Instruction: Generate impression based on findings.

Input: Pituitary microadenoma. Assess for changes. As discussed previously, the pituitary gland is elongated craniocaudally, measuring up to 12 mm, but is narrow in the transverse dimension. It also shows homogeneous normal signal on T1 and T2 sequences as well as appropriate homogenous contrast enhancement. The cavernous internal carotid arteries are medialized impinging on the sella, which is probably causing or at least contributing to the craniocaudal elongation of the pituitary gland. The pituitary infundibulum is midline and not thickened. There is no hypothalamic abnormality and the optic chiasm is unremarkable. There is no intrasellar acute infarct or hemorrhage nor in the included part of the brain.Included part of the brain shows nonspecific T2-hyperintense white-matter lesions which are unchanged and may reflect chronic microvascular ischemia.

Output: The pituitary gland is elongated craniocaudally but is compressed in transverse by the cavernous internal carotid arteries. The gland continues to be homogeneous on all pre and post contrast sequences. Therefore, the increase in the craniocaudal dimension of the gland may reflect mere distortion of the gland by the mass-effect rather than the presence of a primary lesion such as an adenoma.


Instruction: Generate impression based on findings.

Input: Breast cancer and headaches. There is no acute brain infarct. There is no space-occupying or contrast-enhancing brain lesion. Linear contrast enhancement in the posterior right frontal operculum may reflect either an incidental developmental venous anomaly or volume averaging of a normal cortical vein. There is mild asymmetry in the size of the lateral ventricles, which can be developmental. Otherwise, the ventricles and other CSF-containing spaces are normal in size. There is no midline shift or herniation. There is no abnormal extra-axial fluid collection. The major intracranial vascular flow voids are preserved, reflecting gross patency.There is no gross orbital abnormality. There is a small retention cyst in the right maxillary sinus. There is mild ethmoid mucosal thickening. The mastoid air cells are clear. There is no destructive skull lesion. T1-hyperintense lesion in the anterior aspect of C2 vertebral body is probably a hemangioma.

Output: 1.Normal brain MRI apart from the linear contrast enhancement in the right frontal opercular which may represent volume averaging of normal cortical veins or an incidental developmental venous anomaly.2.No brain mass or abnormal contrast enhancement otherwise.


Instruction: Generate impression based on findings.

Input: 67-year-old female patient with history of HCC and cirrhosis. Patient is called back for TACE/RFA. Note that examination is limited, as only postcontrast sequences were obtained.ABDOMEN:LIVER, BILIARY TRACT: Stable ablation cavities in the right inferior hepatic lobe and segment five.In the area of concern on the previous examination that is peripheral and superior to the initial ablation cavity in segment five, there is an ill-defined area of increased T2 and DWI signal intensity. This area demonstrates arterial enhancement and central washout in a serpiginous morphology (series 5 image 153). Additionally, there appears to be contrast going around the thrombus proximally on portal venous phase images, favoring portal vein etiology as opposed to biliary.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Area peripheral and superior to the initial ablation cavity in segment five demonstrates arterial enhancement with serpiginous washout. These findings are most compatible with recurrent tumor thrombus in the right anterior portal vein.


Instruction: Generate impression based on findings.

Input: Headache. History of Chiari. Also, history of hemangioma in the right orbit. Orbits: The well-defined avidly enhancing T2 hyperintense superotemporal intraconal mass within the right orbit is unchanged. It measures 12 mm maximally. The globes and ocular adnexa are unremarkable as well as the optic nerves. Brain: The cerebellar tonsils extend up to 12 mm inferior to the foramen magnum which is unchanged. Crowding of the level of foramen magnum but neural structures has not changed. There is biphasic flow anterior to the brainstem/upper cervical spine and a blush of flow posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a left frontal developmental venous anomaly. There are minimal scattered foci of T2 hyperintensity in the cerebral white matter which are unchanged. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is very minimal ethmoidal mucosal thickening without fluid, most likely of no significance. The small T2 hyperintense focus along the posterolateral aspect of the right mandibular condyle has not changed and may represent a small synovial cyst.

Output: 1.Findings compatible with Chiari malformation are not anatomically changed. There is CSF flow across foramen magnum as described above.2.The 12 mm, well-defined avidly enhancing T2 hyperintense superotemporal intraconal mass within the right orbit is unchanged and as described previously most likely represents a cavernous hemangioma.


Instruction: Generate impression based on findings.

Input: Reason: evaluation for thoracic mets History: breast cancer new diagnosis breast cancer MRI thoracic spine:There is diffuse marrow replacement present. Compression fractures are present at multiple levels including T6 were there is 40% loss of vertebral body height, and T8 were there is 40% loss of vertebral body height T11 where there is 25% loss of vertebral body height and L1 where there is 60% loss of vertebral body height. There is extraosseous extension into the spinal canal at L1 and T8 and T6. At L1 there is a mild degree of spinal stenosis, retropulsion of T12 on L1 and encroachment of the exiting nerve roots within the neural foramina.The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are bilateral pleural effusions present.There small enhancing nodules scattered in the peri-vertebral musculature and subcutaneous tissues behind the thoracic spine which could represent metastatic foci. One in the left peri-vertebral musculature at the T9 vertebral level measures 12mm x 5 mm sagittal dimensionsLumbar spine:Compression fracture is present at L1 where there is 60% loss of vertebral body height. There is extraosseous extension into the neural foramina and adjacent spinal canal at L1. There is a mild degree of spinal stenosis and retropulsion of T12 on L1 resulting in encroachment of the exiting nerve roots within the neural foramina.The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy present at this level. There is marked thickening of the right L5 pedicle as a result of tumor with some extension into the adjacent neural foramina without compromise to the exiting nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Diffuse osseous metastases throughout the visualized spine with multiple pathologic compression fractures at T6, T8, T11 and L1 but worse at L1. There is a small amount of epidural extension at T6, T8 and L1. There is some subluxation of T12 on L1 with encroachment of the exiting nerve roots within the neural foramina. There is mild spinal stenosis at L1 as a result of the compression fracture and retropulsion with minimal spinal canal narrowing contributed from the at the epidural extension.2.There are a few small scattered subcutaneous and perivertebral musculature nodules present which are suspicious for metastatic involvement.3.There are bilateral pleural effusions present.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine which is likely positional. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Right facet hypertrophy causes mild right neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, prominent in the midline, abuts and deforms the anterior cord. This is associated with focal cord atrophy and intrinsic T2 hyperintense abnormality most consistent with myelomalacia.C4/5: Posterior osteophyte disc complex, ligamentum flavum thickening with mineralization, bilateral uncinate hypertrophy, severe left facet hypertrophy, and moderate right facet hypertrophy combine to result in cord deformation associated with intrinsic T2 hyperintensity and moderate to severe central stenosis. There is also severe left neural foraminal and moderate to severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, bilateral uncinate hypertrophy, mild left facet appeared, and severe right facet hypertrophy. There is mild to moderate central and moderate to severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, ligamentum flavum thickening, and mild left facet hypertrophy. There is minimal central and moderate bilateral neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex eccentric to the right and mild bilateral facet hypertrophy. There is slight flattening of the anterior right hemicord without intrinsic cord signal abnormality. There is mild left neural foraminal and moderate right neural foraminal stenosis.

