Instruction: Generate impression based on findings.

Input: Tongue vascular malformation: evaluate extent as well as type. MRI: There is a T2 hyperintense, enhancing lesion in the anterior oral tongue, which measures up to 25 mm. There is also an infiltrative T2 hyperintense, enhancing lesion in the right submandibular space that measures up to 45 mm, as well as a subcentimeter nodular component within the submandibular gland itself. There appear to be septations, flow voids, and perhaps phleboliths within the lesions. An area of high T2 signal in the left supraclavicular fossa may represent an additional lesion or a cluster or lymph nodes, although assessment is limited due to artifacts in this region on some sequences. Otherwise, there is no evidence of significant cervical lymphadenopathy. The thyroid is unremarkable. The osseous structures are unremarkable. The airways are intact. The imaged intracranial structures are unremarkable. MRA: The major venous and arteries structures are intact, without evidence of enlarged feeding arteries or draining veins associated with the tongue and submandibular space lesions. There is no significant steno-occlusive disease in the cervical arteries.

Output: Lesions int he oral tongue and right submandibular space likely represents a low flow vascular malformation, such as a venous malformations. An area of high T2 signal in the left supraclavicular fossa may represent an additional vascular malformation or a cluster or lymph nodes, although assessment is limited due to artifacts in this region on some sequences.


Instruction: Generate impression based on findings.

Input: Bilateral sensorineural hearing loss IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.There is signal hyperintensity present within the left middle ear and mastoid air cellsBRAINThe CSF spaces are appropriate for the patient's stated age with no midline shift. Myelination pattern is age-appropriateNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are underdeveloped and partially opacified. The visualized portions of the orbits are intact.

Output: 1.There is opacification of the left middle ear and mastoid. Etiology cannot be established on this exam.2.If there is persistent clinical suspicion for congenital abnormality involving the inner ear structures and temporal bone CT may be helpful.3.No abnormal lesions are appreciated within the brain parenchyma


Instruction: Generate impression based on findings.

Input: 70-year-old female patient with right shoulder pain. ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus tendon, suggestive of tendinosis, and perhaps mild articular and bursal surface fraying. We see no fluid-filled tear of the supraspinatus tendon, and the muscle appears normal. There may be mild tendinosis of the anterior fibers of the infraspinatus tendon, otherwise, the muscle and tendon appear normal. The teres minor muscle and tendon appear normal. There is increased intrasubstance signal intensity within the subscapularis tendon, suggestive of mild interstitial tearing. However, we see no full-thickness tear and the subscapularis muscle appears normal. Note is made of a small cyst in the anterior aspect of the humeral head at the insertion of the subscapularis tendon.SUPRASPINATUS OUTLET: Minimal degenerative changes affect the acromioclavicular joint, essentially normal for patient's age. There is trace fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment appears normal. There is no frank osteoarthritis of the glenohumeral joint. There are perhaps mild degenerative changes in the glenoid labrum, but we see no fluid-filled tear given the limitations of this non-arthrographic study. We see no large joint effusion, but there is heterogeneous signal intensity on T2 imaging extending into the subscapularis recess, which is suggestive of fluid and debris or synovitis.BICEPS TENDON: The short head of the biceps tendon appears normal given the limitations of a non-arthrographic study.

Output: 1.Mild tendinosis and possible surface fraying of the supraspinatus tendon as well as mild intrasubstance tearing of the subscapularis tendon. However, no full-thickness tear is evident.2.Other findings, as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hemangioma of intracranial structures Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus Hemiplegia, unspecified affecting unspecified side Other amnesiaClinical question: h/o CCM; please do on 3T with CCM protocol/QSM/permeabilitySigns and Symptoms: surveillance; seizures There is a hemorrhagic lesion centered in the left thalamus which extends to the adjacent internal capsule and centrum semiovale which has a popcorn-like appearance on T2-weighted imaging. This measures 22 x 18 mm coronal dimensions. It is contiguous with the ependymal lining of the left lateral ventricle and mildly protrudes into the trigone of the left lateral ventricle. This lesion is stable since the prior exam.There is a hemorrhagic lesion present within the posterior aspect of the right temporal lobe along the superior temporal gyrus with a 6 adjacent lesion at the right supramarginal gyrus. These lesions abut the subarachnoid space. These lesions are stable since the prior exam.There is a small lesion measuring approximately 8 mm along the right pons at the junction of the right middle cerebellar peduncle and adjacent to the right trigeminal nerve. This abuts the subarachnoid space and the root entry zone of the right trigeminal nerve. This lesion is stable since the prior exam.In addition to the above described lesions are multiple punctate foci of signal hypointensity throughout the brain parenchymaNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening within the left maxillary sinus and to lesser degree right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are multiple lesions within the brain parenchyma compatible with multiple cavernomas which are stable since the prior exam.


Instruction: Generate impression based on findings.

Input: Reason: sle/MYASTHENIA PT with severe LBP r>L side radiates to either leg, at various times. Left leg most painfu. History: severe LBP r>L side radiates to either leg, at various times. Left leg most painful. 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. A 12-mm lesion located within the L2 vertebral body present and redemonstrated which is larger relative to the prior exam. It is high signal on T1 and suppresses on the fat suppressed STIR T2 images. Most likely this represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation and a small central disk protrusion at this level. This is stable when compared to the prior exam. This disk protrusion is adjacent to the nerve root the right lateral recess but does not appear to displace it on this exam.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: 1.There are degenerative changes present in the lumbar spine worse at L5-S1 where there is a small central disk protrusion which is stable in size when compared to the prior exam it is disk protrusion abuts the nerve root at the right lateral recess.2.A vertebral body lesion suspected to represent hemangioma in the L2 vertebral body has mildly enlarged when compared to the prior exam.3.No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 38 years Male (DOB:11/8/1977)Reason: stroke History: AphasiaPROVIDER/ATTENDING NAME: WILLARD W SHARP TAO W XIE MRI of the brainThere is gyral T2 and FLAIR signal hyperintensity associated with diffusion restriction involving the inferior aspect of the left inferior parietal lobule as well as the left superior temporal gyrus of the left temporal lobe and the lateral aspect of the adjacent left occipital lobe at the level of the cuneus and posterior aspect of the left insular cortex. There are some associated small foci of gyriform susceptibility effect.There are small T2 hyperintense lesions in the pons.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 and is small in diameter. There is fetal origin of the left posterior cerebral artery associated with a hypoplastic left P1 segment. The right posterior communicating arteries is very small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery origin is not adequately visualized on this exam.

Output: 1.Subacute phase infarction involving the confluence of the left inferior parietal lobule, adjacent left temporal lobe and small portion of the left occipital as well as the posterior aspect of the left insular cortex2.Periventricular and subcortical white matter lesions of a mild degree as well as lesions in the pons are nonspecific. At this age they are most likely vascular related.3. The left vertebral artery origin is not adequately visualized on this exam. The possibility of left vertebral artery origin stenosis cannot be excluded.4.There is no evidence for intracranial cerebrovascular occlusion or stenosis.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: serial evaluation of cirrhosis, portal vein thrombosis History: uptrending LFTs Heterogeneous, coarse echotexture of the liver consistent with cirrhosis.

Output: Very Limited to no flow in the main portal vein.


Instruction: Generate impression based on findings.

Input: 71-year-old male with history of bladder cancer, status post cystectomy. ABDOMEN:LIVER, BILIARY TRACT: Stable small scattered cysts. Cholelithiasis without evidence for acute cholecystitis. No intra or extrahepatic biliary ductal dilatation. No suspicious lesions. Normal signal intensity and enhancement.SPLEEN: Small accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or hydroureter. Symmetric uptake and excretion of contrast. No focal lesions. Status post cystectomy and ileal conduit.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Surgical changes from ileal conduit without evidence of complication.BONES, SOFT TISSUES: Rectus diastases with unchanged small widemouth periumbilical hernia.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small bilateral fat-containing inguinal hernias. Stable sclerotic focus within the left iliac bone and compatible with a bone island (axial series 9 image 17).OTHER: No significant abnormality noted.

