Instruction: Generate impression based on findings.

Input: Diagnosis: HeadacheClinical question: Evidence of intracranial pathologySigns and Symptoms: headache and intractable headache MRI of the brainNo diffusion weighted abnormalities are appreciated.The patient is status post suboccipital craniotomy likely for Chiari decompression. There is no obstruction at the level of foramen magnum.There are punctate foci of susceptibility effect along the periphery of the cerebellar hemispheres at the suboccipital craniectomy site.There are a couple subcortical punctate foci of T2 and FLAIR signal hyperintensity present along the left external capsule and left orbital gyrus. In isolation these are of little clinical significance..The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses 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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is triplication of the anterior cerebral artery present. The posterior communicating arteries are intact. The right posterior communicating artery is larger than the left posterior communicating artery. The left vertebral artery slightly larger than the right vertebral artery. The right anterior inferior cerebellar artery is dominant. The left posterior inferior cerebellar artery is dominant.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The right transverse sinus, sigmoid sinus and jugular bulb are larger than the left-sided counterparts. The corresponding grooves and foramina are similarly smaller based on the recent CT of the head.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is no evidence for acute cerebral infarction or intracranial mass lesion.2.Status post suboccipital craniotomy for Chiari decompression. There is no obstruction at the level of the foramen magnum.3.There are microhemorrhages present along the cerebellar hemispheres. These can only be visualized on susceptibility weighted sequences.4.There is no evidence for intracranial cerebral aneurysm5.There is no evidence for dural venous sinus occlusive disease.6.There is no evidence for spinal stenosis in the cervical spine.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease involving the small bowel and colon. Presents with abdominal cramping. 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: Subcentimeter left renal superior pole probable benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.There is mild wall thickening postcontrast enhancement and wall thickening of the terminal ileum extending for approximately 6 cm with a intervening skip segment. More proximally there is approximately 8 cm of wall thickening enhancement and restricted diffusion of the distal ileum with pseudosacculation. This extends into the deep pelvis where there appears to be tethering of the adjacent small bowel and sigmoid colon with suspected enterocolonic fistulization in a clover-leaf configuration. There is associated mild inflammation of the segment of sigmoid colon where the fistula tract extends to.No evidence of fixed luminal narrowing or prestenotic/upstream dilatation to suggest a flow-limiting stricture.No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Predominantly active inflammation of the distal and terminal ileum with suspected enterocolonic fistulization. No significant free fluid or loculated fluid collection.


Instruction: Generate impression based on findings.

Input: There are punctate foci of susceptibility effect in the right frontal lobe and right cerebellar hemisphere. There is interval resolution of T2 signal abnormality associated with the right cerebellar lesion. There is no abnormal enhancement. There are scattered punctate foci of abnormal T2 hyperintensity within the bifrontal subcortical white matter, which is nonspecific. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is a left posterior fossa arachnoid cyst. There is no midline shift or herniation. The skull appears unremarkable. There is a subcentimeter skin excrescence along the right aspect of the nose.

Output: Punctate foci of susceptibility effect in the right frontal lobe and right cerebellar hemisphere are compatible with treated metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 19 years old male with history of craniopharyngioma now with increased headache, evaluate ventricular size. Patient is status post right frontal craniotomy, with placement of ventriculostomy catheter having tip in the third ventricle and small amount of encephalomalacia abutting the distal catheter; this is not significantly changed in appearance from the 2007 comparison study. Lateral and third ventricles are effaced secondary to decompression.Cystic focus with internal calcification in the interhemispheric fissure is unchanged in size from recent prior MRI study.There is no evdence of intracranial hemorrhage, mass or edema. The remaining ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No hydrocephalus or change in ventriculostomy catheter position since 2007.


Instruction: Generate impression based on findings.

Input: Evaluate for biliary obstruction, history of sickle cell disease Suboptimal study secondary to patient motion artifact/patient's difficulty holding his breath. ABDOMEN:LIVER, BILIARY TRACT: Markedly T2 weighted hypointense signal involving liver, spleen and bone marrow, appearance compatible with severe iron deposition/hemosiderosis as a result of patient's sickle cell disease/multiple blood transfusions. Similar findings seen to a mildly lesser extent in the pancreas. Micronodular liver contour suggestive of underlying cirrhosis. No biliary ductal dilatation delineated. Status post cholecystectomy.SPLEEN: Small dark signal spleen, related to patient's known history of sickle cell disease.PANCREAS: Markedly T2 weighted hypointense signal involving liver, spleen and bone marrow, appearance compatible with severe iron deposition/hemosiderosis as a result of patient's sickle cell disease/multiple blood transfusions. Similar findings seen to a mildly lesser extent in the pancreas. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small kidneys (right kidney measures 7 cm, while left kidney measures 5.6 cm in longitudinal dimension) that are replaced by innumerable small cysts, measuring up to 1.4 cm.RETROPERITONEUM, LYMPH NODES: IVC filter incompletely seen.BONES, SOFT TISSUES: Markedly T2 weighted hypointense signal of bone marrow, reflecting sequela of iron deposition disease. OTHER: Incompletely imaged large left retroperitoneal hematoma, involving left psoas muscle and seen in posterior pararenal space; on transaxial imaging, measures approximately 8 0.1 x 3.7 cm. Mild to moderate cardiomegaly. Patchy bibasilar airspace disease. Anasarca.

Output: 1. Suboptimal study due to patient motion artifact.2. No biliary duct dilatation.3. Findings compatible with severe iron deposition disease as above, micronodular liver contour suggestive of underlying cirrhosis. Additionally, diffuse abnormal signal of pancreas alluded to above may be seen in setting of primary hemochromatosis, correlation with patient's clinical history recommended; alternatively, may represent an additional site of severe iron deposition disease. 4. Large left-sided retroperitoneal hematoma partially imaged. 5. Patchy bibasilar pulmonary airspace disease.Findings discussed with fellow Dr. E. Coronel at 12 p.m. on 2/22/15.


Instruction: Generate impression based on findings.

Input: 61 year old male with a history of ischemic cardiomyopathy s/p NSTEMI with percutaneous coronary intervention to the LAD in 12/2015 with residual LCx disease. Patient referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with low-normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 225 ml (normal range 142+/-34), the LV end systolic volume index is 55 ml/m2 (normal range 25+/-9), the LVESV is 105 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 87 g (normal range 164+/-36). There is thinning of the apical to basal lateral to inferolateral wall with associated hypokinesis/akinesis. There is late gadolinium enhancement of the apical to basal inferior, anterolateral, and inferolateral wall that is nearly full thickness (75%) to full thickness (lower probability of viability), corresponding to the LCx territory. Additionally, there is partial-thickness subendocardial late gadolinium enhancement (~50%) of the apical to mid anterior wall (intermediate viability). Pre-contrast native myocardial T1 relaxation times is normal (1010 ms) at the level of the septum. Left AtriumThe left atrium is normal sized. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 196 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 92 ml (normal range 54+/-17).Right AtriumThe right atrium is normal sized.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 ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with low-normal systolic function (LVEF 53%).2. The right ventricle is normal in size and systolic function (RVEF 53%). 3. There is thinning of the apical lateral and mid and basal anterolateral and inferolateral walls with associated hypokinesis/akinesis.4. There is partial-thickness subendocardial late gadolinium enhancement (~50%) of the apical to mid anterior wall (intermediate viability). Additionally. there is late gadolinium enhancement of the apical to mid inferior, anterolateral, and inferolateral wall that is nearly full thickness to full thickness correlating with nonviable myocardium and corresponding to the LCx territory.


Instruction: Generate impression based on findings.