Output: 1.C2/3: Mild right neural foraminal stenosis.2.C3/4: Posterior osteophyte disc complex, prominent in the midline, abuts and deforms the anterior cord. This is associated with focal cord atrophy and intrinsic T2 hyperintense abnormality most consistent with myelomalacia.3.C4/5: Posterior osteophyte disc complex, ligamentum flavum thickening with mineralization, bilateral uncinate hypertrophy, severe left facet hypertrophy, and moderate right facet hypertrophy combine to result in cord deformation associated with intrinsic T2 hyperintensity and moderate to severe central stenosis. There is also severe left neural foraminal and moderate to severe right neural foraminal stenosis.4.C5/6: Mild to moderate central and moderate to severe bilateral neural foraminal stenosis.5.C6/7: Minimal central and moderate bilateral neural foraminal stenosis.6.C7/T1: Mild left neural foraminal and moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis and paresthesias. Brain: There is no significant interval change in the number and extent of the multiple T2 hyperintense supratentorial and infratentorial white matter lesions, many of which also display low T1 signal. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No significant interval change in the intracranial demyelinating lesions.2. No convincing evidence of cervical spinal cord demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Ms. Szynal is a 55-year-old female with a personal history of right breast mastectomy in 2012 for DCIS, now presenting with new left breast cancer of ILC/LCIS. Family history of breast cancer in paternal grandmother. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left upper outer breast, posterior depth, there is an irregular enhancing mass identified measuring 1.4 x 1.2 x 1.5 cm (AP times mL times SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this lesion, compatible with biopsy-proven malignancy.Seen approximately 1.5 cm anteromedially, is an additional irregular enhancing mass measuring 2.0 x 1.5 x 1.6 cm. This is suspicious for an additional area of malignancy.RIGHT BREAST: The patient is status post right breast mastectomy. No abnormal enhancement is seen in the right reconstructed breast.No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Biopsy-proven malignancy of the left upper outer breast with appropriate clip placement.(2) Additional suspicious enhancing mass is seen anteromedial to the biopsy-proven malignancy. If breast conservation therapy is desired, then an MR directed ultrasound is recommended in order to find a sonographic correlate and subsequently biopsy the correlate. If no sonographic correlate is identified, then an MR guided biopsy may be required.(3) No MR evidence of malignancy in the right reconstructed breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Clinical question: 24-year-old male with metastatic Ewing sarcoma, persistent headaches, evaluate for progression of Ewing's, brain abscess or other pathology. Signs and symptoms: Headaches Nonenhanced CT of brain:Examination demonstrate a large extra-axial mass of high density in the right posterior parietal region with associated lytic changes of inner table of the skull (axial images 35 through 38) the mass causes significant mass effect and buckling of the cortex. At this level there is also a large extracranial high-density mass which measures approximately 62 mm times 30 mm in size. This finding is also associated with some irregularity of the outer table of the skull. Considering the provided clinical history of Ewing sarcoma this finding is highly suspected of a metastatic lesion to the calvarium with intracranial and extracranial spread of tumor.There is evidence of associated edema of brain parenchyma adjacent to this finding (axial images 29 through 34). The extra-axial mass has higher density than brain parenchyma and on a few of the images appears like a subdural hematoma. Further evaluation with an enhanced MRI of brain is highly recommended.There is no evidence of parenchymal hemorrhage, hydrocephalus or midline shift.Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: Lytic changes of the inner and outer cortex of right parietal bone with associated large high density mass in the extra-axial intracranial space and within the soft tissues of the scalp. Finding is highly suspected of osseous metastatic lesion with both intracranial and extracranial spread. The combination of these masses measures approximately 40 mm in thickness and 85-mm in longus cranial slice cephalad axis (coronal reformatted image 47). There is evidence of mass effect on the brain parenchyma and vasogenic edema. No midline shift or hydrocephalus.Above findings were discussed with Dr. Gornli Jerome pager number 2841 at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Please note that a brain fusion protocol was ordered and performed, although the clinical indication and EMR notes suggest that perhaps a complete standard brain MRI was desired.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal T2 signal or pathological enhancement. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: Unremarkable but limited MR brain with fusion protocol. Please note that many conventional sequences are not obtained with this protocol, and if a complete MR evaluation is clinically warranted, the exam should be performed with standard protocol.


Instruction: Generate impression based on findings.

Input: Personal history of NF1. Evaluate left flank plexiform neurofibroma and compare it to previous, also intra pelvic tumors. BONE MARROW: No fractures. Bone marrow signal is within normal limits.SOFT TISSUES: Again seen is a heterogeneously enhancing soft tissue mass in the left lower back centered just above the iliac crest (series 1301, image 41) unchanged in size measuring approximately 6.2 x 11.0 x 4.5 cm (AP x TV x CC) previously measured 6.5 x 11.1 x 4.5 cm. The mass remains somewhat heterogeneous and demonstrates increased T2 signal and decreased T1 signal compared to the adjacent fat. The deep margin of the lesion is indistinct and blends with the underlying fat. The lesion appears separate from the adjacent deep paraspinal and gluteal muscles; the intervening fat planes appear intact. Additional numerous round targetoid T2 hyperintense lesions are present throughout the soft tissues of the abdomen, pelvis and bilateral lower extremities compatible with neurofibromas. An example lesion in the anterior musculature of the right thigh (series 1301, image 13) measures approximately 1.4 x 1.8 cm, (previously 1.3 x 1.8 cm).JOINTS: No significant abnormality noted.ADDITIONAL

Output: 1.No change in size of soft tissue mass centered in the left lower back immediately superior to the left iliac crest measuring 6.2 x 11.0 x 4.5 cm 2.Additional smaller neurofibromas scattered throughout the soft tissues of the abdomen, pelvis and bilateral lower extremities appear similar.


Instruction: Generate impression based on findings.

Input: History of PSC. Evaluate for dominant stricture or lesion. ABDOMEN:LIVER, BILIARY TRACT: Stable narrowing and irregularity of the intrahepatic bile ducts including a focal stenosis at Klatskin's point appearing similar to the prior. No new dominant stricture or focal lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination without dominant stricture or mass lesion.


Instruction: Generate impression based on findings.

Input: 76-year-old male with possible inflammation/mass in pancreatic head as noted on CT 11/23/2015 status post endoscopic ultrasound 12/10/2015 that showed dilatation of the pancreatic duct to 8 mm. Evaluate for pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is mild focal pancreatic ductal prominence measuring up to 8 mm at the pancreatic head, which is most likely age-related; there is tapering of the pancreatic duct at the level of the ampulla of vater. No evidence of a suspicious pancreatic head mass. There is evidence of signal loss on the out of phase images in the pancreatic head consistent with microscopic fat. No abnormal T2 signal or diffusion restriction to suggest pancreatitis.There is appropriate response to secretin stimulation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nonenhancing T2 hyperintense foci compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focal pancreatic ductal prominence at the pancreatic head is most likely age-related. There is evidence of signal loss on the out of phase images in the pancreatic head consistent with microscopic fat. 2.No evidence of a suspicious pancreatic mass with other details as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Smoldering multiple myeloma. Rule out bone lesions. Signs and symptoms: As above. Nonenhanced cervical MRI:Examination demonstrates normal anatomical alignment of vertebral column however with mild straightening of cervical lordosis.There is no detectable foci of marrow signal replacement to suggest multiple myeloma. There is normal signal intensity and caliber of the cervical cord.Moderate disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophy at C5-C6 resulting in moderate bilateral neural foraminal compromise and mild central spinal stenosis. Degenerative changes at C6-C7 results in mild bilateral neural foraminal compromise and no central spinal stenosis.Nonenhanced thoracic MRI:Examination demonstrates a focus of T1 hyperintense, T2 hypointense and minimally T2 STIR hyperintense involving the dorsal aspect of vertebral body of T4 and extending into the left pedicle and left inferior facet. The signal changes of the findings are suggestive of a focus of fatty deposit or a capillary hemangioma. There is no evidence of destructive changes of the bone. Follow-up with CT is recommended for further assessment.The signal intensity and the alignment of the vertebral column is otherwise within normal and without finding to suggest multiple myeloma. The signal intensity and caliber of the thoracic cord is within normal. There is no evidence of spinal canal or neural foraminal compromise/stenosis at any level.Nonenhanced lumbar MRI:There is no detectable focus of signal abnormality of the vertebral column to suggest multiple myeloma.There is a well-demarcated round focus of T1 hyperintense, 2 hyperintense and minimally hyperintense on T2 STIR in the left lateral aspect of L1 vertebrae. On axial T2 weighted images there are multiple tiny internal foci of hyperintensity within this finding which is suggestive of a skeletal capillary hemangioma.The alignment and signal intensity of vertebral column is otherwise unremarkable. Mild degenerative changes of the lumbar spine are noted however without evidence of spinal stenosis or definitive neural foraminal compromise at any level. Mild facet effusion on the left at L4-L5 is noted.