Output: Status post cystoprostatectomy with ileal conduit. No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with back pain status post lumbar instrument fusion, status post epidural hematoma evacuation. Evaluate for hematoma. Evidence of posterior instrumented fusion is again seen with pedicle screws on the right at L4-S1, and on the left at L5 and S1. Interbody devices have also been placed at L4-5 and L5-S1. Evidence of laminectomy/facetectomy is also seen on the right at L4-5 and on the left at L5-S1.Since the prior examination, the previously seen large fluid collection within the superficial soft tissues of the lumbar region has resolved. A fluid collection which was evident more deeply within the right L4-5 operative bed, extending to the epidural space, has also significantly improved with only a small amount of residual fluid or edema present. Previous encroachment upon the thecal sac has improved as well.Marrow signal abnormality compatible with edema is seen involving nearly the entirety of the L4 and L5 vertebral bodies, a finding which has progressed from the prior examination. There may be some edema in the prevertebral soft tissues, but this is equivocal. No definite evidence of any new epidural or paraspinal fluid collection is seen. Edema persists within the right psoas musculature.Straightening of the cervical lordosis is again seen. Vertebral body heights are largely preserved with the exception of postoperative change at L4 and L5. No other areas of marrow signal abnormality are seen.At L3-4, facet arthropathy, ligamentum flavum thickening, and a disc bulge with central annular fissure contribute to mild spinal canal narrowing. The foramina are not significantly compromised.At L5-S1, posterior element hypertrophy and bulging disc material resulting in a moderate narrowing of the spinal canal, but improved from the prior examination. Moderate right and mild left foraminal narrowing is seen.At L5-S1, posterior element hypertrophy and disc bulging asymmetric to the left lateral recess is seen. No significant generalized spinal canal stenosis is seen. The neural foramina are mildly narrowed.

Output: 1.Since the prior examination, the previously demonstrated subcutaneous and epidural fluid collections within the operative region have resolved or nearly completely resolved. No findings are seen to suggest new or progressive bleeding. The thecal sac remains narrowed at the L4-5 level though this is improved relative to the prior study.2.Progressive edema is seen within the L4 and L5 vertebral bodies when compared to the prior examination. There may be mild edema within the prevertebral soft tissues but this is equivocal. No new fluid collections are seen. In the absence of leukocytosis or an abnormal ESR, these findings may simply represent edema reactive to surgical instrumentation. Infection is considered less likely but cannot be eliminated as a possibility based on imaging. At least one follow-up MRI can be considered if the patient's symptoms do not improve.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Cystlike changes within the tibial plateau centrally may reflect small intraosseous ganglion. A minimal amount of edema-type signal is seen within the medial femoral condyle anteriorly.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Nonspecific subcutaneous edema overlies the patellar tendon. Otherwise the extensor mechanism is intact.ADDITIONAL

Output: No evidence of internal derangement of the knee. Nonspecific edema overlies the patellar tendon which may reflect a mild prepatellar bursitis.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with history of recurrent meningioma status post resection and radiation. Surveillance scan. Postsurgical findings are again seen compatible with right craniotomy for tumor resection.The residual right parafalcine meningioma is unchanged in size and morphology measuring 19 x 12 mm (image 45 series 10). As noted previously, this lesion abuts the superior sagittal sinus but without evidence to suggest invasion or occlusion. The resection cavity surrounding this lesion, and mild T2 hyperintensity within the adjacent parenchyma, are also unchanged.A small hemosiderin stained, centrally T2 hyperintense lesion within the right middle frontal gyrus is also unchanged.Mild patchy periatrial T2 hyperintensity is unchanged and nonspecific. No new intracranial lesions are detected. No evidence of parenchyma edema or mass effect is seen. There are no new abnormal fluid collections. The ventricles are stable and normal in size.

Output: 1. Stable right parafalcine meningioma.2. Stable presumed cavernous malformation in the right middle frontal gyrus.3. No new intracranial lesions.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with metastatic renal cell carcinoma, weakness, altered gait and neuropathy. An oval focus of restricted diffusion is seen in the right thalamus measuring up to 13 mm in diameter. In addition, an ill-defined cortically based area of restricted diffusion is also seen affecting the paramedian right occipital lobe. Finally, restricted diffusion affects the entire right hippocampus with sparing of the dentate and parahippocampal gyri. Numerous scattered foci of FLAIR hyperintensity are seen predominantly within the cerebral white matter. There may be at least one tiny chronic cortical infarct in the left occipital lobe. No evidence of significant edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is observed. Mucosal thickening is seen in the left maxillary sinus.

Output: 1.Areas of restricted diffusion are seen including a relatively well-circumscribed oval in the right thalamus, ill-defined cortical signal in the paramedian right occipital lobe, and specific involvement of the right hippocampus with sparing of the adjacent structures. These lesions could potentially be ischemic in nature. However, the morphology is atypical, particularly the hippocampal involvement. As such, the differential diagnosis would also include an autoimmune or paraneoplastic process, a post-ictal effect, or an atypical infectious process.2.No enhancing lesions are seen to suggest the presence of metastases. No evidence of intracranial hemorrhage is observed. The background brain demonstrates changes which may reflect moderately advanced chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, neck pain with radiation into the right arm. Straightening of the cervical lordosis is seen. Vertebral body heights are preserved. Degenerative signal abnormality is noted at multiple levels, particularly C4-5 and C5-6, where findings have progressed. No concerning marrow replacement is seen. The spinal cord shows normal signal and morphology. No epidural lesions are seen. C2-3: Mild facet arthropathy. Minimal disc osteophyte formation. No spinal canal stenosis. No foraminal narrowing. C3-4: Mild facet arthropathy. Mild disc osteophyte formation, progressed. No spinal canal stenosis. Mild bilateral foraminal narrowing.C4-5: Uncovertebral hypertrophy. No spinal canal stenosis. Moderate bilateral foraminal narrowing. No changes. C5-6: Disc osteophyte formation, progressed. Moderate spinal canal stenosis without significant cord deformation, progressed. Severe foraminal narrowing.C6-7: Disc osteophyte formation, progressed. Mild spinal canal stenosis, similar to prior. Moderate foraminal narrowing.C7-T1: Minimal disc degeneration without spinal canal or foraminal compromise. Thoracic levels: Mild disc bulging as assessed on sagittal images, without spinal canal compromise.

Output: Multilevel disc degeneration is seen, progressed at some levels including at C5-6 where there is a moderate spinal canal stenosis. Severe foraminal narrowing is also present at this level.


Instruction: Generate impression based on findings.

Input: Right auditory nerve schwannoma: dizziness, tinnitus, and right-sided hearing loss There is a punctate focus of restricted diffusion and high T2 signal in the posterior aspect of the left cerebellar hemisphere, compatible with acute infarct. There are also a few scattered periventricular and subcortical white matter T2 hyperintense foci without restricted diffusion. There is an avidly enhancing tubular lesion in the right internal auditory canal that measures up to approximately 10 mm. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Punctate acute infarct in the left posterior cerebellar hemisphere. 2.Unchanged right vestibular schwannoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 15 year old with history of tetrology of fallot requiring multiple cardiac surgeries presenting for cardiac evaluation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 81 ml/m2, the LVEDV is 135 ml, the LV end systolic volume index is 39 ml/m2, the LVESV is 65 ml. There is a "D" sign in systole consistent with right ventricular overload, otherwise normal left ventricular wall motion. No residual VSD was noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly-moderately enlarged with moderately reduced systolic function. There is right ventricular hypertrophy. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 117 ml/m2 , the RVEDV is 195 ml, the RV end systolic volume index is 84 ml/m2, and the RVESV is 139 ml .Right AtriumThe right atrium is mildly enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere is a bioprosthetic valve in the pulmonary position, there is moderate-severe pulmonic regurgitation, quantified at a regurgitant fraction of 31% and 37% using 2 different methodologies. 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 mildly dilated (37mm x 34mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is poorly visualized due artifact from the PV prothesis. LPA and RPA visualized. There is artifact in the right pulmonary artery likely due to known RPA stent. Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is no anomalous drainage seen. Calculated Qp/Qs is within normal limits. 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. Low normal LV EF2. Dilated RV with reduced RV EF of 29%3. PV prothesis with moderate - severe PR 4. RPA stentI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old woman with history of multiple sclerosis, evaluate for progression. Again seen are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with morphology and distribution consistent with known demyelinating disease. There is no new lesion compared to the prior examination. There is a mild to moderate burden of T1 hypointense lesions in the periventricular and subcortical white matter. There is mild parenchymal volume loss.The ventricles and basal cisterns are otherwise normal in size and configuration. There is no mass, midline shift, or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and calvarium are unremarkable.