Input: Reason: Eval DLBCL. History: DLBCL. There is motion artifact limiting the 3-D T1 postcontrast images. There is redemonstration of enhancement and mild enlargement involving multiple cranial nerves, most conspicuously involving the trigeminal nerves. Involvement of the right internal auditory canal contents is slightly less conspicuous than the remote exam from 3/8/2016. No definite new abnormal enhancement is appreciated.There is a stable right frontal approach Ommaya catheter with interval resolution of previously seen susceptibility relating to pneumocephalus. The ventricles and sulci are stable. There remains a similar extent of confluent T2/FLAIR hyperintensity within the bilateral cerebral white matter. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a left maxillary sinus mucosal retention cyst.CERVICAL SPINE

Output: 1. No significant interval change in enhancement involving multiple cranial nerves consistent with known lymphomatous involvement. Compared to more remote exam, decreased conspicuity of enhancement in the right internal auditory canal.2. Similar degree of residual enhancement involving the multiple bilateral cervical and visualized upper thoracic nerve roots.2. Stable extent of confluent areas of bilateral cerebral white matter signal abnormality, likely posttreatment changes.


Instruction: Generate impression based on findings.

Input: Reason: r/o cord compression History: b/l sciatica, sudden Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disk dessication and a mild disk bulge present at this level.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: No compromise to lumbar spinal canal or neural foramina. There is mild degenerative disk disease present at L4-5.


Instruction: Generate impression based on findings.

Input: 55 year old female with EF 52% and abnormal EKG, cardiac stress MRI to further delineate etiologyMEDICATIONS: None First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no 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 normal in size and global function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 157 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 48 g/m2, and the LV mass is 88 g. There are no regional wall motion abnormalities present. No evidence of underlying myocardial fibrosis, inflammation, or infiltration. Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 75 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 63 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate 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 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 52%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 54%).5. Mild-to-moderate tricuspid regurgitationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Racelis-Paradiso is a 52 year old female with recently diagnosed multicentric malignancy of the left breast (12:00 - IDC/ALH, 2:00 - ILC/LCIS). She presents for MRI evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.In the left superior breast, 12:00 location, there is an irregular enhancing mass identified measuring approximately 1.5 x 1.7 x 1.5 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within this lesion, compatible with biopsy-proven IDC/ALH. In the left upper outer breast, 2:00 location, there is an additional irregular enhancing mass identified measuring 1.4 x 0.8 x 1.1 cm. Susceptibility artifact from biopsy marker clip is seen immediately anterior to this lesion, compatible with biopsy-proven ILC/LCIS. The distance between the 2 clips measures approximately 5 cm in the AP dimension and 5.7 cm in the AP oblique dimension. There is no additional abnormal enhancement seen in the left breast.There is no abnormal enhancement seen in the right breastNo abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Multicentric malignancy of the left breast. Biopsy marker clips are separated by approximately 5.7 cm in the AP oblique dimension.(2) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: eval for superior labral tear History: L shoulder pain, positive O'Briens ROTATOR CUFF: There is a full-thickness tear of the rotator cuff at the junction of the supraspinatus and infraspinatus tendons approximately 1 cm proximal to the cuff insertion on the greater tuberosity. There is just under 1 cm of retraction of the undersurface fibers of the infraspinatus tendon. An undersurface component of the tear propagates into the posterior fibers of the supraspinatus tendon, and more posteriorly the tear also propagates distally through the infraspinatus tendon to its insertion on the greater tuberosity. There is a small cyst in the underlying humeral head. Overall, the tear is approximately 1.5 cm in AP dimension. There also appears to be insertional tearing of the fibers of the subscapularis tendon. We see no fatty atrophy of the subscapularis, supraspinatus or infraspinatus muscles. The teres minor tendon and muscle appear normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. There appears to be slight posterior/superior subluxation of the humeral head relative to the glenohumeral joint on the ABER view. Although we see no gadolinium entering the labrum, the superior labrum appears attenuated which may reflect chronic attritional tearing or debridement. The inferior labrum appears intact. BICEPS TENDON: The tendon of the long head of the biceps is identified within the bicipital groove but not within the rotator interval, which either reflects rupture or prior surgery.

Output: 1. Full-thickness rotator cuff tear as described above.2. Nonvisualization of the tendon of the long head of the biceps within the rotator interval may reflect prior rupture or tenotomy.3. Although we see no fluid-filled labral tear, the superior labrum appears attenuated which may reflect chronic attritional tearing or debridement.4. Mild osteoarthritis affects the glenohumeral and AC joints; other findings as above.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with history of thoracic meningioma status post resection related to von Hippel-Lindau. Brain:A few scattered foci of T2 hyperintensity are demonstrated, nonspecific and unchanged. No edema or mass effect is detected. No pathologic enhancement is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. Ventricles are normal in size and morphology. Scattered defects of the soft tissue scalp are seen, primarily on the right, which are unchanged and perhaps related to prior surgery.Spine:Postoperative findings compatible with laminectomy are redemonstrated from T9 through T12. The spinal cord through the operative region remains thinned and deformed, particularly at the T10 level where the posterior cord appears to be splayed or perhaps cystic. Findings are unchanged. No pathologic spinal cord enhancement is seen in the operative region or elsewhere.Trace anterolisthesis of C2 on C3 is redemonstrated. Otherwise, spinal alignment is anatomic. Vertebral body heights are preserved. No concerning marrow replacement, edema or enhancement is observed. Mild degenerative findings in the lumbar spine are unchanged. No high-grade spinal canal stenosis is seen, though the neural foramina at L5-S1 are moderately narrowed. Small renal cysts are demonstrated.

Output: 1.No significant intracranial abnormalities are identified.2.Postoperative findings are redemonstrated in the lower thoracic spine. Thinning and deformity of the spinal cord through the operative region is unchanged. No evidence of any pathologic spinal cord enhancement is seen.3.Mild degenerative disease in the lumbar spine is unchanged. No significant osseous spinal lesions are detected.


Instruction: Generate impression based on findings.

Input: Female; 44 years old. Reason: probable left adrenal myelolipoma on CT at Northwestern; confirm benign nature of lesion ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 8.1 x 6.6 cm well-circumscribed mass (series 12/344), which appears to be arising from the lateral limb of the left adrenal gland and demonstrates mild enhancement and internal fat, most compatible with benign myelolipoma.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: Left adrenal mass most compatible with benign myelolipoma.


Instruction: Generate impression based on findings.

Input: Reason: preop planning for craniotomy- meningioma resection History: preop planning There is redemonstration of the previously seen homogeneously enhancing and rounded extra-axial infratentorial mass in the midline. The mass currently measures 1.7 x 2.0 cm in greatest axial dimensions on 401/70, comparable to previous measurements of 1.7 x 2.2 cm, allowing for differences in technique. Current axial 3-D T2 weighted images suggest the flow-void associated with the straight sinus distally at the level the mass is at least displaced if not invaded with occlusion, with a smaller caliber likely cortical collateral vein identified just to the left of the straight sinus as seen on 301/71-79. The masses dominant centered on the venous confluent and may also involve the medial aspect of the left transverse sinus minimally.A small area of T2 hyperintensity inferior to the left putamen again may be related to a chronic lacunar infarct. Other previously described scattered punctate foci of T2/FLAIR hyperintensity are again suggested and are nonspecific. Mild/moderate age-related volume loss is present. There is no midline shift. There is again extensive diffuse paranasal sinus opacification and mucosal thickening, slightly worsened since the prior exam especially involving the ethmoid sinuses bilaterally.

Output: No significant interval change in size of a midline infratentorial presumed meningioma with suspicion for early invasion of the adjacent dural venous sinuses as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: history of brain metastases. MRI for SRS treatment planning History: none. There are subcentimeter lesions in the right cuneus. Other previously demonstrated lesions are not conspicuous. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is mild scattered paranasal sinus mucosal thickening.