Output: 1.Nonenhanced MRI of cervical spine demonstrate no evidence of multiple myeloma. Degenerative changes at C5-C6 and C6-C7 level with resulting mild central spinal stenosis and neural foraminal compromise as detailed above. Normal signal intensity and caliber of cervical cord.2.Nonenhanced MRI of thoracic spine demonstrate a well-demarcated focus of T1 hyperintense, T2 hyperintense and minimally hyperintense T2 and STIR involving dorsal aspect of the vertebral body of T4 and left pedicle/articulating facet highly suggestive of a hemangioma. Unremarkable exam otherwise and without convincing evidence of multiple myeloma.3.Nonenhanced MRI of lumbar spine demonstrate a round well-demarcated focus of marrow signal replacement highly suggestive of a capillary skeletal hemangioma and unremarkable otherwise for multiple myeloma. Mild degenerative changes however without spinal stenosis or convincing evidence of neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Syncope. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a subcentimeter left pons focus of susceptibility effect that corresponds to calcification on CT. There is focal right pons and periventricular frontoparietal white matter T2 hyperintensity. The ventricles and sulci are dilated due to cerebral volume loss. There is a partially empty sella. There is no midline shift or herniation. Partial loss of flow void in the V4 segment of the left vertebral artery correlates with the proximal stenosis described on the recent CTA. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the ethmoid sinuses and left mastoid air cells. The retrodental pannus moderately narrows the upper cervical spinal canal. There is also a posterior disc-osteophyte complex at C3-4 that abuts the spinal cord.

Output: 1.No evidence of acute intracranial hemorrhage or acute infarct.2.A subcentimeter left pontine lesion may represent a chronic calcified hemorrhage or cavernous malformation.3.Moderate cerebral and pontine white matter chronic microvascular ischemia and moderate brain volume loss, with slight frontotemporal predominance.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42] / Tinnitus, bilateral [H93.13], Reason for Study: ^Reason: Persistent tinnitus (pulsatile) and vertigo. Evaluate for vascular abnormality or schwannoma History: Persistent tinnitus (pulsatile) and vertigo. Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Considering the patient's symptom (pulsatile tinnitus), potential vascular lesions include dural arteriovenous shunts which cannot be excluded with MR angiography. Thus, if clinically indicated, diagnostic catheter angiography can be considered.

Output: 1. Normal brain MRI2. No evidence of arterial aneurysm, stenosis or vascular malformation.Comment: Diagnostic catheter angiography can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Fatigue and numbness, MS protocol There is a subtle focus of T2 hyperintensity and volume loss involving the cervical cord at the left ventral C3 level, seen on the STIR, axial T2, and axial proton density sequences suspected to be related to chronic demyelinating plaque. A second left lateral cord lesion is suspected at C3-C4 which is seen on the sagittal STIR as well as prior 3-D FLAIR brain sequence. Subtle T2 hyperintensity involving the right ventral aspect of the cord C5 level is also suspected which is seen on the sagittal T2, STIR, and axial T2 sequences.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from mild loss of cervical lordosis. Bone marrow signal is benign. Mild degenerative changes including a small central disc protrusion at C5-C6 as well as a small right paracentral disc extrusion at the C6-C7 level. There is no significant spinal canal or neural foraminal stenosis at any level. There is no abnormal enhancement in the cervical spine.

Output: There are three small cervical cord lesions without enhancement which are favored to represent chronic demyelinating plaques.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment. Mild loss of disc height and minimal desiccation of the T11-12 disc, otherwise the vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is multilevel mild facet arthropathy in the lower thoracic spine.At T9-10 there is bilateral paracentral annular fissuring/small disc protrusions. There is no significant neural foraminal or central spinal stenosis.At T10-11 there is a far left lateral protrusion. There is no significant neural foraminal narrowing or spinal canal stenosis.At the remaining levels there is no significant disk bulge, herniation, spinal canal or foraminal stenosis.

Output: Bilateral paracentral annular fissuring/small protrusions at T9-10, and far left lateral protrusion at T10-11. No significant neural foraminal narrowing or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 66-year-old male with prostate cancer. Planning confirmatory biopsy for active surveillance.Additional history per EMR:PSA 5.7 (March 2015)TRUS-guided prostate biopsy (May 2015) 1 of 12 cores positive for prostatic adenocarcinoma, left lateral apex, Gleason 3+3=6, <1mm (5% of submitted tissue) PELVIS:PROSTATE:Prostate Size: 4.5 x 4.2 cm.Peripheral Zone: No suspicious lesion is identified within the peripheral zone.Central Gland: The transitional zone is enlarged containing several nodules demonstrating benign morphology without suspicious characteristics.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No candidate lesion identified on imaging for patient's known prostatic adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with status epilepticus, history of epilepsy, new dysphagia requiring PEG. Brain: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. No pathologic intracranial enhancement is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Moderate fluid signal is present within the right mastoid air cells. The paranasal sinuses are grossly clear.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is no pathologic enhancement in the cervical spine within limits of motion artifact. No high-grade spinal canal or neural foraminal stenoses are identified in the cervical spine.There are mild multilevel degenerative changes in the cervical spine, most prominent at C4-5. Small disc osteophyte complexes are present at C3-4 and C4-5 without significant spinal canal stenosis. Right uncal vertebral hypertrophy and facet arthropathy results in mild to moderate right and mild left neural foraminal narrowing at C4-5.A partially imaged soft tissue mass is present in the left supraclavicular region with heterogeneous signal and questionable enhancement. The imaged portion measures up to 2.4 cm. This was also seen on the outside CTA of the neck. A normal thyroid gland is not visualized.

Output: 1. Normal MRI appearance of the brain, specifically no seizure focus identified.2. No cervical spinal cord compression, abnormal spinal cord signal or pathologic intradural enhancement.3. Incidental partially imaged left supraclavicular mass measuring up to 2.4 cm. Correlation with outside imaging or dedicated imaging of the neck is suggested.4. Fluid signal in the right mastoid air cells may be inflammatory.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 16 year old female with sickle cell disease. Headache. There is no evidence of intracranial hemorrhage, mass or edema. Slight prominence of the sulci in the right frontoparietal region and small areas of hypoattenuation in the right centrum semiovale are consistent with known prior strokes in this region as visualized on the MRI dated 4/1/2009. As with all CT findings of prior stroke, superimposed acute stroke cannot be entirely excluded.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: Sulcal prominence and white matter hypoattenuation in the right frontoparietal region consistent with known prior stroke as detailed above.


Instruction: Generate impression based on findings.

Input: History of CVA and cognitive impairment. There is no evidence of restricted diffusion to suggest acute ischemia. Again seen is encephalomalacia involving the right occipital lobe with associated ex vacuo dilatation of the right atrium and occipital horn. There are multiple areas of chronic infarcts in the bilateral cerebellum, right thalamus, unchanged. There is bilateral cerebral periventricular white matter T2/FLAIR hyperintense lesion most likely, related to chronic small vessel ischemic changes. There is partial volume loss at the level of left caudate head, unchanged. There are several foci of susceptibility in the region of right occipital lobe encephalomalacia related to chronic microhemorrhage.There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the left more than the right ethmoid sinus and the left frontal sinus.

Output: 1. No evidence of acute ischemia.2. Stable encephalomalacia in the right occipital lobe, chronic infarcts in the bilateral cerebellum and right thalamus, mostly along the posterior circulation. 3. Moderate chronic small vessel ischemic changes and chronic infarct in the head of caudate nucleus, unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate arachnoid cyst for change. Compare with previousSigns and Symptoms: Arachnoid cyst The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an 11 x 9 mm axial dimension cystic lesion in the left middle cranial fossa anteriorly which has not changed in dimensions when compared to the previous exam. It is associated with some scalloping of the adjacent sphenoid bone.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.