Output: No evidence of progression of demyelinating disease compared to 11/5/2015.


Instruction: Generate impression based on findings.

Input: Loss of smell, possible inflammation of olfactory recesses, thinning of right optic canal. The olfactory bulbs are not well-delineated, perhaps due to skull base susceptibility effect. Otherwise, no gross evidence of tumor in this region and the paranasal sinuses are grossly unremarkable. There is mild sigmoid deviation of the nasal septum with a leftward spur. There appears to be slight protrusion of cerebrospinal fluid through the right foramen ovale. There is diffuse atrophy of the cerebellum. The orbits and optic apparatus are unremarkable.

Output: 1. The olfactory bulbs are not well-delineated, perhaps due to skull base susceptibility effect. Otherwise, no gross evidence of tumor in this region and the paranasal sinuses are grossly unremarkable. 2. Mild sigmoid deviation of the nasal septum with a leftward spur. 3. Slight protrusion of cerebrospinal fluid through the right foramen ovale may represent a meningocele. 4. Nonspecific diffuse atrophy of the cerebellum.


Instruction: Generate impression based on findings.

Input: Clinical question: History of metastatic salivary gland cancer. Evaluate new pulmonary mass. Measurements please. Signs and symptoms: None Enhanced CT of soft tissues of neck:Limited images of the intracranial contents demonstrate a high density mass (likely an enhancing) in the right posterior temporal lobe measuring 12.2 x 12.4 millimeters in transaxial dimension (axial image 15 of 91) follow-up with dedicated CT or MRI exam is recommended.Images through the skull base, cavernous sinuses, bilateral petrous bones and paranasal sinuses are negative.Enhancement along the fascial planes in the left infratemporal fossa are likely result of anatomical venous and structures. This finding is best appreciated on axial image 23. This finding was also noted on prior study.There is evidence of complete right-sided parotidectomy with no evidence of recurrence of tumor.Extensive postoperative changes of neck are noted however no evidence of a mass is detected.There is a nonenhancing left-sided lymph node at the level of hyoid bone measures 8.8 x 6.3 mm in transverse axis and 16.8-mm in cranial -- cephalad axis. This node shows no interval change since prior exam.Images through the neck are otherwise unremarkable.There is limited images of the bases of the lungs demonstrate a large right apical mass measuring 43.5 x 31.3-mm in transaxial dimension and approximately 34 mm in cardial/cephalad axis. There is also a very large mediastinal mass which surrounds the trachea and is only partially visualized. This mass measures 55-mm in AP axis and 61-mm in transverse axis. Please review the dictated report of CT of the chest for more detailed information.60 cc of Omnipaque 250 is administered.

Output: 1.No detectable tumor in the neck. Nonenhancing lymph node in the left neck at the level of the high a bone measuring 8.8 x 6 in transaxial dimensions and 16.8-mm in cardial slice cephalad axis. There is no detectable change since prior examination from an outside institution as described above.2.Limited view of intracranial space demonstrate a high density mass measuring 12.4 x 12.2-mm in size in the right posterior temporal. This is highly suspected for intracranial metastatic lesion.3.Right upper lung field tumor measuring 43.5 x 31.3 in transaxial and 34-mm in cranial cephalad. Large additional right-sided mediastinal tumor measuring 61 x 54.5-mm in transaxial dimensions.


Instruction: Generate impression based on findings.

Input: 51 years, Female, metastatic renal cell carcinoma, post stereotactic radiation therapy, follow-up evaluation. Again seen is an enhancing lesion involving the right cerebellar hemisphere measuring 15 x 14 x 11 mm in the AP, transverse, and craniocaudal dimensions, previously 11 x 9 x 9 mm on 4/20/2015. There is a second lesion involving the right subinsular white matter abutting the putamen measuring 4 x 5 x 6 mm and also slightly larger, previously approximately 4 mm in diameter. There is associated susceptibility effect consistent with chronic blood products associated with the lesion and increased since 4/20/2015. There is also mild increase in surrounding FLAIR hyperintensity compatible with vasogenic edema. No significant mass effect, midline shift, or herniation. No hydrocephalus. No restricted diffusion to suggest acute ischemia. No abnormal meningeal enhancement. Major flow-voids are preserved.Small right maxillary mucus retention cyst. Paranasal sinuses and mastoid air cells appear otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Compared to 4/20/2015 and 5/8/2015, there has been mild interval enlargement of enhancing lesions involving the right cerebellar hemisphere (which has been previously treated) as well as a smaller lesion involving the right subinsular white matter. There is mild increase in associated blood products and mild increase in associated edema.No significant mass effect, midline shift, or herniation. No hydrocephalus.


Instruction: Generate impression based on findings.

Input: Sudden onset lower extremity weakness and numbness. Assess for demyelinating disease. BRAIN MRI:No signal abnormalities are seen in the brain to suggest demyelinating disease. There is a small pineal cyst measuring up to 10 mm which is incidentally noted. Brain parenchyma is otherwise unremarkable. There is no acute infarct or intracranial hemorrhage. There is no mass-effect or midline shift. There is no abnormal extra-axial fluid collection. There is no abnormal intracranial contrast enhancement. The major intracranial vascular flow voids are preserved. There is a retention cyst in the inferior aspect of the left maxillary sinus. The orbits are unremarkable. There is no destructive skull lesion.CERVICAL SPINE MRI:The study is limited by patient motion.There is T2-hyperintense, T1-hypointense signal within the central spinal cord from C5-C6 level and extending caudally into the upper thoracic spine. While the lower end of the abnormality is not included on the current exam, it is probably an extension of the previously described similar abnormality of this thoracic spine, which on February 27, 2016 ended cranially at T1-T2 level. There is no definite abnormal contrast enhancement.Otherwise, there is straightening of the cervical spine and minimal disc desiccation but no significant degenerative disease otherwise. There is no spinal canal or neural foraminal stenosis. There is minimal dependent atelectasis in the lungs.

Output: 1.No evidence of demyelinating disease in the brain.2.There is nonenhancing T2 hyperintensity in the lower cervical cord extending into the upper thoracic cord which appears to be increased in the cranial direction when compared to thoracic MRI from 2/27/2016. Differential remains broad. Finding may represent progression of myelitis (inflammatory or demyelinating), increased edema associated with the thoracic lesion, with ischemic injury not excluded. No additional lesions are seen in the upper or mid aspect of the cervical cord to suggest a background of chronic demyelinating 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: Redemonstrated is mild diffuse volume loss without a specific lobar predominant atrophy pattern, unchanged in appearance. There are no findings of ventricular obstruction or hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Redemonstrated is mild diffuse volume loss without a specific lobar predominant atrophy pattern, unchanged in appearance. Otherwise, negative contrast-enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with history of metastatic breast cancer presenting with back pain and bowel incontinence. Assess for leptomeningeal tumor spread. Marrow replacement has progressed at T12 now involving nearly the entire vertebral body. Focal marrow space lesions within the L1-L3 vertebral bodies have also increased in size since the prior examination. Ill-defined marrow replacement involving the right aspect of L5, a small lesion in S1, and marrow replacement in the right iliac wing also appear larger. At no level is there any significant paraspinal or epidural disease extension. No pathologic spinal cord or leptomeningeal enhancement is seen.Vertebral body heights are preserved. Fatty replacement of the spine from L1 down is compatible with prior radiotherapy. A mild scoliotic curvature of the lumbar spine is seen but sagittal alignment is anatomic. Generalized edema is seen within the posterior paraspinal musculature. A metastatic deposit in the posterior soft tissues at T11 has increased in size.Multiple intra-abdominal findings including liver nodularity, a left adrenal region mass and ascites, are better assessed on dedicated abdominal imaging.At L1-2 through L3-4, there is no significant spinal canal or foraminal stenosis.At L4-5, there is mild facet hypertrophy and mild disc bulging but no significant spinal canal or foraminal stenosis.At L5-S1, there is moderate facet hypertrophy and mild disc bulging, no significant spinal canal stenosis, but mild right foraminal narrowing.