Output: Pre-treatment planning MRI demonstrates subcentimeter lesions in the right cuneus. Other previously demonstrated lesions are not conspicuous.


Instruction: Generate impression based on findings.

Input: Newly diagnosed lung carcinoma. Evaluate for brain metastases. The brain parenchyma appears unremarkable. There is no abnormal parenchymal or meningeal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Low-lying cerebellar tonsils are incidentally noted. No destructive lesions in the calvarium are appreciated.

Output: No intracranial mass or abnormal enhancement to suggest metastatic diseaseI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58 old male with history of TIA a couple of years ago. Patient states frontal headaches for two months. Today the patient had dizziness since 3 a.m., "eclipse" over eyes and sees shadows, left-sided weakness. There is no evidence of intracranial hemorrhage, or mass. Evidence of small lacunar infarct of the left basal ganglia of indeterminate age, unchanged from prior.There is a questionable decreased attenuation in the right posterior parietal region of uncertain clinical significance. If clinically warrented MRI could be done for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1- Questionable decreased attenuation in the right posterior parietal region of uncertain clinical significance. If clinically warrented MRI could be done for further evaluation.2- Old small lacunar infarct are redemonstrated.


Instruction: Generate impression based on findings.

Input: 18-year-old male with injury, unable to bear weight and swelling. Evaluate for ligament/tendon injury TENDONS: The peroneal, flexor and extensor tendons are intact.LIGAMENTS: There is thickening of the anterior talofibular ligament with full thickness disruption at its talar attachment. There is also abnormal thickening of the calcaneofibular ligament indicating at least a sprain; the calcaneal attachment is somewhat ill-defined and we cannot exclude the possibility of a ligament avulsion. The posterior talofibular ligament is intact. The tibiofibular syndesmotic complex is intact. There is perhaps mild edema in the deep fibers of the deltoid ligament which could represent a mild sprain, however this is equivocal.ARTICULAR SURFACES AND BONE: We see no osteochondral defect. There is a small tibiotalar and subtalar joint effusion. Focal marrow signal abnormality just below the angle of Gissane likely represents a vascular remnant. There is a cystic lesion just inferior to this which may represent a small simple bone cyst, but is of doubtful clinical significance.ADDITIONAL

Output: Tear of the anterior talofibular ligament and tear/sprain of the calcaneofibular ligament and other findings as described above. The tendons are intact.


Instruction: Generate impression based on findings.

Input: 71-year-old male with right hepatic lobe mass seen on outside ultrasound measuring 6.8 x 5.9 x 5.9 cm. ABDOMEN:LIVER, BILIARY TRACT: Normal surface contour of the liver. No specific evidence of cirrhosis.Large segment 8 lesion measuring 7.6 x 5.6 cm (image 11/series 6). demonstrates T1 hypointensity, mild T2 hyperintensity, restricted diffusion, and heterogeneous enhancement on delayed phase images, compatible with metastasis. Central T1 hyperintensity and T2 hypointensity with nonenhancement, most likely due to tumor necrosis with internal hemorrhage and/or proteinaceous material. Few additional scattered subcentimeter T2 hyperintense lesions are too small to characterize and may be due to cysts.No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesions in both kidneys are too small to characterize but likely due to cysts. RETROPERITONEUM, LYMPH NODES: Marked porta hepatis lymphadenopathy. Mild retroperitoneal and upper abdominal lymphadenopathy.BOWEL, MESENTERY: Enhancing annular mass in the proximal descending colon, most compatible with colon cancer (series 903/42).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Annular mass in the proximal descending colon, most compatible with colon cancer.2. Large segment 8 hepatic lesion, most compatible with metastasis.3. Marked porta hepatis lymphadenopathy and mild upper abdominal and retroperitoneal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 50-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.5 x 4.1 x 3.8 cm.Peripheral Zone: Large focus of prostate cancer extending from the right base to mid gland anteriorly with low T2 signal, restricted diffusion, and increased enhancement, measuring up to 20 x 16 mm.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: There is slight extracapsular extension of the above-described prostate cancer in the right anterior prostate gland.BLADDER: No significant abnormality noted.LYMPH NODES: A nonspecific right external iliac lymph node measures 6 mm (series 1 701/104). No pathologically enlarged lymph nodes by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right anterior prostate gland cancer with slight extracapsular extension. This lesion would be amenable to MR-guided biopsy.


Instruction: Generate impression based on findings.

Input: Left first MTP joint mass, suspicious for ganglion cyst. A marker was placed on the skin dorsal to the neck of the first metatarsal. There is a lobulated mass of near-fluid signal intensity situated deep to this marker, along the lateral aspect of the extensor tendon extending inferiorly along the lateral margin of the first metatarsal head/neck. I see no appreciable enhancement of the mass. In total, it is approximately 1.5 x 0.7 cm in cross-section, and approximately 0.7 cm in longitudinal dimension. It does not appear to erode underlying bone. I see no additional soft tissue masses. Mild osteoarthritis affects the first metatarsophalangeal joint. I see no abnormal enhancement.

Output: Findings compatible with a ganglion as described above.


Instruction: Generate impression based on findings.

Input: 73-year-old male with urinary retention. Evaluate for cord compression. Brain MRI:There are diffuse osseous myelomatous bony changes throughout the calvarium without cortical breakthrough. Dural thickening along the clivus is likely reactive to marrow diseae. There is no abnormal intraparenchymal enhancement or mass-like lesion. There is nonspecific scattered FLAIR signal abnormality involving the periventricular and subcortical white matter which is likely related to small vessel ischemic changes.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Lumbar Spine MRI:Again visible within the lumbar spine is diffuse T1 dark signal indicating marrow replacement most likely from a history of myelomatous disease. There are multilevel degenerative changes and grade 1 anterolisthesis of L4 on L5. The remainder of the lumbar spine shows lordotic curvature. There is approximately 25-50% vertebral body height loss involving the L2 vertebral vertebral body. There is no evidence of retropulsion of the fracture fragments. There is variable disc height loss involving the lumbar spine, most prominent at the L2-3, L4-5 and L5-S1 levels. Within the spinal canal is abnormal enhancing soft tissue invading the epidural space, dorsally more than ventrally. This abnormality begins at the L1 vertebral body level and continues down to the L5 level. This tissue results in significant spinal canal stenosis and crowding of the cauda equina from L2 through L4. There is at least moderate to severe spinal canal stenosis extending more superiorly from the L4-5 level to the posterior aspect of the L2 vertebral body. There is also prominent enhancement and edema of the adjacent paraspinal muscles and psoas muscles.

Output: 1.Severe spinal canal narrowing in the lumbar region due to circumferential epidural tumor with some contribution from adjacent degenerative change. 2.Prominent enhancement and edema of the lumbar paraspinal muscles and psoas muscles is most likely to represent an inflammatory process perhaps reactive to radiotherapy, less likely paraspinal myelomatous involvement.3.Diffuse osseous myelomatous bony changes involving the calvarium without cortical breakthrough an no abnormal intraparenchymal enhancement or tumor-like lesions. 4.Scattered likely chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 71-year-old male with history of thoracic soft tissue mass. Additional clinical history of prior radiology requisitions indicates myeloma and prostate cancer.IMAGE ACQUISITIONS: CT of the thoracic and lumbar spine was performed without the administration of IV contrast. On this nonenhanced CT examination, there is no gross soft tissue abnormality to suggest a mass. The paraspinal soft tissues appear normal. However, this type of examination is not optimal for detection of soft tissue masses, and if there is continued clinical concern, MRI is recommended for a better evaluation of the soft tissues.Within the thoracic spine, there are diffuse bone changes of myeloma. There is kyphosis at the level of the severe compression fracture of the T5 vertebral body. Severe compression deformity of the T12 vertebral body is also present. T11 is status post vertebroplasty. More mild compression deformities are seen at the T7, T8 and T 11 levels.Within the lung bases, there is patchy opacity with air bronchograms which could be infectious in etiology.LUMBAR SPINE

Output: 1. No definite soft tissue mass. If there is continued concern for soft tissue mass, MRI is recommended for a more sensitive evaluation.2. Extensive changes within the bony spine consistent with the history of myeloma. Numerous compression fractures throughout the thoracolumbar spine.3. Opacity within the lungs which could represent pneumonia.