Output: Stable small left middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 43-year-old female. Crohn's disease, status post complete colectomy with ileostomy. Report from outside hospital shows a 3 x 3 cm mass containing gas adjacent to ileostomy compatible with probable abscess. Pus from JP drain. Evaluate for abscess. Evaluate for new fistula. ABDOMEN: LUNG BASES: No significant abnormality noted. LIVER, BILIARY TRACT: No significant abnormalities seen within the liver or gallbladder. SPLEEN: No significant abnormality noted. KIDNEYS, URETERS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted. PANCREAS: No significant abnormality noted. Prominent pancreatic duct is unchanged.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes. Small mesenteric nodes identified as well. Several mildly enlarged nodes adjacent to ostomy site are probably reactive. BOWEL, MESENTERY: There is a percutaneous drain in the anterior abdominal wall which has resolved the loculated fluid collection in the subcutaneous fat at the site of the ileostomy. No new abscess. BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted. PELVIS: UTERUS, ADNEXAE: Patient is status post hysterectomy. There is a 2.6 x 3.7 cm cystic mass in the right adnexa (image 109/150 series number 3). This is this was present on the prior examination and it appears slightly smaller. If indicated the mass may be further evaluated with transvaginal ultrasound or MRI. The left adnexa is unremarkable. BLADDER: Unremarkable LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Right lower quadrant ileostomy is present compatible with patient's known Crohn's disease and total colectomy. Stable multiple loops of small bowel with wall thickening in the pelvis. No intraperitoneal abscess and no bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No other significant abnormality was found.

Output: 1. Status post colectomy with right lower quadrant ileostomy. Status post drainage of abscess lateral to ostomy site. Thickening of pelvic small bowel loops is stable. No new abscess or fistula. 2. Stable right adnexal mass. If indicated, transvaginal ultrasound or MRI would be helpful in further evaluating this lesion.


Instruction: Generate impression based on findings.

Input: Reason: ? Meniscal injury History: knee pain. MENISCI: Complex tear of the medial meniscus including a horizontal component through the body and oblique components through the posterior horn that extend to the femoral and tibial articular surfaces.The lateral meniscus is intact without discrete tear.ARTICULAR CARTILAGE AND BONE: Diffuse thinning of the medial compartment with full-thickness defect involving the weightbearing portion of the medial tibial plateau with underlying mild bone marrow edema. Moderate thinning of the lateral compartment. Full-thickness thinning of the lateral trochlea and lateral facet of the patella. Moderate thinning of the medial facet of the patella and near full-thickness thinning of the medial facet of the trochlea.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex tear of the medial meniscus as described above.2.Severe osteoarthritis as described above.3.Moderate joint effusion.4.Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, history of right ethmoid cancer status post chemoradiation. Redemonstrated are findings compatible with sinonasal tumor resection and bilateral frontal craniotomy. Thick enhancing tissue along the ethmoid roof and subjacent to the frontal craniotomy is unchanged. Mild soft tissue thickening and enhancement along the right lamina papyracea, and extending along the walls of the right maxillary sinus, has also not significantly changed.No evidence of any destructive or masslike lesion is seen in the ethmoid operative bed. Since the prior examinations, peripheral mucosal thickening and enhancement has increased within the left sphenoid sinus, but this enhancement conforms to the sinus wall and shows no evidence of invasion. Nonenhancing secretions are also evident within the left sphenoid sinus.Mild postoperative encephalomalacia affects the inferior frontal lobes along the operated ethmoid roof similar to prior. A few additional scattered small foci of nonspecific T2 hyperintensity are seen in the brain parenchyma without significant interval change.No evidence of parenchymal edema or mass effect is seen. No new or pathologic intracranial enhancement is detected. No evidence of significant intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricular system is patent and normal in size.

Output: 1. Stable postoperative findings compatible with sinonasal tumor resection. Enhancing soft tissue along the reconstructed ethmoid roof and subjacent to the frontal craniotomy is likely postsurgical in nature and not significantly changed.2. Mild increase in sphenoid sinus mucosal thickening is most likely inflammatory in nature.3. No new brain lesions and no evidence of brain parenchymal metastases.


Instruction: Generate impression based on findings.

Input: , trouble speaking. Unspecified chest pain. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal. Considering provided clinical data follow-up with an MRI is recommended.Calvarium, visualized orbits, paranasal sinuses and mastoid air cells are unremarkable.

Output: Unremarkable nonenhanced CT brain and calvarium.


Instruction: Generate impression based on findings.

Input: Male, 31 years old, with oligodendroglioma, 1p19q co-deleted, surveillance imaging. A region of T2 hyperintense, nonenhancing parenchymal thickening is again seen involving the left superior and middle frontal gyri. Evidence of prior biopsy of this lesion is seen including visualization of the biopsy trajectory and placement of a titanium marker.There has been no significant interval change in the size or geographic extent of this lesion. As before, signal abnormality extends to the left body of the corpus callosum but does not cross to the contralateral side.No new parenchymal lesions are seen. No pathologic parenchymal or extra-axial enhancement is observed. The ventricular system is normal in size and morphology. A mucous retention cyst is unchanged in the left sphenoid sinus.

Output: No significant progression of the left frontal lobe tumor.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a small focus of increased marrow signal intensity affecting the lateral tibia near the epiphysis best seen on images 24 and 25 of series 901 and image 7 of series 1001. No discrete fracture line is appreciated on T1-weighted imagesLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Abnormal marrow signal affecting the proximal tibiofibular joint which may relate to contusion or early degenerative changes. The knee is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Concern for stenosis, myelopathy with abnormal reflexes. There is a small eccentric left disc protrusion at C5-6 with mild narrowing of the neural foramen, but no significant spinal canal stenosis. There is no significant neural foraminal or spinal canal stenosis at the other levels of the cervical spine. There is straightening of the cervical spine alignment in the sagittal plane, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. However, the thyroid gland is mildly enlarged diffusely and contains a subcentimeter left lobe nodule.

Output: 1. A small eccentric left disc protrusion at C5-6 results in mild narrowing of the neural foramen, but no significant spinal canal stenosis. 2. The thyroid gland is mildly enlarged diffusely and contains a subcentimeter left lobe nodule, all of which is nonspecific. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 10 years Female (DOB:7/25/2005)Reason: daily headaches. History: daily headachesPROVIDER/ATTENDING NAME: CAROL J. MACMILLAN CAROL J. MACMILLAN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no intracranial mass lesion to explain the patient's headaches.


Instruction: Generate impression based on findings.

Input: Reason: meniscus degen History: pain MENISCI: A complex tear affects the posterior horn of the medial meniscus, with horizontal and vertical components. The lateral meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the patellar articular cartilage, without focal defect. There is underlying bone marrow edema within the medial aspect of the lateral patellar facet. The remainder of the articular cartilage is unremarkable.LIGAMENTS: The anterior collateral ligament is not visualized, consistent with complete tear. The posterior collateral ligament is unremarkable. The medial and lateral collateral ligament complex are unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complete tear of the anterior collateral ligament.2.Complex tear of the posterior horn of the medial meniscus, with horizontal and vertical components.3.Marked thinning of the patellar articular cartilage without focal defect.


Instruction: Generate impression based on findings.

Input: Clinical question: History of pituitary adenoma. Signs and symptoms: Surveillance scan. Pre and post enhanced pituitary MRI:Examination redemonstrate residual pituitary adenoma within the left lateral aspect of the sella and with extension into the left cavernous sinus and partial encasement of the left internal carotid artery. On coronal post enhanced images the maximum craniocaudal cephalad axis of tumor measures at 23.4 mm which is nearly identical to prior exam. Expanded left cavernous sinus and tumor on the left lateral aspect of the due to measures maximum of 15.3 mm in transverse axis which is also identical to prior study. The caliber of the internal carotid artery remains within normal.There is significant rightward deviation of pituitary stalk which terminates to the right lateral aspect of expanded sella similar to prior exam. There is no detectable mass within the basal cistern. There is inferior herniation of the suprasellar visual complex inferiorly likely as a result of treatment and scarring which also remain similar to prior exam.