Output: Progressive osseous metastatic disease in the lumbar spine, but without evidence of epidural extension, spinal canal or foraminal compromise, or leptomeningeal spread.


Instruction: Generate impression based on findings.

Input: 51-year-old female with back pain status post extensive lumbar fusion. Evaluate for spinal abscess/osteomyelitis. Wound infection per recent neurosurgery notes. Detailed evaluation of the previous surgical site is limited secondary to lack of contrast and distortion from adjacent surgical hardware.New since the previous MRI examination is extensive emphysema throughout the dorsal soft tissues, subcutaneous inflammatory change and adjacent skin thickening within the posterior soft tissues of the back. There is a is a small focal fluid collection posterior to surgical hardware, at approximately the L4 level, within the surgical site which measures approximately 25 x 20 7 mm, (axial T2 series 501, image 11).Inflammatory change, fluid density and foci are extends in craniocaudal dimension by approximately 17cm from the inferior aspect of L4 to the superior aspect of T12. There are multiple foci of air within the subcutaneous tissues at this level. This focal collection is concerning for inflammatory change versus infection. Evaluation of bony structures surrounding hardware is limited secondary to metallic artifact. No definitive evidence of osseous or hardware complication.Redemonstrated is a burst fracture present at L3 grossly unchanged compared with MRI dated 7/13/2011. There is posterior retropulsion of fragments into the central canal which causes crowding of the cauda equina and central stenosis, unchanged. Interval development of trace retrolisthesis of L2 on L4, not significantly changed.Compression deformity is central with compression noted of both the superior and inferior endplates of L3. Posterior retropulsion of cortex also affects both neural foramina causing severe stenosis. The visualized lower thoracic spine demonstrates multilevel degenerative endplate change.L1-2: no central neuroforaminal narrowing.L2-3: Mild disk bulge and mild bilateral neural foraminal stenosis, unchanged. L3-4: Compression deformity as described above. Interval postsurgical change of a posterior stabilization device with bilateral pedicular screws entering the vertebral bodies of L2 and L4, without foraminal involvement. Left L3 laminectomy with bony graft, unchanged. No new fracture or hardware compromise is identified. L4-5: Mild disc bulge without significant compromise to spinal canal or neural foramina, unchanged.L5-S1: Mild disc bulge without significant compromise to spinal canal or neural foramina, unchanged.Lung bases demonstrate multifocal linear areas of opacification which may be secondary to scarring, atelectasis or infection/inflammation, not significantly changed compared to the previous examination.

Output: 1. No evidence of diskitis or osteomyelitis.2. Interval development of subcutaneous stranding, focal fluid and soft tissue emphysema within the posterior soft tissues as described above, concerning for inflammatory change versus infection. 3. Postsurgical changes of a bilateral posterior stabilization device at L2 and L4 without definitive evidence of hardware or osseous complication.4. Unchanged appearance of an L3 compression fracture with posterior retropulsion of fragments into the central canal which causes crowding of the cauda equina, central stenosis and left greater than right bilateral neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Progressive memory impairment No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 47-year-old female patient with question of obstructive venous thrombosis in setting of significant polycystic liver disease. Pain, early satiety. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged, measuring 26 cm in the craniocaudal dimension, by innumerable cysts replacing a majority of the hepatic parenchyma. The largest within the right hepatic lobe measures 11 x 12 cm and demonstrates internal intermediate T1 hyperintensity likely reflecting proteinaceous material or blood products. No suspicious arterial enhancing component is identified. Furthermore, there are additional small cystic foci within the liver compatible with peribiliary cysts. There is diffuse mild intrahepatic biliary ductal dilatation. The common bile duct is nondilated. The gallbladder is unremarkable.The central hepatic venous vasculature appears patent, however, is poorly delineated peripherally secondary to the multiple hepatic lesions. A large hepatic cyst additionally compresses the IVC and the portal vein at it enters the hilum. The azygous vein is prominent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts with a few cysts containing layer T1 hyperintensity compatible with blood products. Additional subcentimeter T2 hypointense and T1 hyperintense lesions likely represent hemorrhagic cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enlarged multicystic liver compatible with diagnosis of polycystic liver disease.2.Poorly delineated hepatic vasculature peripherally secondary to the numerous cysts with compression of the IVC and portal vein from a dominant cyst.3.Diffuse mild intrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Follow-up evaluation of mass. Evaluate for ventricles history of normal pressure hydrocephalus and mass anterior to pons. Implanted defibrillator. Status post VPS placement Nonenhanced CT of brain:There is revisualization of a left sided extra axial mass in the left cerebellopontine angle with extension across the midline posterior to the clivus. The mass superiorly reaches the dorsum sella. There is subtle mass effect on the pons. There is no detectable in edema of brain parenchyma. On this non-infused study this lesion remains similar in size and density.Findings a brief to represent a meningioma. Fourth ventricle is normal in size and unchanged since prior exam.Images through supratentorial space demonstrated enlargement of supratentorial ventricles with a right sided ventricular catheter. The measurements of lateral ventricles demonstrate a very subtle interval decrease in their size. There is better visualization of subarachnoid space surrounding the knee to high complexity of brain parenchyma compared to prior exam. I suspect a small nonhemorrhagic subdural in these locations. This can be only definitively diagnosed with an MRI examination or a post infused CT of brain. The thickest portion of this collection measures approximately 5 mm.

Output: 1.Stable extra-axial left cerebellopontine and prepontine mass to represent a meningioma.2.Slight interval decrease in the size of the supratentorial ventricular system.3.Better visualization of extra-axial CSF in the midpole hypodensity bilateral frontal -- parietal regions which suspect the extra-axial subdural nonhemorrhagic collections.


Instruction: Generate impression based on findings.