Instruction: Generate impression based on findings.

Input: Reported history of chronic pancreatitis. Assess for ductal abnormalities. The study was limited by lack of intravenous contrast. The patient's IV access failed and the patient refused to have a new IV placed. Motion artifact degrades image quality. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Fatty liver. SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal in caliber. Limited unenhanced evaluation demonstrates no focal lesion. The pancreatic parenchyma demonstrates normal intrinsic T1 weighted signal intensity. 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: Motion limited nonenhanced examination shows no over signs of chronic pancreatitis. The main pancreatic duct is normal in caliber and the pancreatic parenchyma is unremarkable. Two punctate calcifications in the pancreatic head are noted on the comparison CT.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 26-year-old female. Hepatic mass with chronic right upper quadrant pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Patient's known mass near the caudate lobe cannot be well seen on this single phase CT but remains grossly unchanged compared to previous MRI. No evidence of a complication related to this mass such as hemorrhage.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 7 x 4.3 cm cystic mass arising from the right ovary. Further evaluation with pelvic ultrasound is recommended.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: No significant change in the patient's known, most likely benign hepatic lesion. This lesion cannot be well seen or measured on this single phase CT.Right ovarian cystic lesion. Further evaluation with pelvic ultrasound is recommended to exclude a cystic ovarian neoplasm.


Instruction: Generate impression based on findings.

Input: New nocturnal headaches. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.There is also noted definitive evidence of small vessel ischemic disease as was noted on prior MRI exam.There is prominence of cortical sulci and supratentorial ventricular system similar to prior study. This may be begin or more range for patient's stated age of 89.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are unremarkable. Limited view of the orbits demonstrate evidence of prior bilateral cataract surgery.

Output: 1.No evidence of acute intracranial process.2.Stable exam since prior MRI study from 8 -- 20 -- 10.3.Normal pneumatization of paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: BRAIN: Compared to 2/19/2015, there is minimal progression in appearance of the extensive skull base osteomyelitis. Again seen is abnormal enhancement of the bilateral nasopharyngeal soft tissues slightly worse on the right in the interval. There is abnormal enhancement along with innumerable foci of non-enhancement representing extensive infection with innumerable abscesses extending into the clivus. There is a low marrow T1 signal with enhancement involving the sphenoid bone at the level of the left pterygoid process, the clivus including the basisphenoid and basiocciput, the left occipital condyle, the left lateral mass of C1 as well as the visualized odontoid process.Again seen is abnormal enhancement and fluid collection involving the cervical epidural space. Left sided epidural collection at the left C2 level measures 8 x 22 mm in the AP and craniocaudal dimensions (sag postgad image 13/25), previously of 6 x 21 mm. There is extensive enhancement with multiple abscesses in the left prevertebral, paravertebral and the paraspinal left postero-lateral neck soft tissues. There is a fluid collection in the visualized left upper paraspinous soft tissues which appears slightly larger than 2/19/2015 but better evaluated on recent CT neck study.There is involvement of the sella surrounding the pituitary gland. There are erosive changes at the posterior cortex of the clivus with extension into the right prepontine cistern as noted previously. These findings are grossly unchanged from the prior examination.There is similar signal abnormality with somewhat bulky appearance and enhancement of the bilateral cavernous sinuses with multiple small abscesses, consistent with bilateral cavernous sinus thrombophlebitis, similar to prior examination. However, there remains no abnormal superior ophthalmic vein enlargement or proptosis. There is persistent enhancement of the walls of the cavernous carotid arteries bilaterally without significant narrowing of the internal carotid arteries.There is contiguous infection extension from the right cavernous sinus, with a thin subdural empyema along the right tentorial leaflet again seen. There is asymmetric signal abnormality with heterogeneous enhancement in the left jugular tubercle and left hypoglossal canal. The left proximal internal jugular vein appears occluded and infectious process surrounds the left jugular foramen as on the prior examination. These findings are also grossly unchanged from the prior examination. There is no acute infarct, mass effect or midline shift. There is no evidence of infection involving the brain parenchyma, or suspicious brain parenchymal enhancement. The ventricles and sulci are normal for patient's age. There are mucus retention cysts in the bilateral maxillary sinuses. Polypoid inflammatory mucosal thickening involving the sphenoid sinuses is slightly increased since 2/19/2015.MR VENOGRAM BRAIN: MR venogram demonstrates absent flow within the distal aspect of the left sigmoid sinus and left upper internal jugular vein. Asymmetrically diminished flow is seen within the left transverse sinus and proximal sigmoid sinus without evidence of thrombosis. Remainder of the visualized superficial and deep venous systems appear patent. Thrombus is noted within the left sigmoid sinus and internal jugular vein on recent CT neck from 4/2/2015. Thin enhancing fluid collection is noted at the left sigmoid sinus and internal jugular vein junction which may be compressing the left-sided venous system.

Output: 1.Interpretation of outside MRI brain dated 4/5/2015. There is no MRI evidence of meningoencephalitis or intracranial abscess.2.Compared to 2/19/2015 there is minimal progression in the appearance of the trans-spatial neck/skull base infection with innumerable abscesses centered in the skull base with extension into the sella, thrombophlebitis of the bilateral cavernous sinuses, and contiguous extension of infection into the right tentorial leaflet resulting in a small subdural empyema. The tiny subdural empyema is not significantly changed.3.Extensive erosive changes in the clivus with extension of infection into the pre-pontine cistern on the right, similar to prior study. Infectious marrow involvement of the left greater than right sphenoid and occipital bones as well as left lateral mass of C1 appear similar to prior study. Infectious process surrounding the left jugular foramen and hypoglossal canals, similar to prior study.4.Visualized cervical epidural collection at the C2 level appears minimally larger than 2/19/2015.5.Extensive infectious involvement of the left sided deep neck/paraspinous and prevertebral soft tissue with multiple abscesses are again seen and better imaged on recent CT neck study.6.MR venogram demonstrates occlusion of the left internal jugular vein and distal aspect of the left sigmoid sinus. This finding is grossly similar when compared to prior brain and cervical spine MRI from 2/19/2015 allowing for differences in technique. Thin enhancing fluid collection is noted at the left sigmoid sinus and internal jugular vein junction which may be compressing the left-sided venous system. Remainder of the intracranial venous system appears patent.


Instruction: Generate impression based on findings.