Output: 1.Stable size, signal intensity and extent of residual pituitary adenoma within the left lateral aspect of sella and with extensive extension into the left cavernous sinus as detailed.2.Adhesion of the pituitary stalk to the right lateral wall of expanded sella similar to prior exam.3.Inferior herniation of the suprasellar visual complex as result of treatment remain similar to prior study as well.


Instruction: Generate impression based on findings.

Input: Male, 13 years old, with left frontal cortical dysplasia and intractable epilepsy. Functional MRI for surgical planning. Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation and the verb generation paradigms. Language is left dominant. Wernicke's area is identified in its customary location along the posterior aspect of the left superior temporal sulcus. Cortical activation related to Broca's area is present in the left inferior frontal gyrus, primarily the pars opercularis and the pars triangularis. This activity is well removed from the patient's left frontal focal cortical dysplasia.

Output: Successful functional MRI for language mapping. Language is left dominant. Broca's and Wernicke's areas are identified in their customary locations. Activity related to Broca's area is well removed from the patient's left frontal cortical dysplasia.


Instruction: Generate impression based on findings.

Input: 38 year old with family history of breast cancer in her mother and aunt. Known fibroadenoma in the left breast. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Non-enhancing mass, which is known fibroadenoma, is present at lower outer quadrant in the left breast, measuring 22 x 19 x 12 mm (AP x LR x CC). A metalic artifact is present in the posterior 6:00 position.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Intraosseous meningioma post resection: 3 month follow up. There are postoperative findings related to left parietal cranioplasty. There is no evidence of gross tumor in the surgical bed or adjacent calvarium. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of susceptibility effect in the bilateral parietal lobes. There is minimal scattered nonspecific cerebral white matter T2 hyperintensity. 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. There are bilateral lens implants. There is fluid within the left sphenoid sinus.

Output: 1. Postoperative findings related to left parietal cranioplasty without evidence of gross tumor in the surgical bed or adjacent calvarium.2. A few punctate foci of susceptibility effect in the bilateral parietal lobes may represent chronic microhemorrhages. 3. Possible acute sinusitis.


Instruction: Generate impression based on findings.

Input: Reason: Pt w/ diffuse rash and Upper and Lower extremity swelling and pain c/f dermatomyositis History: Distal Upper/Lower extremity weakness, pain, edema There are bilateral findings of diffuse edema in all of the visualized muscles consistent with the patient's history of dermatomyositis. There is no evidence of any significant fatty muscle atrophy. Bone marrow signal intensity is within normal limits.

Output: Diffuse muscular edema without evidence of significant muscle atrophy. No abnormal bone marrow signal intensity.


Instruction: Generate impression based on findings.

Input: Small hepatic nodule with history of cirrhosis. Rule out progression. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There is mild hepatomegaly. Hepatic steatosis is noted. The liver enhances homogeneously without focal lesion, including in the location of the previously suggested hepatic nodule on CT. Gallbladder is unremarkable.SPLEEN: Moderate splenomegaly.PANCREAS: Pancreas is unremarkable.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: The kidneys enhance symmetrically without focal lesion. No hydronephrosis or ureteronephrosis. RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The bowel is normal in caliber without evidence of obstruction or ileus. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology without focal lesion identified.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain Grade 1 anterolisthesis of L3 on 4 and L4 on 5. Relatively preserved vertebral body heights with severe disc space and degenerative changes L3 distally. Moderate scoliosis

Output: Limited evaluation with severe degenerative changes of the lower lumbar spine with pronounced anterolisthesis of what appears to be L3-4 and L4-5 I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 6 year old with juvenile pilocytic astrocytoma receiving vinblastine - any signs of progression? History: JPA. Postsurgical findings in the right posterior fossa appear similar to the prior exams. There is redemonstration of a predominantly extra-axial soft tissue mass at the right cerebellopontine angle measuring approximately 3.4 x 1.9 cm (801/20), previously 3.4 x 1.7 cm. The tumor is stable in extent, encasing the basilar and vertebral vertebral arteries, extending into Meckel's cave and the right internal auditory canal, and tracking along the posterior lateral aspect of the spinal cord beyond the inferior slice of the MRI. Cystic components more inferiorly are unchanged in size. There is decreased FLAIR signal intensity with overall increased heterogeneous appearance on this sequence, likely reflecting treatment-related changes. Postcontrast images show no significant enhancement within the lesion. There is persistent significant mass effect on the leftward displaced lower brainstem and upper cervical cord, with slight increased visualization of the foramen of Magendie compared to remote comparisons.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are stable in size and configuration. A right parietal ventriculostomy catheter is unchanged in position with its tip in the midline. There is no midline shift or herniation. The major cerebral flow voids are intact. There has been resolution of severe mucosal thickening of the maxillary sinuses.

Output: No significant interval change in size of a predominantly extra-axial posterior fossa juvenile pilocytic astrocytoma, although with interval increased heterogeneity on FLAIR with overall decreased FLAIR hyperintensity, which likely reflect posttreatment changes.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other intervertebral disc degeneration, lumbar regionClinical question: herniated disk? spinal stenosis? facet inflammation?Signs and Symptoms: LBP radiating to BLE 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 bilateral facet and ligamentum flavum hypertrophy present associated with some effacement of the fat at the lateral recesses bilaterally and encroachment of the nerve roots at the lateral recesses.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with moderate bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of fat at the lateral recess at this level. Overall there is a mild degree of spinal stenosis present.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.There is a partially visualized cystic lesion in the pelvis which is bright on T2 and intermediate signal on T1. It measures 50 x 36 mm axial dimensions but is not entirely included on this exam appears to extend into the pelvis. It is adjacent to the right common iliac artery and vein one possibility is these represent ovarian lesions.

Output: 1.There is a cystic pelvic lesion present which is not entirely included on this exam. Additional imaging may be useful. It could be ovarian or GI in origin.2.There is encroachment of the nerve roots at the lateral recesses bilaterally at L5-S1 due to facet hypertrophy.3.There is mild spinal stenosis at L4-5 due to degenerative changes.At the time of this dictation an alphanumeric page as well as an email were sent to Dr. Shaan SUDHAKARAN regarding the above findings.


Instruction: Generate impression based on findings.

Input: A few sequences are motion degraded. Given this caveat:There is asymmetric increased enhancement of the descending (a.k.a. mastoid) portion of the left facial nerve. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There is asymmetric increased enhancement of the descending (a.k.a. mastoid) portion of the left facial nerve, suggestive of neuritis, consistent with the provided history of left facial palsy.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with GBM. Pretreatment. Compare to outside MRI. Please note that comparison is limited to postcontrast images as the prior examination contains only postcontrast and perfusion sequences.Findings are demonstrated compatible with left parietal craniotomy and tumor resection. An extra-axial fluid collection measuring up to 6 mm in thickness is evident subjacent to the craniotomy appearing similar to the prior examination.The left parietal lobe resection cavity also appears similar in size to that seen on the prior exam. The cavity contains a heterogeneous mixture of likely fluid and blood product. Diffusion restriction within the cavity likely represents viscous debris and/or the effect of blood product. No evidence of definite enhancement is seen above and beyond the intrinsic T1 hyperintensity of this blood product and some T1 hyperintense rimming of the surgical cavity. Ill-defined T2 hyperintensity extends into the parenchyma surrounding the resection cavity, particularly inferiorly within the periatrial region. No abnormal enhancement or mass effect is seen in this location.Within the left frontal operculum, a region of mildly T2 hyperintense, diffusion restricting, and nearly solidly enhancing tissue is evident measuring up to 31 x 23 mm in the axial plane, increased from the prior examination where it measured at most 21 x 16 mm.Minimal periatrial T2 hyperintensity is seen on the right. No other significant areas of parenchymal signal abnormal are detected. No other pathologic parenchymal or extra-axial enhancement is seen. The ventricular system is stable and within normal limits for size.