Input: 34 year old female with face, arm and foot numbness. Evaluate for demyelinating disease. Brain MRI: There are no significant T2 foci within the periventricular and subcortical white matter. There is also no significant burden of T1 hypointense lesions. 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. There is mild bilateral maxillary mucosal sinus and ethmoid air cell thickening.Cervical Spine MRI: The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: No intracranial or cervical spine lesions to suggest a demyelinating process.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: any change in plexiform of left side of neck and face History: facial weakness, plexiform tumor of the left side of neck and face and axilla. Reason: Status post plexiform neurofibroma decompression, 9 month follow up after surgery for surveillance /changes History: follow up after surgery for NF tumor There is redemonstration of an extensive STIR hyperintense enhancing infiltrative mass centered in the right pterygopalatine fossa with extension into multiple skull base foramina as previously detailed, including significant expansion of the right cavernous sinus. There is medial extension into the right nasal cavity with minimal extension into the right inferior orbit via the inferior orbital fissure. There is also extension inferolaterally into the right lower facial subcutaneous fat. The mass now measures up to 7.4 cm oblique on coronal imaging 1201/20, compared to previous 7.2 cm.In addition, there is an additional larger transspatial STIR hyperintense enhancing mass in the left posterior lateral neck, along the posterior triangle. This mass is more fully included within the field-of-view on the current exam, measuring approximately 11.4 cm in area of greatest confluence (1201/44), where as it previously measured at least 10 cm.Postoperative changes of left-sided thoracotomy are also noted related to debulking of previously seen extensive left chest wall plexiform neurofibroma with involvement of the left supraclavicular fossa and left axilla. There also postoperative changes from C5 to L1 laminotomy for lower cervical tumor resection. Significant kyphosis is again seen cervical thoracic junction, similar to prior exam with grade 1 anterolisthesis of C6 on C7, C7 on T1 as well as retrolisthesis of T1 on T2. Overall, there is up to moderate central spinal canal stenosis at C7-T1 with slight flattening of the right ventral cord.Tumor again extends into multiple left-sided foramina, including down to at least the T1-T2 in a confluent fashion, with a smaller mass at left T2-T3 and additional prominent left foraminal components on the left at T3-T4 and T4-T5. The left T4-T5 lesion results in the most mass effect upon the thecal sac although overall there is no significant stenosis. There is also no abnormal cord signal. There remains a stable prominent lesion along the right T7-T8 foramen without extension into the spinal canal. There is opacification of left ethmoid air cells. There is decreased fluid within right mastoid air cells/middle ear. There is moderate mucosal thickening within the left maxillary sinus with mild mucosal thickening in the smaller right maxillary sinus. A tiny linear T2 hyperintense lesion is again seen along the left upper lip. There is also partially visualized infiltrative mass extending into the left upper extremity down at least to the level of the elbow. There are multiple scattered enhancing STIR hyperintense lesions in the posterior intercostal spaces at multiple levels, which may represent additional nerve sheath tumors. Mild dependent atelectasis is suggested. There is redemonstration of the mass extending into the mediastinum on the left side.

Output: 1. Overall, no significant interval change in extensive plexiform neurofibroma with right-sided facial/skull base component centered in the right pterygopalatine fossa.2. Improved visualization of overall extensive left transfacial plexiform neurofibroma centered in the left lower neck and left upper chest, with multilevel left foraminal components without evidence of cord compression. The most medialized exophytic component of the mass is located at the T4-T5 level.3. Stable prominent kyphotic deformity at the cervical thoracic junction, with mild grade 1 subluxations. 4. Continued mild-moderate central spinal canal stenosis at C7-T1 with mild flattening of the right ventral cord.


Instruction: Generate impression based on findings.

Input: History of AML and pancreatitis. Evaluate pancreatic lesion. History of hepatitis B. AML. ABDOMEN:LIVER, BILIARY TRACT: Loss of signal on in phase imaging compatible with iron deposition. The liver is of normal morphology and size. No focal lesion biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is low in signal intensity compatible with iron deposition.PANCREAS: Lobular cystic lesion in the head of the pancreas measures approximately 1.9 x 1.8 cm and appears to be multilocular and/or septated. The lesion appears to communicate with a normal caliber main pancreatic duct (series 7/100) which measures up to 3 mm in caliber. No suspicious postcontrast enhancement or mural nodularity is apparent. The pancreas is otherwise normal in morphology and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.9 x 1.8 cm multilobular multiloculated/septated pancreatic head cystic lesion may represent a branch type IPMN without suspicious enhancing features. The main pancreatic duct measures up to 3 mm.2.Hemosiderosis.3.No suspicious liver lesion or specific morphologic stigmata of cirrhosis. Surveillance imaging is recommended in the setting of Hepatitis B.


Instruction: Generate impression based on findings.

Input: 19 years Male (DOB:6/4/1997)Reason: CCM Protocol/QSM/permeability 3T scanner, please evaluate known lesion (CCM?) History: SeizuresPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. Some of the imaging is degraded due to patient motion artifact.There is a hemorrhagic focus present along the medial aspect of the left temporal lobe which is associated with some surrounding T2 signal hyperintensity. It measures approximately 6 by 4mm. It can also be identified on the susceptibility weighted imaging on the prior exam as well. On FLAIR imaging it appears stable relative to the prior exam. It is associated with some ill-defined enhancement along the medial aspect of the left temporal lobeNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the right maxillary sinus which was also present on the prior exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a hemorrhagic lesion present in the medial aspect of the left temporal lobe. This appears stable and compared to the January exam. Although not classic in appearance cerebral cavernous malformation is a differential consideration. Other entities such as neoplasm cannot be entirely excluded based on this exam alone. Given the lack of interval change in an inflammatory/infectious focus is less likely.


Instruction: Generate impression based on findings.

Input: 66-year-old Male with prostate cancer now with increased PSA ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral punctate stones without evidence of hydronephrosis. Bilateral hypodense lesions like representing cyst. Some Ultima to small to accurately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland demonstrates nodular contour. Posterior laterally on the left side with slight enhancement. Residual disease in the prostate cannot be excluded. MRI may be helpful for further evaluation.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Nodular contours in the left posterior lateral aspect of the prostate, suspicious for residual disease. MRI is recommended for further evaluation. This lesion may be amenable to MR guided prostate biopsy if clinically indicated.Bilateral punctate stones and small renal cysts.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with lower back and groin pain, occasional leg weakness, history of lumbar stenosis. The T1 signal of the bone marrow is diffusely somewhat lower than expected for age. However there is no evidence of pathologic T2 signal abnormality. Spinal alignment is anatomic. Vertebral body morphology is within normal limits. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.The spinal canal is congenitally slender through the lower lumbar region. Additional levels the findings are as follows.L1-2 through L3-4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-5: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. L5-S1: Mild facet arthropathy. Small left foraminal annular fissure. No significant spinal canal or foraminal stenosis.

Output: 1.Minimal degenerative findings without significant spinal canal or foraminal stenosis. The lower spinal canal is somewhat slender though this is related to congenital variation.2.Marrow signal is diffusely somewhat lower than expected on T1-weighted images. However, vertebral body morphology is within normal limits and there is no evidence of any pathologic marrow edema. Findings could represent normal variant persistent hematopoietic marrow, or perhaps marrow reconversion related to anemia or some other systemic process.


Instruction: Generate impression based on findings.

Input: Male; 69 years old. Reason: h/o chronic prostatitis, now w neutropenic fever, concern for abscess History: chronic prostatitis PELVIS:PROSTATE:Prostate Size: Enlarged prostate gland measuring up to 5.3 x 6.2 x 7.7 cm.Peripheral Zone: No evidence of prostate cancer or abscess.Central Gland: Heterogeneous with scattered foci of T1 hyperintensity due to hemorrhage and multiple BPH nodules. No evidence of abscess.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Stable specific, mildly enlarged perirectal lymph nodes (e.g. series 1601/120).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Prostatomegaly without focal lesion suspicious for prostate cancer or abscess.2. Stable nonspecific, mildly enlarged perirectal lymph nodes.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with word finding difficulty and known left temporal tumor. fMRI is requested for language mapping prior to surgery. Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. All paradigms produce a similar pattern of language related cortical activation. Language is left dominant. Cortical activation related to the putative Broca's area is identified in the left inferior frontal lobe (primarily the pars opercularis and pars triangularis). Broca's area is well removed from the patient's temporal lobe tumor and does not appear to be affected by the nonenhancing peritumoral signal abnormality. Cortical activation related to the putative Wernicke's area is identified along the posterior aspect of the left superior temporal sulcus. Wernicke's area is also well removed from the enhancing component of the patient's tumor. However, it is encompassed by the nonenhancing peritumoral signal abnormality.

Output: Technically successful functional MRI with language mapping as above.


Instruction: Generate impression based on findings.