Input: New onset seizure and breast cancer, evaluate for leptomeningeal carcinomatosis. The post-contrast images are particularly degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are extensive areas of patchy cerebral white matter T2 hyperintensity. There is a small area of encephalomalacia in the right cerebellar hemisphere. There is no abnormal intracranial enhancement. There is a partially-empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of gross leptomeningeal carcinomatosis or other forms of intracranial metastases, although the post-contrast images are degraded by patient motion. 2. Extensive areas of patchy cerebral white matter T2 hyperintensity may represent treatment effects and/or chronic microvascular ischemic disease otherwise. 3. Small chronic infarct in the right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Ms. Somers is a 65 year old female with history of bilateral breast cancer. She is status post bilateral lumpectomies and sentinel lymph node biopsies in 2012 (right breast invasive ductal carcinoma and DCIS; left breast invasive ductal carcinoma and DCIS). Patient received bilateral XRT. History of left breast cancer in 2004. Status post left lumpectomy, XRT and hormonal therapy. She has a family history of breast cancer in two sisters and ovarian cancer in her mother. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Postsurgical changes consistent with bilateral lumpectomies are unchanged in appearance. Susceptibility artifact from biopsy marker clip is again seen in the right inferior breast, at site of prior benign breast biopsy. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of both breasts. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical portion: Multiple myeloma, history of T4 compression fracture and a skeletal survey showed multiple lytic lesions. Follow up exam. Signs and symptoms: As above. Nonenhanced cervical MRI:Examination demonstrates multiple tiny foci of marrow signal changes without appreciable interval change since prior study and suspect that all multiple myeloma. There is no evidence of fracture and the alignment of the column is anatomical. Foramen magnum is unremarkable.C2 -- C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate moderate disk disease and loss of disk height with interval worsening since prior exam. There is asymmetrical left-sided uncal acute hypertrophy changes resulting in moderate to severe left neural foraminal compromise without central spinal stenosis.C4 -- C5 demonstrate mild disk disease with mild right neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate moderate disk disease and loss of disk height without evidence of spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease and loss of disk height no significant change since prior exam. Mild bilateral neural foraminal compromise without significant change since prior study and no central spinal stenosis.C7 -- T1 is unremarkable.Nonenhanced thoracic MRI:Examination redemonstrated findings of multiple myeloma of the thoracic spine primarily at T4, T5 and T6 levels and minimally at other levels without evidence of any significant change. There is no convincing evidence of any new lesion since prior exam.Significant compression deformity and flattening of T3 vertebrae without malalignment or spinal stenosis demonstrate no significant change since prior exam.Mild wedged shaped compression deformity of T4 and with associated marrow signal abnormality without malalignment or spinal stenosis demonstrate no convincing evidence of interval change.Patchy diffuse marrow signal changes of vertebral body or T6 without fracture or malalignment or interval change since prior study.There is very subtle depression of the superior endplate of T7 without associated marrow signal changes is a new finding since prior exam.Demarcated round foci of marrow signal changes in the vertebral body of T8 and T12 consistent with hemangiomas remains stable since prior study.No evidence of spinal canal compromise at any level is detected.No evidence of neural foraminal compromise at any level.Normal signal intensity and caliber of thoracic cord.Nonenhanced lumbar MRI:Examination demonstrate tiny foci of marrow signal replacement consistent with multiple myeloma with altered interval change since prior exam. The findings are identified in the vertebral body of L2, L4 and punctate foci in the other levels.The alignment of the vertebral column remains within normal and without evidence of spinal stenosis at any level. There is also no evidence of neural foraminal compromise at any level. Mild to moderate bilateral ligamentum flavum hypertrophy at the L3 -- 4 and L4 -- L5 levels are identified.

Output: 1.Examination of the cervical spine demonstrate stable few tiny foci of marrow signal change suggestive of multiple myeloma. Slight interval progression of degenerative changes of cervical spine however without resultant central spinal stenosis at any level. Multilevel neural foraminal compromise as detailed per level above. Normal signal intensity and caliber of the cervical cord.2.Examination of thoracic spine demonstrate no evidence of any new lesions since prior study. Stable significant compression fracture of T4 and mild wedge compression deformity of T5 demonstrate no appreciable interval change since prior study. Diffuse marrow signal changes of the T6 vertebral body without fracture consistent with multiple myeloma remain stable since prior exam. No malalignment and no evidence of spinal canal or neural foramina compromise at any level. 3.Examination of the lumbosacral spine minimal findings of multiple myeloma without interval change since prior exam. Normal anatomic alignment the vertebral column and without evidence of central spinal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reevaluate inflammatory lesions. No signs or symptoms at this time. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from minimal anterolisthesis of C4 on C5 and minimal retrolisthesis of C5 on C6. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology. There is no abnormal enhancement.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex including a right paracentral protrusion which partially effaces the right ventral aspect of the thecal sac. There is no significant spinal canal stenosis overall. There is mild narrowing of the neural foramina.C6-7: There is a small disc osteophyte complex including a right paracentral disc protrusion. There is no significant spinal canal stenosis. There is mild right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There is partial opacification of the left-sided mastoid air cells

Output: 1. There is no abnormal signal or enhancement involving the cervical cord to suggest recurrent inflammation.2. Mild multilevel degenerative changes in the cervical spine are again seen.


Instruction: Generate impression based on findings.

Input: Female, 64 years old. Reason: patient with known thyroid cancer. please evaluate for central and lateral suspicious lymph nodes RIGHT LOBE MEASUREMENTS: 4.3 x 2.2 x 1.1 cmLEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous echotexture, without focal lesion.LEFT LOBE: An elongated hypoechoic structure in the left thyroid bed measures 0.4 x 0.3 by 1.4 cm. this area appears more rounded on transverse imaging and very longitudinally oriented on sagittal imaging, may represent postoperative scarring. This structure was not clearly seen on prior outside ultrasound, although that exam is limited in this region.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A nodule within the left level 4 lymph node station measures 1.9 x 1.8 x 3.1 cm, solid, predominantly isoechoic and heterogeneous, with a hypoechoic rim and punctate calcifications, with internal vascularity.A left level 3 lymph node measures 0.8 x 0.3 x 0 .8 cm, with a fatty hilum. A left level 4 lymph node measures 0.9 x 0.5 x 0.8 cm, without definite fatty hilum.OTHER: No significant abnormality noted.

Output: 1. Status post left thyroid lobe resection, with a hypoechoic area within the left thyroid bed which may represent postoperative changes.2. A 2 to 3 cm solid nodule in the left neck, as detailed above, corresponds with a focus of biopsy-proven papillary thyroid carcinoma.3. Additional subcentimeter cervical lymph nodes as described above, including in indeterminant left level 4 lymph node.


Instruction: Generate impression based on findings.

Input: 40 year-old female with newly diagnosed brain tumor. High density likely calcific tumor in left frontal region is noted. Further evaluation with an MRI is recommended. This mass may be extra-axial in origin.The tumor measures approximately 14 mm times 16-mm. There is no evidence of surrounding vasogenic edema. No evidence of hemorrhage, midline shift, hydrocephalus is detected. The bony density of calvarium, paranasal sinuses and mastoid air cells are also unremarkable.

Output: Calcific left frontal tumor as detailed


Instruction: Generate impression based on findings.

Input: Parkinson's disease [G20] / Concussion without loss of consciousness, initial encounter [S06.0X0A], Reason for Study: ^Reason: please check for chronic subdural, s/p head injury 1/16, still with headache, please eval SAH, SDH History: headache, c/w prior There is no evidence of acute ischemic or hemorrhagic lesion.Scattered FLAIR high signal intensity lesions on periventricular white matter are again seen, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged minimal nonspecific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There are numerous, greater than ten, T2 hyperintense lesions involving the cerebral white matter. A lesion in the right frontal centrum semiovale has increased in size, while the other lesions do not appear to have significantly changed. The brain parenchyma and pituitary gland appear unremarkable. The presumed subcentimeter cystic pineal gland appears unchanged. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Numerous cerebral white matter lesions are compatible with multiple sclerosis. A lesion in the right frontal centrum semiovale has increased in size, while the other lesions do not appear to have significantly changed.


Instruction: Generate impression based on findings.

Input: Reason: seizure focus? History: epilepsy The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is no evidence for mesial temporal sclerosis.The visualized portions of the paranasal sinuses demonstrate partial opacification of the ethmoid air cells as well as mucous retention cysts in the maxillary sinuses and right sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for intracranial mass lesion or other lesion that would explain the patient's seizures.