Output: 1.Stable left parietal lobe resection cavity containing a heterogeneous mixture of fluid and blood product. No clear evidence of suspicious nodular tumor or pathologic enhancement is seen within or around this cavity.2.Since the prior examination, a remote site of tumor involvement within the left frontal operculum has increased in size.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with right-sided weakness and dysarthria. Patchy periventricular T2 hyperintensity is again seen without significant interval change since the prior examination. No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected.There is no evidence of any acute intracranial hemorrhage or abnormal extra-axial fluid collection. A vaguely serpiginous, hemosiderin stained lesion with surrounding T2 hyperintensity in the medial left temporal lobe is unchanged from prior examinations and dates back at least to 2005.Volume loss of the cerebellum, out of proportion to the cerebral hemispheres, is also a stable finding. The ventricular system is within normal limits.

Output: 1.No evidence of acute ischemia or any other acute intracranial abnormality.2.Chronic small vessel ischemic disease.3.Stable lesion within the medial left temporal lobe which may represent a vascular malformation.4.Stable cerebellar atrophy.


Instruction: Generate impression based on findings.

Input: Male 48 years old with metastatic renal cancer, on everolimus, assess for progression. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 18 cm in craniocaudal dimension. A few subcentimeter T2 hyperintensities are stable and most likely represent cysts. No new or suspicious hepatic lesion. No cholelithiasis, biliary ductal dilatation or ascites.SPLEEN: The spleen measures 10 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post total resection of the left moiety and partial resection of the right moiety of the horseshoe/cross fused ectopic kidney. Mild soft tissue irregularity along the medial margin of the right lower pole (series 11, image 41) is stable and nonspecific but favored to reflect treatment changes. A cyst in the right lower pole adjacent to the resection margin has decreased in size.Anterior and inferior to the right renal vessels is in an amorphous area of enhancement and stranding seen best on subtraction images which, in retrospect, appears similar to the previous exam and may represent post treatment changes and fat necrosis (favored) although minimal residual tumor is not excluded. This is visibly improved when compared to the exam from 11/13/2015. There is nonspecific flow artifact versus adherent, nonenhancing thrombus in the IVC (series 9, image 412).RETROPERITONEUM, LYMPH NODES: The previously described mass abutting the third portion of the duodenum described on previous reports series is favored to represent a lymph node which has decreased in size measuring 2.0 x 1.1 cm (series 9, image 136).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left basilar airspace opacity is new. Please refer to the separately dictated report for same day chest CT.

Output: 1.No discrete measurable tumor. When compared to most recent prior imaging, stable appearance of amorphous enhancement and stranding along the of the right kidney which is favored to represent posttreatment changes and fat necrosis, although small residual tumor is not excluded. Continued follow up recommended.2.Nonspecific flow artifact versus adherent, nonenhancing thrombus in IVC.3.No new sites of disease.


Instruction: Generate impression based on findings.

Input: 32-year-old male with history of ulcerative colitis with elevated LFTs and concern for primary sclerosing cholangitis. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. The gallbladder remains distended measuring 5 cm. There is smooth tapering of the very distal common bile duct near the level of the ampulla which raises suspicion for a distal common bile duct stricture. The common bile duct measures up to 9 mm with mild intrahepatic biliary ductal prominence; this finding is unchanged compared to the previous examination. No specific evidence of intrahepatic biliary ductal irregularity or stricturing.Hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydroureteronephrosis. The kidneys enhance symmetrically.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.Findings raise suspicion for distal common bile duct stricture near the level of the ampulla. 2.No intrahepatic biliary ductal dilatation or irregularity.


Instruction: Generate impression based on findings.

Input: Right amydohippoampal laser ablation in January: 3 month follow up.. There is encephalomalacia and peripheral linear hemosiderin staining associated with the laser ablation zone involving the medial portions of the right hippocampus and posterior amygdala. There is also mild linear T2 hyperintensity along the right transfrontal prior probe track. The left hippocampus appears unremarkable. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Expected postoperative findings related to right amydohippoampal laser ablation.


Instruction: Generate impression based on findings.

Input: Medial right knee pain MENISCI: There is increased globular signal within the anterior horn of the lateral meniscus however there are no distinct linear components extending to the articular surface to suggest the presence of a tear. The medial meniscus demonstrates extensive branching signal with extension to the inferior articular surface reflecting a complex tear of the posterior horn and body.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage, medial greater than lateral, however no discrete focal defect is identified.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tearing of the medial meniscus involving the posterior horn and body. There is degenerative signal within the anterior horn of the lateral meniscus which is otherwise intact.2. Mild to moderate cartilage thinning of the knee most notable in the medial compartment. No discrete full-thickness defect is identified.


Instruction: Generate impression based on findings.

Input: 35-year-old with known right breast cancer on I-SPY protocol. MRI #3. Evaluate response to neoadjuvant chemotherapy. Redemonstration of a large anterior right breast mass with central necrosis. The necrotic cavity extends to the skin surface and the previously present central fluid has decompressed through a defect in the skin. The residual mass now measures 2.1 x 3.0 x 2.9 cm (AP by transverse by CC), previously 6.5 x 4.9 x 5.2 cm. There are 2 dominant enhancing nodules felt to reflect the larger peripheral nodular components of the primary mass noted previously. The medial enhancing nodule measures 16 mm while laterally it measures 10 mm in maximum dimension, previously 13 mm and 9 mm.The posterior satellite enhancing masses are no longer clearly separable from the main mass. There is associated anterior skin thickening and enhancement compatible with tumor involvement.Scattered benign enhancing foci within the left breast are not significantly changed.The biopsy-proven metastatic right axillary lymph node measures 1.9 x 2.0 cm (previously 2.4 x 1.6 cm). An additional enlarged enhancing lymph node located more posteriorly measures 1.7 x 1.5 cm (previously 1.6 x 1.3 cm).There are innumerable enhancing lesions within the liver compatible with metastases. These are increased compared to the prior MRI, but this is grossly similar to the CT chest performed on 9/8/2015 accounting for differences in technique.

Output: 1. Interval decompression of the central necrotic core of the primary right breast mass resulting in significant reduction in size and change in the mass morphology which limits comparison measurements. Best comparisons are provided. 2. Minimal interval reduction in size of metastatic right axillary lymph nodes with measurements provided.3. Innumerable enhancing metastatic lesions within the liver grossly similar to recent CT chest accounting for differences in technique.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 73-year-old female with history of pancreatic lesions. Evaluate for abnormalities. ABDOMEN: Susceptibility artifact from spinal hardware limits evaluation.LIVER, BILIARY TRACT: Stable hepatic cysts. Cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Scattered T2 hyperintense foci throughout the pancreas, some of which appear to be connected to the pancreatic duct, likely side branch IPMNs. No appreciable enhancement or nodularity within these lesions. Reference pancreatic body lesion measures 1.8 x 1.3 (series 4, image 26), unchanged. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Susceptibility artifact from spinal hardware limits evaluation of the kidneys. Stable renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from spinal hardware. OTHER: Stable subcentimeter right lateral breast 8 mm nodule.

Output: 1.Stable likely side branch IPMNs in the pancreas.2.Stable redemonstrated 8 mm nonspecific enhancing nodule in the right lateral breast.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within anterior ethmoid air cells, otherwise the paranasal sinuses and mastoid air cells are clear.Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities or masses identified within the medial temporal lobes on either side. Incidental note is made of a right choroidal fissure cyst. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: Incidental note is made of a right choroidal fissure cyst, otherwise negative MRI of the brain. Specifically, there are no MRI findings to explain the patient's seizures.


Instruction: Generate impression based on findings.

Input: History of subependymoma status post resection: surveillance. There are unchanged postoperative findings related to right transcallosal resection of a right lateral ventricular tumor with confluent T2 hyperintensity in the right frontal lobe and anterior corpus callosum, which may represent encephalomalacia and gliosis. There is no evidence of residual or recurrent tumor. The ventricles are unchanged in size and configuration. There are a few unchanged nonspecific punctate foci of highT2 signal in the cerebral white matter, but no evidence of acute intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Stable postoperative findings without evidence of residual or recurrent subependymoma.


Instruction: Generate impression based on findings.

