Instruction: Generate impression based on findings.

Input: Clinical question: Mass-effect. Signs and symptoms: Syncope. Has known brain cancer of unclear etiology. Non-infused CT of brain:There is no evidence of hemorrhage, edema mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. Sinusitis of the right maxillary sinus is noted and the rest of the paranasal sinuses are essentially unremarkable.Mastoid air cells and middle ear cavities are well pneumatized and unremarkable. Calvarium is intact.There is no evidence of a mass on this examination as clinically indicated. If clinical concern persist a follow-up with an MRI examination is recommended.

Output: 1.Essentially unremarkable non-infused CT of brain.2.Calvarium is unremarkable.3.Minimal sinusitis as detailed.4.No evidence of mass is detected as clinically is indicated. Porter follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Enlarged orbital muscles: proptosis. Orbits: There is interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior and lateral rectus muscles. There is mild protosis bilaterally, right more than left, which appears to be attributable to diffuse prominence of the orbital fat in addition to the rectus muscle swelling. Otherwise, the bilateral globes, lacrimal glands, and optic nerves bilaterally are intact. There is no evidence of orbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific punctate foci of T2 hyperintensity in the right parietal lobe white matter. The brain, brainstem, and cerebellum otherwise appear unremarkable. There is no abnormal meningeal 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 grossly unremarkable.

Output: 1. Interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior and lateral rectus muscles, which may be related to evolution of an inflammatory process, such as sarcoidosis. Otherwise, mild protosis bilaterally, right more than left, appears to be attributable to diffuse prominence of the orbital fat in addition to the rectus muscle swelling.2. Mild thickening of the pituitary infundibulum may represent an inflammatory process as well, such as sarcoidosis.3. No evidence of intracranial hemorrhage, mass, or acute infarct. Punctate foci of T2 hyperintensity in the right parietal lobe white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example.


Instruction: Generate impression based on findings.

Input: 33-year-old female with cavernous angioma, six-month follow-up. There is an unchanged cavernous malformation that measures up to 9 mm, with an associated developmental venous anomaly in the left frontal lobe, but no surrounding edema. There is also an unchanged focus of increased T2 signal in the posterior right frontal lobe without enhancement or susceptibility effect. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Unchanged left frontal lobe cavernous malformation and associated developmental venous anomaly.2.A persistent small lesion in the posterior right frontal lobe remains nonspecific, but may represent a manifestation of endothelial abnormalities that can be associated with cavernous malformations, although other possibilities, such as gray matter heterotopia or low grade glial tumor, may be considered as well.


Instruction: Generate impression based on findings.

Input: 44-year-old female with history of Devics disease. Patient presents with 3 day history of left-sided numbness and right-sided weakness. There is no evidence of intracranial hemorrhage, mass or edema. Patchy diffuse white matter changes compatible with patient's previous MRI. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses, although limited appear patent and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of upper lobe, right bronchus or lung [C34.11], Reason for Study: ^Reason: initial lung ca staging History: initial lung ca staging No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Multifocal bihemispheric scattered FLAIR/T2 high signal intensity lesions on periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Focal fluid collections on the right mastoid air cells are seen.

Output: 1. No evidence of intracranial metastasis.2. No evidence of acute ischemic or hemorrhagic lesion.3. Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 39 years Male (DOB:8/16/1977)Reason: h/o status epilepticus as a child, TBI, and HTN History: cognitive decline - global dysfunction (may have been longstanding)PROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI 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.There is a lesion present within the left frontal lobe subcortical white matter associated with susceptibility effect on inversion recovery imaging which appears to be heterogeneous on FLAIR and T2 imaging and does not enhance with contrast. It appears be slightly hypointense on T1There are a couple periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyes are have increased AP dimension and are associated with lumen of scleral thickening.The visualized upper cervical spine at C2-3 there is a disc bulge associated with effacement of spinal fluid ventral and posterior the spinal cord suggesting spinal stenosis.

Output: 1.A small chronic hemorrhagic lesion is present in the left frontal lobe superior frontal gyrus subcortical white matter. One possibility is it is related to prior injury.2.Findings raise the question of spinal stenosis in the upper cervical spine. Please correlate with clinical symptoms. If appropriate MRI of the cervical spine may be of further benefit in evaluating this.3.Staphylomas of the eyes.


Instruction: Generate impression based on findings.

Input: 60-year-old female with possible leg length discrepancy. Measurements were made at the superior aspect of the femoral head, superior aspect of the tibial spines, and superior aspect of the talar dome:Left femur length: 42 cmRight femur length: 42 cmLeft calf length: 42.5 cmRight calf length: 42 cmOverall left leg length: 84.5 cmOverall right leg length: 84 cm

Output: No significant leg length discrepancy. Please see measurements above.


Instruction: Generate impression based on findings.

Input: Known left breast cancer with positive axillary node. MRI for staging and evaluation of opposite breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally which is a limitation to this examination.In the left upper central breast, there is segmental enhancement extending from the nipple to the mid-posterior depth, with a 1 cm more mass like enhancement seen posteriorly near the biopsy clip. Overall extent of abnormal enhancement is 9.0 x 2.9 x 3.8 cm, inclusive of the nipple. The pectoralis muscle enhances normally. A subcentimeter intramammary lymph node is seen in the left outer breast.A left axillary lymph node contains clip artifact from the recent biopsy and measures up to 1.6 cm. An additional lymph node with a focally thickened cortical region measures 0.9 cm. No suspicious enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: 1. Extensive abnormal enhancement in the left upper central breast measures up to 9 cm AP and includes the nipple. Two abnormal left axillary lymph nodes are present, one containing the biopsy clip. 2. Extreme parenchymal enhancement is a limitation to this exam. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Recurrent nasopharyngeal carcinoma: weight loss. There is an enhancing tumor in the left upper carotid space with extension through the widened left hypoglossal canal and cerebellomedullary cistern, as well as into the widened left jugular foramen. There is no mass effect upon the brainstem. The tumor measures up to approximately 30 mm in length and 25 mm in width. There is asymmetric effacement of the left lateral nasopharyngeal recess, without measurable tumor in this location. There is diffuse patchy enhancement of the clivus. There is mild scattered paranasal sinus mucosal thickening. The orbits are unremarkable. There is a partially empty sella. There is a disc-osteophyte complex at C3-4 that mildly indents the spinal cord.