Instruction: Generate impression based on findings.

Input: Reason: 65yo female with history of recurrent acute pancreatitis. Evaluate for chronic pancreatitis History: abdominal pain, recurrent acute pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly. Common bile duct is mildly dilated to 1.0 cm with mild intrahepatic biliary ductal dilatation which may be within normal limits given patient's age and status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma appears normal. The main pancreatic duct is nondilated. Sequential post secretin images show normal filling to the fourth portion of the duodenum. No side branch dilatation. No significant distention of the main pancreatic following secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy containing loops of bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: Assess for intracranial pathology, ischemic causes of dementia: altered mental status. There is extensive, mainly confluent, T2 hyperintensity in the cerebral, brainstem, and cerebellar white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Extensive cerebral, brainstem, and cerebellar white matter disease is nonspecific, but may represent hypertensive encephalopathy or sequelae of a prior toxic-metabolic process, for example. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male; 68 years old. Reason: 1.4 cm HCC pre liver transplant for reassessment History: cirrhosis. LIVER, BILIARY TRACT:Mild nodular liver contour, fissural prominence, and caudate hypertrophy are compatible with cirrhosis. Reference segment 8 lesion demonstrates high T2 signal as well as arterial enhancement and washout and now measures 2.5 x 2.2 cm, previously 1.4 x 1.3 cm (series 5, image 16). The hepatic vasculature is patent, although it should be noted that the segment 8 lesion is near a right anterior portal venous branch and right hepatic venous branch. No new suspicious enhancing lesions. No biliary ductal dilatation or intraductal filling defect on MRCP images. Previously described gallstone is not evident on today's exam. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mildly atrophic kidneys bilaterally. No suspicious lesions or hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with interval increase in size of solitary segment 8 lesion which meets criteria for HCC.2.No new suspicious lesions or biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Clinical question: History of metastatic breast cancer, presents with seizure-like activity, please assess for brain metastases. Signs and symptoms: Rule out brain metastases. Nonenhanced brain MRI:Negative diffusion weighted series.There is normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination. There is no finding to suggest presence of a metastatic disease on the nonenhanced series.The signal void of major intracranial arterial branches are identified. The calvarium demonstrates multiple varying-sized foci of T2 hypointensity without interval change since prior exam and consistent with multiple sclerotic calvarial metastases. None of the lesions demonstrate any extra osseous components.Unremarkable images through the orbits. All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Multiple sclerotic calvarial metastatic lesions without change since exam.2.No detectable parenchymal metastatic lesions on this nonenhanced exam.


Instruction: Generate impression based on findings.

Input: Left knee clicking and instability. Due to the patient's body habitus the high definition knee coil could not be used. An alternate knee coil was used instead resulting in slightly suboptimal image quality.MENISCI: Minimal increased signal intensity along the undersurface of the posterior horn of the lateral meniscus may represent fraying, but we see no discrete fluid-filled tear. The medial meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: Foci of increased signal intensity within the articular cartilage of the medial facet of the patella likely represent regions of degeneration. The articular cartilage of the tibiofemoral compartments appears preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings suggestive of undersurface fraying of the posterior horn of the lateral meniscus with no discrete fluid-filled tear evident.2. Focal degeneration of the articular cartilage of the medial facet of the patella.


Instruction: Generate impression based on findings.

Input: 56 year old man referred for evaluation of possible cardiac sarcoid. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. There is hypokinesis of the basal to mid anterior and anteroseptal walls. There is a mild diastolic septal bounce. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 118 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There are two small foci of late gadolinium enhancement in the apical septum that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 82 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is significant thickening of the pericardium with evidence of increased T2-signal and pronounced late gadolinium enhancement of both the visceral and parietal pericardium. A trivial pericardial effusion is noted. There is evidence of myocardial to pericardial tethering mostly along the basal inferolateral wall. These findings are suggestive of active pericarditis.Extracardiac FindingsSubcarinal and hilar lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function (LVEF 48%). There are two small (<5% of myocardial mass) foci of late gadolinium enhancement in the apical septum that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Assuming a diagnosis of extra-cardiac sarcoidosis is confirmed, these findings support the diagnosis of cardiac sarcoidosis. 2. Normal RV size and systolic function (RVEF 50%).3. There is significant thickening of the pericardium with evidence of increased T2-signal and pronounced late gadolinium enhancement. A trivial pericardial effusion is noted. There is evidence of myocardial to pericardial tethering mostly along the basal inferolateral wall. These findings are suggestive of active pericarditis.4. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 55 year old man with history of follicular lymphoma, undergoing anthracycline chemotherapy, referred for further evaluation of RV size/function after abnormal echo. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 170 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 116 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 102 ml (normal range 54+/-17). The RV appears trabeculated with less than normal tapering towards the apex. No mass or external compression noted. No evidence of aneurysms or wall motion abnormalities. There is no late gadolinium enhancement of the RV. Right AtriumThe right atrium is mildly dilated.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 ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is a central line noted in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsAbnormal curvature of the spine. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%2.The right ventricle is normal in size mildly reduced systolic function. The overall RV ejection fraction is 46%. The RV appears trabeculated with less than normal tapering towards the apex. No mass or external compression noted. No evidence of aneurysms or wall motion abnormalities. There is no late gadolinium enhancement of the RV. No minor or major criteria for arrythmogenic right ventricular cardiomyopathy. 3. Mild dilatation of the right atrium.4. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Progressive severe headache. BRAIN:The left cerebellar tonsil is elongated/peg-shaped and extends up to 2.8 cm below the level of the foramen magnum, to upper C3 level. It causes mild deformity of the caudal medulla and upper cervical spinal cord, which is more eccentric to the right within the spinal canal. There is faint T2STIR hyperintensity within the upper cervical cord at the C2-C3 level on sagittal and perhaps axial imaging which may reflect soft syrinx. The right cerebellar tonsil barely extends below the level of the foramen magnum. The fourth ventricle is normal size and there is no hydrocephalus. Overall volume of the posterior fossa is normal and the cerebellum is otherwise normal in morphology. Myelination is appropriate for age. There is no midline shift. A focal 10-mm CSF-intensity structure along the superior surface of the anterior edge of the tentorium cerebelli (vs adjacent to and extending through a small dural defect) which may represent a small arachnoid cyst. There is no abnormal intracranial contrast enhancement. Major intracranial vascular flow voids are preserved. There is minimal ethmoid mucosal thickening. A 4 mm fluid intensity within the pineal region is probably a small cyst, of doubtful significance. The adenoids, tonsils and retropharyngeal lymph nodes are prominent, which is a common incidental finding in this age group.The CSF study was performed at the mid sagittal plane. Dorsally, the flow signal is significantly attenuated with loss of synchronicity compared to the ventral flow. Ventrally, there is focal attenuation of the flow at the level of the most severe narrowing at C1 level but preserved biphasic flow cranial and caudal to this otherwise. WHOLE SPINE:There is a multiloculated lower cervical syrinx that is 3.0 cm craniocaudally extending from C4-C5 level to C7-T1 level which measures transaxially 7 mm x 6 mm. Two other smaller focal dilatations of the central canal are present at the upper and lower T4 levels. In addition, there is the faint T2-hyperintensity within the upper cervical cord at C2-C3 level described above, which may reflect pre/soft-syrinx.The spinal cord is otherwise unremarkable. The tip of the conus medullaris lies at L1-L2 level which is normal. The spinal canal is also preserved. The vertebral bodies are preserved in signal and morphology. The intervertebral discs are also unremarkable. Note, there are no post contrast images through the lower thoracic/lumbar spine. There is no abnormal contrast enhancement in the region of the syrinx.