Input: Foot mass Tendons and ligaments: The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. The Lisfranc ligament is intact. There is no subluxation or dislocation in the tarsometatarsal articulations.Joints: There is no joint effusion. Alignment: There is normal alignment of the metatarsals. There is no hallux valgus deformity.Muscles: There is diffuse atrophy of the musculature.Bone Marrow: The bone marrow signal is normal. There is no fracture or contusion. There is no marrow replacing lesions.Soft tissues: Within the lateral superficial soft tissues adjacent to the fifth tarsometatarsal articulation is a lobulated soft tissue mass measuring approximately 2 cm. This lesion is slightly T1 hyperintense and markedly T2 hyperintense containing a few thin septations. There is a mild amount of associated surrounding subcutaneous edema. Following contrast administration, there is only thin peripheral and septal enhancement.

Output: Superficial soft tissue lesion along the fifth tarsometatarsal articulation demonstrates imaging findings most consistent with a ganglion cyst.


Instruction: Generate impression based on findings.

Input: 82 years Male (DOB:10/27/1933)Reason: now acute ischemia? H/O of prior L MCA and seizures History: new onset Left sided weakness, s/p TpaPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER There is diffusion restriction present along the right pre and postcentral gyri as well as the inferior aspect of the right paracentral lobule and adjacent cingulate gyrus with some scattered punctate foci of diffusion restriction in the right superior and middle frontal gyri as well as the medial aspect of the right cingulate gyrus anteriorly.. There is susceptibility effect present along the inferior aspect of the right paracentral lobule and adjacent right cingulate gyrus.There is a focus of encephalomalacia present in the left frontal lobe involving the left superior, middle and inferior frontal gyri associated with ex vacuo effect.The left internal carotid artery flow-void is absent. The left posterior communicating artery appears large, however, the left P1 segment appears small. Normal vascular flow voids are present in the distal right carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is an acute or subacute infarction involving the right pre and postcentral gyri as well as portions of the right paracentral lobule and right cingulate gyrus with surrounding punctate lesions implying that there has been a thromboembolic event involving parts of the right anterior and middle cerebral artery territories. Please correlate with clinical history2.Findings suggest occlusion of the left internal carotid artery3.There is encephalomalacia present involving the left frontal lobe4.Examination is degraded due to patient motion artifact which will obscure more subtle abnormalities


Instruction: Generate impression based on findings.

Input: 79-year-old man with history of dizziness. There is no diffusion-weighted abnormality to suggest acute ischemic stroke. There are mild scattered areas of subcortical and periventricular white matter T2 signal, as well as in the right pons. There are also small areas of encephalomalacia in the left cerebellar hemisphere. There are punctate foci of susceptibility effect in the right temporal and occipital lobes. There is no intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. The major flow-voids are preserved. There is a small mucus retention cyst is in the left maxillary sinus. The paranasal sinuses and mastoid cells are otherwise clear. The bone marrow signal and extracranial soft tissues are unremarkable.

Output: Small lacunar infarcts in the left cerebellar hemisphere and mild scattered small vessel ischemic disease, including in the right pons, but no evidence of acute infarct. Punctate foci of susceptibility effect in the right temporal and occipital lobes may be related to amyloid angiopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 62 years old Reason: evaluate for AVN of left knee History: pain, stiffness. Evaluation of the knee is slightly limited by patient motion artifact.MENISCI: There is abnormal signal intensity and attenuation of the body and posterior horn of the medial meniscus, indicating a complex tear. The anterior horn appears relatively intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are multiple foci of osteonecrosis within the distal femur and proximal tibia, including a small focus within the subchondral bone of the lateral femoral condyle, as well as small foci within the tibial plateau. We see no subchondral fracture or articular surface collapse. There are additional larger regions of bone infarction in the distal femoral metaphysis and proximal tibial metaphysis. There is severe osteoarthritis of the medial tibiofemoral compartment, with areas along the weight-bearing portion of the medial femoral condyle and medial tibial plateau that are devoid of articular cartilage. Signal abnormalities in the underlying subchondral bone are likely degenerative in etiology. There is mild articular degeneration of the lateral compartment. There is superficial fraying of the articular cartilage of the patella. There are small tricompartmental osteophytes.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Osteonecrosis as described above.2.Osteoarthritis most severely affecting the medial tibiofemoral compartment, with a complex tear of the medial meniscus.3.Joint effusion, Baker's cyst, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Neurogenic claudication. Signs and symptoms: Neck pain. Nonenhanced lumbar MRI:T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 demonstrate minimal degenerative changes and unremarkable otherwise.L3-L4 demonstrate mild bilateral ligamentum flavum and facet hypertrophy. Minimal bilateral facet effusion is noted. No spinal stenosis or neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, diffuse T2/T2 STIR hyperintensity of the endplates and vertebral bodies, bilateral ligamentum flavum hypertrophy, significant bilateral facet space widening with fluid signal intensity consistent with facet effusion. Constellation of above changes results in mild central spinal stenosis and significant bilateral neural foraminal compromise. Above described T2 hyperintensity of the adjacent endplates and vertebral body at this level are believed to be secondary to extensive degenerative disease. Likelihood of an infectious process is considered low and follow-up exam is recommended after conservative treatment for further assessment.L5-S1 demonstrate mild disc desiccation, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. A tiny annular fissure in the midline is detected.

Output: 1.Extensive degenerative changes at L4-L5 with resultant significant bilateral neural foraminal compromise and mild central spinal stenosis as detailed. Please review report above and recommendation for follow-up.2.Mild degenerative changes at other levels without spinal stenosis or significant neural foraminal compromise. Please see detailed report per level above.


Instruction: Generate impression based on findings.

Input: 2 year-old female with history of sickle cell disease and status post Moya Moya surgery. Evaluate for hematoma and CVA. Examination demonstrates an area of hypoattenuation in the right superior frontal gyrus, which corresponds to that on MRI 1/21/2010 and is compatible with a subacute stroke. There is no appreciable change in CT attenuation of areas of the acute infarcts involving bilateral centrum semiovale and right posterior parietal lobe previously seen on MRI. New since prior exam is a focus of hyperattenuation along the left postcentral gyrus, compatible with cortical hemorrhage. New since prior exam are postsurgical changes status post bilateral temporal craniotomies. There are small amount of blood products in the left temporal extraaxial space under the cranial flap. There is bilateral temporal scalp soft tissue swelling. There are small amount of pneumocephalus in the bifrontal regions and in the interhemispheric fissure and small emphysema in the left frontal subgaleal region. There are 2 Burr holes in the bifrontal bones. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, or midline shift. The osseous structures are unremarkable except for postsurgical changes. The mastoid air cells are clear. There is opacification of the ethmoid air cells.

Output: 1. New focus of cortical hemorrhage at the left postcentral gyrus. 2. Interval postsurgical changes status post bilateral temporal craniotomies as described above. 3. Right superior frontal subacute stroke.


Instruction: Generate impression based on findings.

Input: Lung cancer with brain metastasis: SRS planning. The images are markedly degraded by patient motion. There is a peripherally enhancing subcentimeter lesion in the medial left temporal lobe. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Subcentimeter left medial temporal lobe presumed metastasis. The images are markedly degraded by patient motion.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with double vision, vertigo, decreased sensation on the left side. A 3 mm focus of restricted diffusion is seen along the left paramedian pontine tegmentum with very mild associated T2 hyperintensity. This lesion produces no mass effect. No other diffusion restricting lesions are identified.Patchy foci of white matter T2 hyperintensity are seen, a nonspecific finding. None of these is associated with significant edema or mass effect. No evidence of acute or chronic intracranial hemorrhage is seen. No abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits.MRA imaging of the intracranial vessels appears to demonstrate a focal moderate to severe stenosis of the left P1 PCA. No other definite high-grade intracranial vascular stenosis is seen. No aneurysm or vascular malformation is suspected.MRA imaging of the neck demonstrates patency of the great vessel origins. There may be mild atherosclerotic disease at the carotid bifurcations, but no significant stenosis is detected by NASCET criteria. Likewise, the vertebral vessels appear to be free of significant stenosis in the neck.