Input: 52-year-old male with chronic renal insufficiency presents with two weeks of abdominal pain, vomiting, diarrhea. Lack of intravenous contrast is noted to lower the sensitivity for detection of solid organ pathology.ABDOMEN:LUNG BASES: Bi-basilar scarring or atelectasis. Several prominent paraesophageal and paradiaphrgmatic prominent lymph nodes are appreciated, the largest measures 1.5 in length and is unchanged.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Marked fat replaced atrophy of the pancreas is notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild diffuse perinephric fat stranding is seen bilaterally, likely product of chronic renal medical disease. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: A few scattered subcentimeter mesenteric lymph nodes are also identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: A single bladder diverticulum from the posterior-superior aspect of the bladder wall near the right UV junction, may represent a Hutch diverticulum.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is abnormal fat stranding seen involving the proximal portion of the transverse colon in the region of the hepatic flexure. Findings may be seen with an inflammatory, infectious, or possibly ischemic etiologies. There is diffuse chronic gastric wall thickening which may be due to gastritis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Persistent abnormal fat stranding in region of hepatic flexure of transverse colon is identified, findings suggestive of an infectious process given acute abdominal pain, differential includes inflammatory or ischemic etiologies.No significant interval change since 9/9/08.


Instruction: Generate impression based on findings.

Input: Contrast enhancing mass lesion in the left frontal lobe measuring 2.9 x 2.3 cm (axial post contrast image 231). Significant associated vasogenic edema with mass effect on the anterior horn of the lateral ventricle and genu of corpus callosum. Mild rightward subfalcine herniation. This lesion extends to the surface of the cortex with mild dural enhancement, likely reactive. There is another lesion in the right cerebellum measuring 1.8 x 2.3 cm (axial post contrast image 67) with mild deformity of the fourth ventricle contour. There is also left parietal lesion measuring 1.1 x 0.8 cm (axial post contrast image 213). There is minimal susceptibility artifact associated with these lesions compatible with minimal blood products. There is also punctate 4-mm lesion in the posterior aspect of the right inferior temporal gyrus at the occipital junction. No evidence of hydronephrosis. Nonspecific mild diffuse low T1 intensity of the bone marrow without discrete enhancing lesion. No evidence of leptomeningeal disease. No extra-axial fluid collection. Contrast enhancement and flow voids of major vessels indicating patency. The imaged paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.

Output: Intracranial metastatic disease with four enhancing lesions as detailed above. The dominant left frontal and right cerebellar lesions have significant associated vasogenic edema and local mass-effect. Mild rightward subfalcine herniation. No transtentorial herniation. No hydrocephalus.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:11/2/1977)Reason: brain lesion History: haPROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a perineal region mass measuring 23 x 18 mm axial dimensions. The lateral ventricles are enlarged . Biventricular diameter is approximately 44 mm on coronal imaging at the level of foramen of Monro previously was approximately 43 mm. This difference of 1 mm within the range of statistical variance. There is mild T2 hyperintensity adjacent to the lateral ventricles which has been stable since the prior exam.The ventriculostomy tract is identified in the right frontal lobeNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbit s are intact.

Output: Examination was performed for the purpose of stereotactic guidance during surgery and is somewhat limited otherwise.. There is a pineal region mass associated with ventriculomegaly. This has not changed since the prior exam.


Instruction: Generate impression based on findings.

Input: Lung cancer and foot drop. There is no evidence of tumors within the lumbar spinal canal. There is mild multilevel lumbar spine degenerative spondylosis, without associated significant spinal canal or neural foraminal stenosis. There is prominent epidural lipomatosis at L5 and S1 through S3. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a subcentimeter sclerotic focus in the left L5 pedicle, which likely represents an enostosis. There are scattered foci of fat in the vertebral bone marrow. There is no evidence of bone marrow metastases. The spinal cord and cauda equina nerve roots display normal signal and morphology. The paravertebral soft tissues are unremarkable. There is an incompletely imaged right renal cyst.

Output: 1. No evidence of lumbar spine metastases.2. Mild multilevel lumbar spine degenerative spondylosis, without associated significant spinal canal or neural foraminal stenosis.3. Prominent epidural lipomatosis at L5 and S1 through S3.


Instruction: Generate impression based on findings.

Input: 23-year-old female with recent injury/fall. Assess for ACL tear. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Numerous intramedullary cortically-based lesions are noted, as seen on prior imaging studies, previously described as nonossifying fibromas. There has been interval decrease in fluid signal intensity and increase in fat signal intensity suggesting some interval healing of these lesions. There are bone contusions identified along the posterior aspect of the lateral tibial plateau and lateral femoral condyle above the anterior horn of the lateral meniscus. An additional contusion is identified along the posterior aspect of the medial tibial plateau. We see no fluid-filled articular cartilage defects.LIGAMENTS: The is a complete rupture of the ACL through its mid to proximal fibers. The PCL appears intact. The lateral collateral ligament and medial collateral ligament appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: ACL tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: 11-year-old male with history of liver transplant in 2007 with 2 different biliary connections, presenting with transaminitis.EXAMINATION: MRCP with IV contrast 10/28/2016 ABDOMEN:LIVER, BILIARY TRACT: Again seen are changes related to liver transplantation. There is biliary ductal dilatation in the right/anterior segment of the hepatic graft which is connected to the recipient common bile duct, as seen previously. There is also chronic atrophy in the liver segment associated with this bile duct. The biliary ducts of the segment connected to the hepaticojejunostomy limb demonstrate mild enlargement (series 13, image 75-77). The underlying liver parenchyma is homogeneous and enhances normally. No definite biliary stricture is identified. Hepatic artery, portal vein branches and hepatic veins and branches are patent.SPLEEN: There is mild splenomegaly.PANCREAS: The pancreas appears normal without pancreatic ductal dilatation or peripancreatic edema.ADRENAL GLANDS: The adrenal glands are normal in appearance.KIDNEYS, URETERS: There is no hydronephrosis or nephrolithiasis. No focal renal mass is identified.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy in the upper abdomen.BOWEL, MESENTERY: Status post findings relating to hepaticojejunostomy. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is basilar atelectasis.

Output: 1.Again seen is chronic atrophy and obstruction of the anterior transplanted liver segment which is anastomosed to the recipient common bile duct. 2.Mild intrahepatic biliary ductal dilatation in the segment corresponding to the hepaticojejunostomy anastomosis. However, the underlying liver parenchyma in this segment enhances homogeneously.


Instruction: Generate impression based on findings.

Input: Pituitary gland is normal in size and demonstrates normal homogeneous enhancement. There is no evidence for pituitary or suprasellar mass. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: No evidence of pituitary abnormality.


Instruction: Generate impression based on findings.

Input: Possible Lewy body dementia: hallucinations, agitation, and dementia. Many of the images are degraded by patient motion. There is patchy periventricular white matter T2 hyperintensity, particular in the bilateral parietal lobes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild diffuse cerebral volume loss without discernible focal atrophy. Nevertheless, a brain PET scan may be useful for further evaluation of Lewy body dementia.2. Nonspecific patchy periventricular white matter T2 hyperintensity, particular in the bilateral parietal lobes may represent chronic small vessel ischemic disease.3. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Metastatic small cell lung cancer treated with WBRT on 9/27/16. There are postoperative findings related to right frontal craniotomy, with underlying confluent high T2 signal with encephalomalacia and susceptibility effect in the right frontal lobe, with an unchanged subcentimeter area of enhancement. Otherwise, there has been interval decrease in size and number of multiple supratentorial and infratentorial lesions and associated vasogenic edema. For example, a left middle frontal gyrus lesion measures up to 6 mm in diameter, previously 12 mm, a right perirolandic lesion measures 12 mm, previously 20 mm, a left cerebellar lesion measures up to 10 mm, previously 14 mm, and a posterior medullary lesion measures 5 mm in diameter, previously 7 mm. Many of the lesions contain hemorrhagic components levels, some of which have evolved. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Overall interval decrease in size and number of multiple intracranial metastases and associated vasogenic edema.2. Postoperative findings related to right frontal craniotomy, with an unchanged nonspecific subcentimeter area of enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post head first fall. Signs and symptoms: lip laceration. Nonenhanced CT of the brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and all CSF cisterns remain within normal.Limited images through the orbits demonstrate no definitive abnormality. No evidence of any soft tissue abnormality in limited view of facial region.On axial image 16 there is a well-demarcated low density in the occipital bone on the left. This is immediately posterior to the left lambdoid suture (image 16 of 40). This finding measures approximately 7 mm in length and 3-mm in thickness. The outer table of the skull at this location is not visualized. There is no associated intracranial abnormality at this location. There may be minimal soft tissue thickening immediately at this level under the scalp. The exact etiology of this finding is not clear. The finding may represent a skull fracture or possibly an intraosseous lesion.Please correlate with physical findings in particular to detect if palpation of this lesion introduces any pain which may indicate a fracture from patient's recent trauma. This finding is visible only on one image and makes precise evaluation very difficult. Follow up exam with an MRI is recommended to evaluate for expansile intraosseous lesion. These findings were relayed to the resident on duty Dr. Yee at the time of interpretation.