Output: 1.Chiari 1 malformation, more pronounced on the left side. No hydrocephalus or other posterior fossa malformation. CSF flow study is remarkable for marked dorsal attenuation and loss of phasic synchronicity between the ventral and dorsal flow.2.Resultant lower cervical syrinx and smaller upper thoracic syrinxes are present as described above. Faint increased T2 signal in the upper cervical spinal cord at C2-C3 level may represent soft syrinx, but can be followed on the subsequent exams.3.Focal 10-mm CSF-intensity structure along the superior surface of the anterior edge of the tentorium cerebelli (vs adjacent to small dural defect) which may represent a small arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Medial knee pain and locking for 2 weeks after skiing accident. MENISCI: The menisci are normal in appearance.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No bone contusions are noted.LIGAMENTS: The proximal and mid fibers of the anterior cruciate ligament are indistinct and appear thickened with edema type signal suggestive of high grade partial tearing or complete tear. The PCL is intact. The collateral ligaments are intact. The medial retinaculum is prominent, which may be of no clinical significance. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Abnormal appearance of the proximal ACL suggestive of high grade partial tearing or complete tear at its proximal aspect.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with left sixth nerve palsy. A focus of subcortical T2 hyperintensity is present within the right superior frontal gyrus. No associated mass effect is seen. A few additional scattered small foci of white matter T2 hyperintensity are demonstrated elsewhere in the brain.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. On postcontrast images, there is no evidence of any pathologic parenchymal or extra-axial enhancement.No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles demonstrate normal size and morphology.The globes are symmetric and round. The extraocular muscles demonstrate normal morphology and enhancement. The optic nerves, chiasm and visualized optic tracts are within normal limits. No abnormalities of the cavernous sinus are seen.The cranial nerves are within normal limits. In particular the sixth cranial nerves are visualized as they traverse the prepontine cistern and are normal.

Output: 1.A focus of T2 hyperintensity within the right superior frontal gyrus is nonspecific but could reflect the sequela of prior trauma or perhaps a chronic ischemic lesion.2.No acute intracranial abnormalities are seen.3.The orbits, cavernous sinuses and visualized cranial nerves are within normal limits.


Instruction: Generate impression based on findings.

Input: Uterine fibroids UTERUS, ADNEXA: Enhancing broad-based intrauterine mass arising from the right lateral fundus measures 5.0 x 4.9 x 5.4 cm (series 701, image 27). Focus of T1 hyperintensity in the right ovary is suggestive of a hemorrhagic cyst.BLADDER: No mass effect upon the bladder.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Findings consistent with a large non-degenerated submucosal uterine leiomyoma.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with left-sided weakness and word finding difficulty. Assess for stroke. Two or three small foci of nonspecific T2 hyperintensity are evident within the cerebral white matter. The cerebral and cerebellar hemispheres and brainstem otherwise show normal signal intensity and morphology. No restricted diffusion is seen.The pattern of parenchymal enhancement is within normal limits. No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected. Staphyloma of the left globe is noted.

Output: No acute intracranial abnormality, and in particular, no evidence of acute ischemia.


Instruction: Generate impression based on findings.

Input: 21 years Female (DOB:9/15/1994)Reason: s/p 2014 meningioma resection and SRS, please evaluate for changes History: s/p 2014 meningioma resection and SRS, please evaluate for changesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of status post left-sided craniotomy. A focus of encephalomalacia is present along the anterior aspect of the left frontal lobe. This appearance is stable compared to the previous exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right sphenoid sinus and mucous retention cysts in the maxillary sinuses bilaterally.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are partially obscured by high motion and susceptibility artifact..MRI pituitary:There is redemonstration of a heterogeneously enhancing left parasellar mass which currently measures 18 x 16 mm coronal dimensions and previously measured 20 x 18 mm coronal dimensions. It currently measures 22 x 16 mm sagittal dimensions and previously measured 23 x 18 mm sagittal dimensions. It abuts the left internal carotid artery and partially surrounds it also abuts the superior aspect of the left cavernous sinus and the left posterior clinoid process. It extends along the superior lateral aspect of the sella. It abuts the optic chiasm along its medial aspect. Laterally it abuts the medial aspect left temporal lobe.The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: 1.A left parasellar mass is slightly smaller on the current exam when compared to the prior. It affects critical structures adjacent to it as detailed above.2.Status post left-sided craniotomy associated with post surgery changes.


Instruction: Generate impression based on findings.

Input: 64-year-old male with HCV and NASH cirrhosis. Patient presents for hepatocellular carcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Liver contour nodularity, prominence of the fissures, and left hepatic lobe hypertrophy is noted; findings consistent with cirrhosis. Unchanged T2 hyperintense nonenhancing lesion within segment 8 compatible with a cyst. No suspicious arterially enhancing hepatic lesions. Patent hepatic vasculature.SPLEEN: Spleen measures approximately 13 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right interpolar renal T2 hyperintense nonenhancing focus, consistent with a cyst. RETROPERITONEUM, LYMPH NODES: Multiple enlarged portacaval lymph nodes consistent with chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with mild splenomegaly. 2.No suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: 55-year-old female with persistent dizziness and nausea one month post concussion Diffusion-weighted images show no evidence of restricted diffusion to suggest acute infarct. Redemonstrated are a few scattered punctate foci of T2 hyperintensity within the subcortical white matter which are unchanged. The cerebral and cerebellar hemispheres and brainstem are otherwise normal in signal intensity and morphology. No intracranial hemorrhage, mass, edema or midline shift is noted. No abnormal extra-axial fluid is present. The ventricles and basal cisterns are symmetric and normal in size. The visualized paranasal sinuses and mastoid air cells are normally pneumatized, and the bones of the calvarium are intact.

Output: Redemonstrated are a few scattered punctate foci of T2 hyperintensity within the subcortical white matter which are unchanged.


Instruction: Generate impression based on findings.

Input: History of cervical cancer. PELVIS:UTERUS, ADNEXA: The uterus measures approximately 2.0 x 4.2 cm in the sagittal plane x 4.1 cm in the axial plane. Centered in the posterior uterine cervix, there is a focus of abnormal signal intensity (series 901, image 21) measuring approximately 1.2 x 1.4 cm compatible with patient's known cervical malignancy. The lesion extends posteriorly beyond the cervix. The lesion has an ill-defined margin with the rectum, invasion is not excluded. The margin between the uterus and bladder appears intact.The right ovary measures approximately 1.4 x 2.3 cm and contains several subcentimeter cysts measuring up to 7 mm. The left ovary measures approximately 1.2 x 2.1 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No abnormally enlarged intrapelvic nodes are identified. There are several mildly prominent nonspecific inguinal lymph nodes bilaterally.BOWEL, MESENTERY: Diverticulosis.BONES, SOFT TISSUES: Right hip total arthroplasty device susceptibility artifact from which obscures adjacent structures. Degenerative changes affect the left hip joint. There is an approximately 1.3 x 1.7 cm nodule within the right gluteal soft tissues immediately adjacent to the gluteal cleft (series 1202, image 2) which is incompletely imaged. There appears to be mild peripheral enhancement.OTHER: No significant abnormality noted.

Output: 1.Cervical mass extending posteriorly beyond cervical margin with possible invasion of the rectum. No intrapelvic lymphadenopathy by size criteria.2.Incompletely imaged right gluteal soft tissue nodule measuring approximately 1.7 cm, recommend correlation with physical examination.3.Mildly prominent nonspecific inguinal lymph nodes.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with history of lung cancer with metastases to brain status post RT. Signs and symptoms: Doing well but no new disease evaluation compared to prior scans. Pre-and post-enhanced head CT:Examination demonstrates further decrease in the size of a single small metastatic focus in the dorsal aspect of the right cerebellum. It measures approximately 4 x 6-mm in size compared to prior measurements of 11 x 11.There is no detectable surrounding vasogenic edema.Unremarkable pre-and post enhanced head CT otherwise and in particular no evidence of any new additional metastatic lesions of brain parenchymal or leptomeninges.Calvarium is intact.Limited images through the orbits are unremarkable.Paranasal sinuses and mastoid air cells are unremarkable.

