 21 years old Reason: Iron in liver detected on MRI of heart. Please evaluate for presence of iron and evaluate focal liver lesions. ABDOMEN:LIVER, BILIARY TRACT: There is signal dropout on in phase images throughout the liver diffusely indicative of substantial iron deposition. Multiple (greater than 10, difficult to quantify due to a number of punctate lesions) lobulated, arterially enhancing lesions are identified throughout both hepatic lobes. The largest lesion in the left hepatic lobe (segment 2) measures 1.8 x 2.0 cm. Some of the lesions demonstrate a T2 hyperintense central scar. The central scar enhances on delayed images at 3 minutes. All lesions retain contrast on delayed images greater than 1 hour, apart from the central scars which demonstrate washout of contrast. None of the lesions contain fat. The appearance is consistent with focal nodular hyperplasia, known to be associated with iron accumulation in patients treated in past for sarcoma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Multiple liver lesions which are consistent with focal nodular hyperplasia with characteristic retention of contrast on hepatobiliary phase imaging.2.Diffuse iron deposition within the liver.


Instruction: Generate impression based on findings.

Input: Metastatic esophageal cancer to brain. There is an unchanged punctate left cerebellar hemisphere lesion. However, there are several newly apparent enhancing subcentimeter lesions with mild vasogenic edema in the left parietal and occipital lobes. There is no evidence of 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. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses.

Output: 1. Unchanged treated punctate left cerebellar hemisphere metastatic lesion. 2. Several newly apparent subcentimeter lesions in the left parietal and occipital lobes likely represent additional metastases.


Instruction: Generate impression based on findings.

Input: Right knee pain following injury MENISCI: There is truncation of both the anterior and posterior horns with absence of the majority of the body of the medial meniscus. There appears to be fragment displaced into the intercondylar notch just anterior to the PCL. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage of the medial and lateral compartments. Heterogeneous signal within the patellofemoral articular cartilage represents mild degeneration. There are no fluid-filled full-thickness defects appreciated.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Absence of the majority of the medial meniscus with displacement into the intercondylar notch anterior to the PCL.2. Mild articular cartilage thinning without full-thickness defects.3. Lobulated marrow lesion within the distal femur may represent small cartilaginous lesion. Correlation with radiographs may be of benefit.


Instruction: Generate impression based on findings.

Input: Subcortical band heterotopia (DCX), seizures, developmental delay, ADHD. New choreiform-like movements and dystonia. There is extensive band-like subcortical grey-matter signal intensity bilaterally with associated mildly anomalous and simplified cerebral gyration pattern and enlarged ventricles, particularly the posterior lateral ventricles. There is also a prominent retrocerebellar space and diminutive appearance of the inferior cerebellum, particularly the vermis. There is a cystic pineal gland that measures up to 11 mm. The corpus callosum and pituitary gland are intact. There is no herniation or midline shift. The major cerebral flow voids appear to be grossly intact. The orbits are unremarkable. There is mild diffuse paranasal sinus mucosal thickening.

Output: 1. Stigmata of subcortical band heterotopia related to doublecortin gene mutation.2. A cystic pineal gland measures up to 11 mm.3. Findings suggestive of sinusitis.


Instruction: Generate impression based on findings.

Input: Anesthesia of skinClinical question: demyelinating disease?Signs and Symptoms: numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of enhancement along the left superior parietal lobule next to the intra-parietal sulcus.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. 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 cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a focus of T2 signal hyperintensity centered in the spinal cord at the C2 vertebral body level centered along the posterior aspect and right paramedian aspect of the spinal cord. This associated with mild cord enlargement and contrast enhancement.There is a T2 hyperintense lesion along the periphery of the the left hemicord at the C6 vertebral body level. This is not associated with cord enlargement or contrast enhancement.There is a punctate T2 hyperintense lesion present along the cervical spinal cord at the C3-4 disc space level at the right posterior lateral aspect of the spinal cord which is rather subtle. This is not associated with cord enlargement or contrast enhancement.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a subtle focus of T2 hyperintensity within the spinal cord at the T12 vertebral body level. There is no associated contrast enhancement.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.