Output: 1.A 3 mm focus of acute ischemia is suspected within the left paramedian pontine tegmentum. No other acute ischemic lesions are seen.2.Evidence of chronic microvascular ischemic disease is noted.3.A moderate focal stenosis is demonstrated at the left P1 PCA. No other significant intracranial vascular abnormality is detected.4.No significant compromise of the vessels of the neck is seen.


Instruction: Generate impression based on findings.

Input: Possible hemorrhagic stroke. History of kidney disease as an adult. 50 sutural female Since the exam of 2008 the patient has developed hypodense foci in the medial anterior aspect of the left thalamus and the superior aspect of the right thalamus anteriorly and in the right caudate nucleus. These are identified on an MRI of 8/19/09 . There is redemonstration from that time of focus of encephalomalacia in the inferior aspect of the left cerebellar hemisphere also identified and exams dating back to 2006 and the identified during the acute stage on 11/12/05.A focus of encephalomalacia is also present along the left temporal lobe identified on an MRI of 8/19/09. A focus of encephalomalacia is present along the right thigh medial parietal lobe and on either side of the intra-parietal sulcus involving superior parietal lobule, small portion of the precuneus and a small portion of the right inferior parietal lobule. There is also involvement of a small focus along the left cuneus.There is atrophy of the brain a somewhat early for this age.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Multiple foci of encephalomalacia as indicated above most of which are in the posterior circulation however there are a few in the anterior circulation bilaterally. These have developed over time and appeared many of these were not present on 2/25.08 right MRI from 8/19/09 identified. The distribution of the anterior circulation lesions suggests watershed distribution.


Instruction: Generate impression based on findings.

Input: Ms. Siegel is a 70-year-old woman presenting for MR-evaluation after recent diagnosis of left retroareolar malignancy that is mammographically and sonographically occult. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left retroareolar region, at the site of clinical concern, there is an irregular enhancing mass with surrounding non-mass enhancement identified. This entire enhancing area measures approximately 2.8 x 2.1 x 2.8 cm (AP x LR x CC) and extends into and completely involves the left nipple. There is no additional abnormal enhancement elsewhere in the left breast.RIGHT BREAST: There is no abnormal enhancement seen in the right breast. AXILLA: No abnormal lymph nodes are identified in either axillary region.

Output: (1) Unifocal left retroareolar malignancy with complete involvement of the left nipple, measuring up to 2.8 cm.(2) No MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: 15 month old with cardiomyopathy. Evaluate for hemorrhage. Signs and symptoms: Prematurity, sepsis. Unenhanced CT of brain: Hypoplastic and or atrophic left cerebellum is again identified. Images through posterior fossa are otherwise unremarkable and in particular no evidence of hemorrhage is identified.Images through supratentorial space demonstrate no definitive evidence of abnormality and in particular no hemorrhage is identified as clinically questioned. There is prominence of subarachnoid space more in the bifrontal region which is similar to prior MRI examination.

Output: No evidence of acute intracranial findings and stable exam since prior MRI from 3 -- 10 -- 10.


Instruction: Generate impression based on findings.

Input: History of right mastectomy for breast cancer in 2011. Currently on Tamoxifen. There is scattered fibroglandular tissuein the left breast. Right breast reconstruction is stable in appearance.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in either the left breast or right reconstruction. No abnormal lymph nodes are identified in either axillary region. Post-surgical changes in the right axilla are noted.

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


Instruction: Generate impression based on findings.

Input: ankle pain ARTICULAR CARTILAGE AND BONE: No evidence of osteochondral defect. The bone marrow signal is normal. No acute fracture identified.LIGAMENTS: The tibiofibular ligaments are normal. The anterior talofibular ligament is normal.ADDITIONAL

Output: No evidence of ATFL tear.


Instruction: Generate impression based on findings.

Input: Macrocephaly and severe headaches with photophobia and phonophobia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: 49 year old female with biopsy proven cancer in right breast whose recent MRI showed an enhancing mass in the left breast, presents for MR-directed ultrasound with possible biopsy for left breast. Left ultrasound detected an oval mass measuring 7 x 5 x 6 mm at 1 o'clock position, 1 cm from nipple with increased blood flow. This mass corresponds to the MRI findings. PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, three 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location at anterior upper outer aspect, the same location where the enhancing mass was seen on the MRI. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.

Output: Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 49 years Male (DOB:4/29/1966)Reason: tumor? Cause of vertigo with HA and tinnitus History: HA, tinnitus, and vertigoPROVIDER/ATTENDING NAME: RITA M ROSSI-FOULKES RITA M ROSSI-FOULKES The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are likely of little clinical significance.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the maxillary sinuses The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No masses are identified in the internal auditory canals or the cerebellopontine angle cisterns.


Instruction: Generate impression based on findings.

Input: 52 year old male with history of stage IV CLL with suspected transformation to B-cell lymphoma who presents for stress cardiac MRI for further evaluation of newly identified heart failureMEDICATIONS: Carvedilol, Lisinopril, Lasix IV, Acyclovir, Levaquin, Decadron, Diflucan, Zoloft First Pass PerfusionDuring hyperemia, there is no definitive evidence of perfusion defect. A prominent dark rim artifact is present, reducing the diagnostic sensitivity of the test.Viability/ Myocardial ScarThere was no obvious late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely reduced in systolic function and severely increased in size . The overall LV ejection fraction is 28%, the LV end diastolic volume index is 145 ml/m2 (normal range: 74+/-15), the LVEDV is 225 ml (normal range 142+/-34), the LV end systolic volume index is 103 ml/m2 (normal range 25+/-9), the LVESV is 161 ml (normal range 47+/-19), the LV mass index is 91 g/m2, and the LV mass is 142 g. There is global hypokinesis with regional variation.Left AtriumThe left atrium is moderately increased. Right VentricleThe right ventricle is moderately reduced in systolic function and normal in size . The overall RV ejection fraction is 35%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 99 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a large burden of mediastinal lymphadenopathy. Moderate bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No obvious perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Severely increased LV size and severely reduced systolic function (LVEF 28%) without evidence of obvious myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and moderately reduced systolic function (RVEF 35%).5. Moderate left atrial dilation.6. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Right knee pain, evaluate for chronic infection versus osteoarthritis in patient with chronic recurrent cellulitis. The patient's knee would not fit into the standard high definition knee coil, so a torso coil was used instead which results in slightly suboptimal image quality.MENISCI: There is a full-thickness radial tear of the posterior horn of the medial meniscus at/near its root. Globular signal intensity within the remaining posterior horn and body of the medial meniscus indicates intrasubstance degeneration. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is severe loss of articular cartilage along the patella with much of the lateral facet devoid of cartilage. There is also loss of articular cartilage of the femoral trochlea particularly along the inferior aspect of the medial facet. There is full-thickness cartilage loss along the weightbearing portion of the medial femoral condyle with edema type signal in the underlying subchondral bone. There is subjective thinning of the cartilage of the medial tibial plateau with associated mild degenerative subchondral signal abnormality. There is subjective thinning of the articular cartilage of the lateral tibiofemoral compartment. Small tricompartmental osteophytes are present.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis as described above.2.Medial meniscal tear.3.Joint effusion and soft tissue edema without specific imaging features of abscess or osteomyelitis.


Instruction: Generate impression based on findings.

Input: Right-sided weakness and numbness, evaluate for neurosarcoidosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly with mild associated linear T2 hyperintensity. The brain parenchyma otherwise appears to be unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is opacification of the left maxillary sinus, left frontal sinus, as well as mild mucosal thickening on the right maxillary and ethmoid sinuses. There is an anterior nasal septal defect and absence of the let inferior turbinate. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Incidental right cerebellar hemisphere developmental venous anomaly.3. An anterior nasal septal defect and absence of the let inferior turbinate may be postoperative in nature.


Instruction: Generate impression based on findings.