Output: Further decrease in the size of a single right posterior cerebellar metastatic focus to 4 x 6-mm in size compared to prior measurements of 11 x 11. No evidence of any new findings.


Instruction: Generate impression based on findings.

Input: New onset diplopia and memory loss, SLE patient. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. There is an unchanged small linear area of encephalomalacia in the right cerebellar hemisphere. There is unchanged apparent linear enhancement along the planum sphenoidale. The ventricles, sulci, and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is an unchanged enhancing focus in the right parietal bone. There is a small left sphenoid sinus rentention cyst.

Output: 1. Chronic lacunar infarct in the right cerebellar hemisphere, but no evidence of acute intracranial hemorrhage or acute infarct. 2. The unchanged apparent linear enhancement along the planum sphenoidale is likely related to artifact rather than a meningioma.3. Unchanged enhancing focus in the right parietal bone.


Instruction: Generate impression based on findings.

Input: Normal lordotic curvature of the cervical spine. The vertebral body heights are preserved. Redemonstrated is a predominately T2 hypointense lesion in the C6 vertebral body without a decreased in the normal height. There is no extension into the spinal canal and there are is no epidural abnormality. The remaining cervical spine is within normal limits.

Output: Findings compatible with a benign osseous lesion involving the C6 vertebral body appearing similar to the prior CT exam without vertebral body height loss or involvement of the spinal canal or epidural space.


Instruction: Generate impression based on findings.

Input: Ms. Brill is a 35-year-old female with a family history of breast cancer in mother, diagnosed at the age of 34. She is BRCA1 positive. This is the 9th module of the study. There is extreme amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 25-year-old female. Fetus with multiple cardiac anomalies. Evaluate spleen. Cardiac anomalies on fetal ultrasound, including dextrocardia. PELVIS:UTERUS, ADNEXA: Single intrauterine pregnancy is identified in vertex position. The placenta is posterior near the fundus without evidence of placenta previa or increta/percreta.The cardiac apex is on the right side of the fetus, compatible with dextrocardia, with the liver on the same right-side. A gallbladder is noted. The stomach is on the left side of the abdomen. No spleen is identified. No body wall defect is evident. There appears to be malpositioning of the bowel suggestive of malrotation. Fluid-filled bladder is noted. Bilateral kidneys are noted. A triple vessel cord is present. This study was not performed for detailed assessment of the neural axis, which is unremarkable.Bilateral adnexa are noted with numerous follicles. No surrounding fluid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No hydroureteronephrosis.

Output: Given the stated history of cardiac abnormalities including dextrocardia, there are findings compatible with heterotaxy syndrome, specifically asplenia. Suspected bowel malrotation.


Instruction: Generate impression based on findings.

Input: A 68 year old male with history of hypertrophic cardiomyopathy, Crohn's disease, remote colon and bladder cancer status post resection, nephrolithiasis. Referred to cardiac MRI to assess the cardiomyopathy. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 45 ml (normal range 47+/-19). There is concentric hypertrophy with increased myocardial mass. At end diastole, the antero septum is 18mm. The inferolateral wall is 16mm. There is focal, intermediate signal enhancement at the mid myocardial insertion points of the interventricular septum. There are no cardiac MRI findings to suspect cardiac amyloidosis.No intracardiac thrombus.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 57 ml/m2 (normal range 82+/-16), the RVEDV is 113 ml (normal range 142+/-31), the RV end systolic volume index is 20 ml/m2 (normal range 31+/-9), and the RVESV is 40 ml (normal range 54+/-17).Right AtriumThe right atrium is normal size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mitral regurgitation. This was not quantified but is estimated to be at least moderate in the presence of left atrial chamber dilation. Associated moderate to severe systolic anterior motion of the anterior leaflet of the mitral valve with acceleration of antegrade flow at the subvalvular left ventricular outflow tract.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The thoracic aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace pericardial effusion.Extracardiac FindingsLeft renal atrophy with lesions previously characterized as likely cysts. These are incompletely characterized on this exam.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function, the LVEF is 70%. There is hypertrophy with increased mass. Mid myocardial enhancement at RV insertion site at interventricular septum. SAM with MR and accelerated flow in the subvalvular outflow tract. Constellation of findings are compatible with hypertrophic cardiomyopathy.2. The right ventricle is normal in size with normal systolic function, the RVEF is 64%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 19 years, Male, daily headaches, history of cranial radiation.. Per chart, history of rhabdomyosarcoma of the left temporal bone with cholesteatoma. There is artifact related to dental hardware which slightly limits evaluation of the anterior frontal/craniofacial region. Brain parenchyma however appears unremarkable with no intracranial mass or abnormal parenchymal or meningeal enhancement. No evidence of ischemia, hemorrhage, or other parenchymal signal abnormality. Ventricles and sulci appear within normal limits. Major flow-voids are preserved.There is diffuse opacification of the left mastoid air cells with partial left middle ear and mastoid opacification evident on prior temporal bone CT from 1/27/2010. There is thinning of the left-sided tegmen mastoideum which is better assessed with CT. There is extensive opacification of the right anterior and posterior ethmoid air cells. There is moderate mucosal thickening involving the maxillary sinuses and to a lesser degree sphenoid sinuses, right worse than left. Sella and orbits are grossly within normal limits. Remainder of the bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Brain parenchyma appears within normal limits. Specifically, no evidence of intracranial mass or abnormal enhancement.2. Moderate degree of opacification of the paranasal sinuses, right worse than left as described above, compatible with sinusitis.3. Diffuse opacification of the left mastoid air cells, which appears slightly increased since CT temporal bone dated 1/27/2010. Finding is nonspecific, and dedicated temporal bone imaging can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Evaluate for tether cord, syrinx, Chiari malformation: scoliosis, back pain, and headaches. There are postoperative findings in the thoracic spine related to removal of posterior spinal instrumentation. There is a thoracolumbar dextroscoliosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord is low lying, with the conus medullaris extending to the level of the L3 vertebra. The spinal cord signal otherwise appears to be normal. However, there appears to be thin linear T2 hyperintensity in the region of the filum terminale. The cerebellar tonsils are not low-lying.

Output: 1. Thoracolumbar dextroscoliosis and low-lying conus medullaris, which may represent tethered cord and possible small fibrolipoma of the filum terminale.2. No evidence of Chiari I malformation.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient and her father, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was sedated and monitored by the pediatric sedation team throughout the entire procedure. The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. The patient was escorted to the MRI suite under continuous monitoring by the pediatric sedation team. Please refer to the subsequent MRI report for further information.Exposure time: 35 seconds

Output: Successful left hip injection without immediate complication. MRI arthrogram to follow.


Instruction: Generate impression based on findings.

Input: 48-year-old man with history of HBV and HCC status post resection September 2015. ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense ablation cavity without enhancement in segment 4 (3/14) measures 34 x 29 mm, previously 44 x 34 mm. No surrounding abnormal enhancement identified. Liver signal and morphology are otherwise normal.There is a focally dilated bile duct immediately peripheral to this ablation cavity (3/15) but there is no significant intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter sized branch type IPMN in the pancreatic body (3/14) is unchanged.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.Slight decrease in size of ablation cavity without findings suspicious for recurrence.2.No new suspicious hepatic lesions.3.Stable sidebranch IPMN in the body of the pancreas.