Output: 1.There are multiple lesions present in the cervical spinal cord as well as in the distal thoracic spinal cord which are suspicious but not specific for demyelination. Post contrast imaging indicates that a lesion in the upper cervical spine at the C2 level is in the subacute/acute phase.2.There is no evidence for optic neuritis.3.There are several subcortical and periventricular white matter lesions identified which are too few to create a pattern since this is not an uncommon finding. One lesion in the left parietal lobe displays a small amount of enhancement suggesting it may represent a subacute plaque.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of left breast intraductal papilloma. Family history of breast cancer in mother at age 56 and sister at 63. She recently had diagnostic mammogram and ultrasound for a complaint of left bloody nipple discharge for 2 days. There is scattered fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.Dilated ducts are again seen in the anterior left breast. There is an enhancing mass at the 3:00 position of the left breast immediately adjacent to a dilated duct measuring 8 x 4 x 5 cm (AP x ML x CC), previously 8 x 7 x 12 mm (AP x ML x CC), consistent with patient's known biopsy-proven papilloma. Additional enhancing subcentimeter masses and foci on the left are stable.Right retroareolar enhancing mass is nearly unchanged in size measuring 9 x 9 x 6 mm (AP x ML x CC), previously 9 x 10 x 6 mm (AP x ML x CC).No suspicious axillary nodes. There is a questionable hiatal hernia, please correlate with any upper GI symptoms.

Output: Stable bilateral enhancing masses and foci, including a biopsy-proven papilloma at the 3:00 position. No MRI evidence of malignancy. Surgical consultation is recommended for the patient's bloody nipple discharge.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: Fever, leukocytosis, and headache; concern for meningitis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal enhancement within the brain parenchyma or meninges. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial abscess or abnormal meningeal enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Thigh pain, immunocompromised There is diffusely increased T2/STIR signal and reticulation within the subcutaneous tissues of the thighs, right greater than left. There is increased signal within the musculature surrounding the femoral as well. A mild intermuscular fluid is also noted. When compared to the prior exam, the intramuscular component appears slightly more prominent although the subcutaneous inflammation appears slightly improved. The lateral skin contours also thickened.There is mild heterogeneity of the marrow signal which is symmetric in both femora. This likely relates to red marrow. Otherwise marrow signal is normal for the patient's age. A trace amount of fluid are noted within the knee and hip joints, similar to the prior exam. Within the limits of the exam, there is no focal fluid collection identified.

Output: Diffuse edema and inflammation of the subcutaneous tissues and musculature of the right lower extremity which appears slightly improved from the prior exam. Similar changes are also noted to involve the left lower extremity. Within the limits of the exam, there is no focal fluid collection identified.


Instruction: Generate impression based on findings.

Input: Reason: R SI joint/trochanter pain, hip mass, evaluate for etiology of pain and nature of mass Two markers are noted along the right thigh and pelvis without underlying soft tissue mass. Of note, palpable lipoma can be difficult to be recognized when surrounded by subcutaneous fat. No abnormal enhancing structure is identified. There is bone edema at the region of the pubic symphysis, likely degenerative. Left L5/S1 facet arthropathy with surrounding edema, likely degenerative. SI joints appear within normal limits. Gluteus muscle and paraspinal muscle atrophy. Limited evaluation of the intra-abdominal organs appear intact.

Output: No soft tissue mass lesion is identified. Of note, palpable lipoma can be difficult to be recognized when surrounded by subcutaneous fat.


Instruction: Generate impression based on findings.

Input: Delirium. Some of the images are degraded by patient motion. 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Migraines for 9 months with a normal neurological exam. There are numerous nodules with grey matter signal characteristics along the bilateral lateral ventricular margins, right greater than left. THere is also prominence of the bilateral lateral ventricles, particularly the posterior portions, right more than left. There is prominence of the left parasagittal retrocerebellar cerebrospinal fluid spaces, associated with mild cerebellar asymmetry, in which the left cerebellar hemisphere is slightly smaller than the right. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

Output: Extensive bilateral lateral ventricular subependymal heterotopia with associated ventriculomegaly, right more than left, and mild cerebellar asymmetry.


Instruction: Generate impression based on findings.