Input: Diagnosis: Discoid lupus erythematosusClinical question: changes in behavior and hypernatremia, new dx SLE. Eval for intracranial changes. If IC involvement, will change management The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of cavum septum pellucidum and cavum vergae.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: 3T scanner, please evaluate aneurysm for short term stability, please compare to outside images. Small aneurysm involving the left supraclinoid portion of the ICA measuring 1.8 mm pointing 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.In particular, there are infundibulum at the left Pcom artery and left anterior choroidal artery origin. However, there is no MRI evidence of intracranial aneurysm.

Output: No evidence of intracranial arterial aneurysm.Left Pcom artery and left anterior choroidal artery origin infundibulum are seen.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma with left maxillary lesion and liver metastasis. Neck CT:Extensive post-treatment changes are again present involving the left orbit, maxillary region and upper neck. Again noted are enhancing soft tissue lesion involving the left orbit, extending to the orbital apex, superior and inferior orbital fissure. There is extension into the region of the left pterygopalatine fossa and left cavernous sinus. There is lesion at the left nasolacrimal sac and canal. There is lesion involving anterior maxilla with very minimally increased bony erosion, measuring 26 mm (series 8035, image 52), with similar measurement on prior study. There is lesion involving the left nasopharyx and sphenopalatine foramen, with bony destruction at the floor of the sphenoid sinus and bone destruction of the left basisphenoid. There is soft tissue lesion involving the left temporalis muscle. The lesion at the left lacrimal fossa measures 19 x 7 mm (image 14, series 4) compared to prior measurement of 21 x 5 mm (image 12, series 3), not significantly changed in size. There is increased erosion of the lateral wall of the left orbit. There is soft tissue lesion overlying and lateral to the ramus of the left mandible. An enhancing lesion involving the anterior pole of the left temporal lobe is unchanged compared to MRI of 11/16/2010. Enhancement in the left foramen ovale seen on the prior MRI is not as well appreciated on this CT study and may be related to technical difference.There is patchy opacity in the right lung apex, which may represent inflammatory change. Degenerative disease of cervical spine is noted.

Output: 1. Enhancing lesions involving the left and anterior maxillary region and left orbit with extension into the left nasopharynx, left masticator space, sphenoid sinus, skull base, and left cavernous sinus as described above. There is subtle interval increase of bone erosion associated with the lesions at the left lacrimal fossa and anterior maxilla, but the soft tissue components of the lesions demonstrate no significant interval change in size.2. Enhancing lesion in anterior pole of the left temporal lobe seen on prior MRI study is not significantly changed. This could potentially represent post radiation necrosis versus tumor brain parenchymal involvement.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:5/5/1952)Reason: Metastatic ovarian cancer, hx of brain met sp SRS, surveillance MRI History: NonePROVIDER/ATTENDING NAME: PHILIP P CONNELL PHILIP P CONNELL A previously noted ring enhancing lesion in the right temporal lobe within the middle temporal gyrus currently measures 2.5 mm and displacing the Foley less enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since prior exam a right temporal lobe lesion has decreased in size.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with lumbar spine tenderness to palpation, status post recent L4-5 epidural injection three days ago, elevated WBC count. Trace anterolisthesis of L4 on L5 and L5 on S1 is again seen, similar to prior. Sagittal alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. No worrisome marrow replacement or evidence of significant marrow edema is seen.Advanced facet arthropathy is seen at L4-5 with facet effusions, and again at L5-S1. Mild edema is seen in the adjacent soft tissues.The visualized spinal cord, conus and cauda equina are within normal limits. No evidence of any epidural abnormality is seen, and in particular, there are no findings to suggest an epidural abscess or hematoma.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Minimal bulging disc. No significant spinal canal or foraminal stenosis. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Minimal bulging disc. No significant spinal canal or foraminal stenosis. L3-4: Moderate facet arthropathy with ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. L4-5: Advanced facet arthropathy with ligamentum flavum thickening. Loss of disc height, disc bulging and disc uncovering. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. L5-S1: Advanced facet arthropathy. Loss of disc height, disc bulging and disc uncovering with a small left foraminal annular fissure. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing.

Output: 1.No evidence of any epidural abscess or other acute epidural process.2.Trace spondylolisthesis of L4 on L5 and L5 on S1 is unchanged. No acute marrow abnormalities are detected.3.Advanced facet arthropathy is seen at L4-5 and L5-S1, similar to prior.4.Mild degenerative findings are evident at other levels but without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 43-year-old female patient with history of ulcerative clivus versus Crohn's disease presents with abdominal pain, nausea. Restaging disease. 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Visualized terminal ileum/ileocecal valve within normal limits. There is no evidence of active inflammation, significant fibrofatty infiltration, or fixed stenotic disease. Probably collapsed distal ileal loops seen in lower abdomen, e.g., image 53 series 18. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unremarkable MR enterography without evidence of active inflammation or fixed stenotic disease.


Instruction: Generate impression based on findings.

Input: Male 65 years old Reason: osteomyelitis History: diabetic foot ulcer. Abnormal T1 hypointense signal within the metatarsal head of the great toe. There are also multilobulated foci of stir hyperintense signal within the subchondral metatarsal head which appear to demonstrate subtle enhancement. There is significant thickening of the soft tissue surrounding the first metatarsophalangeal joint . There is signal abnormality within the proximal and distal phalanx at the interphalangeal joint of the great toe however the pattern is suggestive of degenerative disease. Soft tissue irregularity overlying this interphalangeal joint likely corresponds to provided history of skin ulceration.There is enhancement and edema within the soft tissues of the foot suggestive of inflammation.

Output: Abnormal signal intensity and enhancement within the first metatarsal head. The appearance may be secondary to patient's gout, in particular as this location is somewhat remote from the area of skin ulceration however in the context of this patient with diabetes and ulceration osteomyelitis cannot be completely excluded.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for intracranial stenosis 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 enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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. No aneurysms are appreciated.There is opacification of the entire left internal artery which changes caliber at the level of the posterior communicating artery due to posterior communicating artery collateral supply. There appears to be a high grade stenosis at the opthalmic segment.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The right posterior communicating artery is tiny. The anterior communicating artery is medium-sized. The left A1 segment is not readily identified. There is some supply to lenticulostriate originating from the left A1/A2 junction which receives supply from the right anterior circulation.The right vertebral artery is slightly larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. There is high-grade stenosis present at the left internal carotid artery origin with associated string sign which would effectively represent a 99% stenosis by NASCET criteria. It is not clear whether the string sign is due to distal ICA or proximal ICA stenosis or both based on this exam, however, the general morphology suggests distal stenosis. There is opacification of the entire left internal carotid artery which changes caliber at the level of the posterior communicating artery due to posterior communicating artery collateral supply.On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a left internal carotid artery string sign present with left internal carotid artery stenosis. It is suspected that there are tandem stenosis, however, the more significant stenosis is not readily identified. The left middle cerebral artery territory is supplied from via the posterior communicating artery. The left anterior cerebral artery territory is supplied via the anterior communicating artery. 2.The left A1 segment is not readily identified.


Instruction: Generate impression based on findings.

Input: Several sequences are mildly limited by motion.ORBITS: The optic nerves are symmetric and normal in size and signal intensity. There is no intraorbital mass or abnormal enhancement. There is no chiasmatic mass or parasellar abnormality. The extraocular muscles are unremarkable.BRAIN: There is no restricted diffusion to suggest acute ischemic infarction. Punctate and confluent foci of increased T2/FLAIR signal within the supratentorial white matter are favored to represent moderate chronic small vessel ischemic changes, minimally progressed compared to 4/14/2010 examination. A few additional punctate foci of increased T2/FLAIR signal are also present within the cerebellum appearing similar to prior. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening within the left sphenoid sinus. The midline structures and craniocervical junction are within normal limits. No abnormal intraparenchymal enhancement is identified.

Output: 1.No evidence of acute ischemic infarction.2.Moderate chronic small vessel ischemic disease, minimally progressed compared to 4/14/2010.3.Orbits appear unremarkable.