Output: 1.No evidence of an acute intracranial finding.2.No definitive evidence of a skull fracture.3.A small foci of lucency within the left occipital bone immediately adjacent to the left lambdoid suture (axial image 16). Please see above comments. Follow up is recommended.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: Seizure protocol 2Signs and Symptoms: new onset seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of cavum septum pellucidum and cavum vergae.A small focus of encephalomalacia is present along the left inferior parietal lobule. Another smaller focus of encephalomalacia is present along the lateral aspect of the left precentral gyrus which is associated with a small focus of susceptibility effect..Normal vascular flow voids are present in the distal carotid and right vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery is not readily identified intracranially. The left posterior inferior cerebellar artery is identified likely a very small left vertebral artery.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening along the right maxillary sinus and frontal sinuses. The visualized portions of the mastoid air cells demonstrate some opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Foci of encephalomalacia are present along the left inferior parietal lobule as well as the lateral aspect of the left precentral gyrus.2.The left vertebral artery is not readily identified intracranially. It is suspected to be hypoplastic.


Instruction: Generate impression based on findings.

Input: 39 years Female (DOB: 9/15/1976)Reason: concussion with evidence of cord involvement. Any cortical damage? History: Wartenberg reflex left hand. Unsteady gait headachesPROVIDER NAME: BARRY G. ARNASON BARRY G. ARNASON MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.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 intracranial hemorrhage or diffuse external injury appreciated on this exam.2.There is no evidence for cervical spinal cord injury. There is no evidence for acute injury to the cervical spine.


Instruction: Generate impression based on findings.

Input: Abdominal pain. Elevated amylase. Previous alcohol use. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No focal hepatic lesions. No biliary ductal dilation. No cholelithiasis or choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Normal anatomy, enhancement, and inherent signal of the pancreas. No pancreatic ductal dilation. No pancreatic mass identified. No peripancreatic fluid collections.ADRENAL GLANDS: The left adrenal gland is not well seen due to the below-described mass. Normal appearance of the right adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is a 4.3 x 4.1 x 4.9 cm well-defined lobulated soft tissue mass anteromedial to the left kidney with nonspecific intermediate T1 and T2 signal and mild enhancement.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 4.9 cm lobulated left retroperitoneal soft tissue mass likely representing lymphoma or metastatic lymphadenopathy, though a primary tumor otherwise is not identified.


Instruction: Generate impression based on findings.

Input: Patient with Li Fraumeni syndrome presents for MRI detected ultrasound of a possible fibroadenoma in the left breast. A targeted left ultrasound was performed for the central left breast area of MRI detected mass. There is a benign appearing area in the left breast 2:00 position measuring 7 x 6 mm. This is oval, avascular, hypoechoic and circumscribed, and may represent a benign area of breast tissue versus a benign morphology mass. Throughout the remainder of the left central breast, no cystic or solid mass was appreciated.

Output: Benign ultrasound appearance, with a questionable ultrasound correlate to the MRI finding. Given the benign ultrasound today, and previous probably benign MRI findings, a six-month follow-up MRI is recommended to ensure stability of the MRI finding.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: 69-year-old female with endometrial cancer. Rule out parametrial involvement. PELVIS:UTERUS, ADNEXA: Extensive irregular endometrial tumor with deep myometrial invasion. Tumor extends through the cervix and is confined within the vagina. No evidence for bulky parametrial invasion. There is bilateral proximal fallopian tube thickening compatible with tumor extension (axial series 1002 images 218, 230).Simple left adnexal cyst measuring 6.2 x 4 cm (series 401 image 33).BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged right common iliac lymph node partially visualized (series 301 image 57).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Extensive endometrial tumor extending to the cervix and into bilateral proximal fallopian tubes. Deep myometrial invasion is noted. No bulky parametrial invasion.2.Partially visualized right common iliac stent noted. Extensive retroperitoneal lymphadenopathy better visualized on the 10/30/2016 CT abdomen and pelvis exam.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.8 x 3.2 x 4.5 cmPeripheral Zone: Anterior mid gland lesion measuring 14 x 8 mm with decreased T2 signal and restricted diffusion (image 88 of series 401).Diffuse linear decreased T2 signal abnormality in the peripheral zone without corresponding restricted diffusion likely benign.Central Gland: Small hyperplastic nodules compatible with BPH.Seminal Vesicles: NormalExtracapsular Extension: The anterior mid gland lesion abuts the capsule but does not invade.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Anterior midgland lesion as above which is highly suspicious for adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Previous septic shock, persistently altered: evaluate stroke. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive cerebral white matter confluent T2 hyperintensity. The ventricles and sulci are diffusely prominent due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is diffuse fluid signal within the bilateral mastoid air cells.

Output: 1. Extensive cerebral white matter confluent T2 hyperintensity is nonspecific, but likely represent the effects of chronic small vessel ischemic disease. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Evaluation for intracranial infection is otherwise limited without intravenous contrast administration.2. diffuse fluid signal within the bilateral mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: Male 40 years old Reason: Assess the topography and severity of chronic myopathy prior to biopsy for genetic testing History: Patient has proximal muscle weakness since pre-teen years, and is slowly progressive Left humerus: Diffuse fatty atrophy of the musculature of the left arm and shoulder. No joint effusion. The bones are unremarkable.Left femur: Diffuse fatty atrophy of the musculature of the left thigh, as well as the right thigh seen on large field coronal view. No joint effusion. The bones are unremarkable.

Output: Severe diffuse fatty muscle atrophy of both the left arm, left thigh, and right thigh.


Instruction: Generate impression based on findings.

Input: 27 year old male with Beckwith-Widemann, HIV, syphillis and aortic stenosis s/p repair presenting for evaluation of aortic regurgitation and left ventricular size and function. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 129 ml/m2 (normal range: 74+/-15), the LVEDV is 260 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 77 g/m2 (normal range 85+/-15), and the LV mass is 155 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 with low normal systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 215 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged in size.Aortic ValveThe aortic valve opens widely and there moderate aortic regurgitation, regurgitation fraction was calculated at 25%.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is borderline in size. The sinus of Valsalva is 37 mm, sinotubular junction is 29 mm, ascending aorta (at 5 cm above aortic annulus), and aortic arch 27 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (31mm x 30mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsEvidence of a sternotomy. 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 moderately dilated with normal systolic function. The overall LV ejection fraction is 55%. 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.2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 48%. 3. Aortic measurements as above, with moderate aortic regurgitation.


Instruction: Generate impression based on findings.

Input: Reason: Hx of atypical meningioma with slowly resolving post-operative changes, surveillance MRI There is redemonstration of diffuse dural thickening and left medial frontal subdural hematoma. The left-sided subdural hematoma has decreased in width from 17 to 6 mm in thickness. There are associated subdural effusions present.There is a redemonstration of small subcortical T2/FLAIR signal hyperintesities at the left precentral and postcentral gyri as well as along the left paracentral lobule. These were present preoperatively.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior examination a left frontal subdural hematoma has regressed in size but has not resolved.2.Patient status post left frontal craniotomy for removal of a meningioma. There are post operative effects redemonstrated. There is no evidence for residual or recurrent tumor on the current exam.