Input: 7 days, Female, encephalopathy. Evaluate for hypoxic injury. Patient is status post cooling protocol. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. The myelination pattern is within normal limits for patient's age. Brain parenchyma is unremarkable. Major flow-voids are preservedSella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: 41-year-old with pelvic pain and menorrhagia. History of uterine fibroids status post myomectomy now undergoing evaluation for possible uterine artery embolization. PELVIS:UTERUS, ADNEXA: Anteverted anteflexed uterus measuring 7.8 x 4.5 x 5.6 cm. There is a single dominant submucosal low T1 and T2 signal mass along the dorsal surface of the endometrial canal compatible with a submucosal fibroid. This measures 1.7 cm in maximum dimension (series 3 image 22). There is an additional small subserosal fibroid at the fundal tip measuring 7 mm (series 3 image 25). On the postcontrast images there is prominent enhancement of the submucosal fibroid. The junctional zone is normal in thickness.The cervix is unremarkable aside from a few nabothian cysts.The ovaries are within normal limits bilaterally. They contain multiple subcentimeter cystic foci compatible with follicles.BLADDER: No significant abnormality noted.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.Single dominant submucosal fibroid measuring 17 mm in maximum dimension which displays prominent vascularity. There is an additional small fundal subserosal fibroid.


Instruction: Generate impression based on findings.

Input: Male; 74 years old. Reason: metastatic renal cell carcinoma to the pancreatic head and R nephrectomy bed, MRI for radiation planning (SBRT). ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation. Cholelithiasis. No suspicious focal hepatic lesions. SPLEEN: No significant abnormality noted.PANCREAS: Status post resection of pancreatic body and tail. Heterogeneously enhancing mass appears to originate from the pancreatic uncinate process and demonstrates increased signal on diffusion weighted imaging and measures 2.9 x 2.2 cm (series 601, image 182). There is mild resultant pancreatic ductal dilatation to 3 mm, slightly progressed since the CT from December 2014. ADRENAL GLANDS: No significant abnormality noted in left adrenal gland. Right adrenal gland not visualized. KIDNEYS, URETERS: Status post right nephrectomy. T2 hyperintense, enhancing mass in the right nephrectomy bed compresses and also appears to invade the adjacent IVC, measuring 2.9 x 2.5 cm (series 901, image 30). Given that soft tissue material within the IVC demonstrates heterogeneous enhancement, tumor thrombus is favored over bland thrombus (series 1201, image 623). Left kidney is unremarkable aside from scattered subcentimeter cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Circumscribed lesion measuring 3.1 x 2.5 cm in the subcutaneous soft tissues of the left lateral pelvic wall. This lesion appears to contain fat on T2 weighted sequences and on prior CT; findings are suggestive of a region of fat necrosis (series 1101, image 27).

Output: 1.Heterogeneously enhancing mass in the right nephrectomy bed which appears to compress and invade the adjacent IVC, compatible with recurrent tumor and probable tumor thrombus. 2.Additional enhancing mass in/near the pancreatic uncinate process, indicative of metastatic disease. Mildly worsening pancreatic ductal dilatation and upstream intrahepatic biliary ductal dilatation are also identified.


Instruction: Generate impression based on findings.

Input: History of 1 cm right-sided prostate nodule on digital rectal examination. PSA most recently 1.69 ng/mL. The patient is seeking a second opinion regarding recommendation for MRI fusion biopsy. PELVIS:PROSTATE:Prostate Size: 4.7 x 3.6 x 4.7 cm.Peripheral Zone: There is diffusely decreased T2 signal within the peripheral zone which somewhat limits evaluation and may be related to prostatitis. There is an area of decreased T2 and ADC signal within the right mid gland (series 23, image 18) measuring 1.1 x 0.6 cm which demonstrates mildly increased early enhancement. There is an additional questionable focus of decreased T2 and ADC signal within the left mid gland (series 23, image 16).Central Gland: Multiple nodules of varying signal intensity on T2-weighted imaging consistent with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: The aforementioned signal abnormality in the right peripheral zone mid gland is associated with mild bulging of the capsule (23/18), raising the possibility of extraprostatic extension. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small fat-containing umbilical hernia. Moderate left hydrocele.

Output: 1.Area of signal abnormality within the right peripheral zone mid gland suspicious for neoplasm, with possible extraprostatic extension.2.Additional, smaller area of signal abnormality within the left peripheral zone mid gland may also reflect neoplasm.