Output: Post-treatment findings in the nasopharyngeal region with tumor in the left upper carotid space with extension through the widened left hypoglossal canal and cerebellomedullary cistern, as well as into the widened left jugular foramen, which is compatible with recurrent nasopharyngeal carcinoma.


Instruction: Generate impression based on findings.

Input: 34 year-old woman with history of pain and swelling. Markers are placed along the posterior aspect of the upper back and right shoulder. Deep to the markers is a large fatty mass which, inferiorly, appears to lie between the trapezius and rhomboid major muscles. This mass courses superiorly and anteriorly between the paraspinal and levator scapulae muscles. In maximal cross-sectional dimension, this mass measures 7.7 x 3.7 cm and in oblique longitudinal dimension 12.7 cm. The majority of this mass is of fat signal intensity with thin septae running through the mass, but we see no dominant non-adipose component. Vascular structures also course through the mass, but we see no gross enhancement following administration of gadolinium contrast.

Output: Fatty mass as described above, most likely representing a lipoma or atypical lipomatous tumor.


Instruction: Generate impression based on findings.

Input: Reason: Right knee injury to the lateral meniscus. History: Right knee pain and swelling. MENISCI: Horizontal tear extending through the body of the lateral meniscus. The tear extends from the posterior apex coursing horizontally and anteriorly through the body and extending to the inferior articular surface in the body and anterior aspects. Minimal debris is present in the lateral gutter without a clear discreet fragment.The medial meniscus appears intact. There is a small, subcentimeter focus likely representing a parameniscal cyst posterior to the medial posterior horn.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is normal throughout. No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Lateral meniscal tear as above.


Instruction: Generate impression based on findings.

Input: Male, 77 years old, with mixed neuropathy and worsening ambulatory status. Cervical:Straightening of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. Marrow signal characteristics are within normal limits. Postoperative changes are seen compatible with laminoplasty from C3 through C6. Patchy cord signal abnormality and loss of cord volume are seen from C4-5 through C6-7. No evidence of pathologic cord enhancement is detected.C2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe right and moderate left foraminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C5-6: Facet arthropathy and ligamentum flavum thickening particularly on the left. Mild spinal canal stenosis. Severe bilateral foraminal narrowing. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: Facet arthropathy. No significant spinal canal or foraminal compromise. Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow signal abnormality is observed. There is a 3 mm focus of T2 hyperintensity within the spinal cord at T10. On postcontrast images, this focus enhances. In addition, there are tortuous prominent vascular structures running along the dorsal surface of the distal spinal cord.The intervertebral discs are preserved. No areas of significant spinal canal or foraminal compromise are detected.Lumbar:Evidence of posterior instrumented fusion is seen from L3 through S1. Laminectomy has also been performed through this region. Spinal alignment is grossly anatomic. Vertebral body height and morphology are within normal limits. Increased STIR signal is seen within the anterior inferior aspect of the L2 vertebral body which is nonspecific but may be degenerative in nature.Within the limitations of metal artifact, the distal spinal cord and conus show no specific abnormalities. No definite pathologic intraspinal enhancement is seen.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Disc bulging. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L3-4: Postoperative changes. No spinal canal or foraminal stenosis. L4-5: Postoperative changes. No spinal canal or foraminal stenosis. L5-S1: Postoperative changes. No spinal canal or foraminal stenosis.

Output: 1.Evidence of laminoplasty is seen in the cervical region. Areas of chronic appearing myelomalacia are noted from C4-5 through C6-7 which likely relate to prior degenerative impingement. Although no high-grade spinal canal stenosis is seen in the cervical region, scattered foraminal narrowing is noted, severe at several levels.2.Prominent enhancing vascular structures are seen along the dorsal surface of the lower spinal cord, along with a possible intramedullary focus of enhancement at T10. Findings are concerning for a spinal arteriovenous shunting lesion. Spinal angiography would provide the definitive assessment for these findings. Consultation with neurointerventional radiology is recommended.3.Findings are seen compatible with posterior instrumented fusion and spinal canal decompression in the lumbar spine. No residual spinal canal or foraminal compromise is seen in the fused segments from L3 through S1. However, at L2-3, disc bulging and posterior element hypertrophy do contribute to a moderate spinal canal stenosis and bilateral foraminal narrowing. Edema within the anterior inferior L2 vertebral body is nonspecific but potentially related to endplate degeneration.


Instruction: Generate impression based on findings.

Input: History of colon cancer with liver lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size morphology. Diffuse fatty infiltration with regions of focal sparing. There are several T2-weighted mildly hypointense lesions demonstrating restricted diffusion and heterogeneous postcontrast enhancement with central hypoenhancement, compatible with metastatic disease.A segment 2 peripheral lesion measures 2.7 x 2.0 cm (series 1 503/87).A segment 6/7 measures 2.8 x 1.9 cm (series 1 503/95).In segment 5 there is a peripheral wedge-shaped region of signal hyperintensity and abnormal enhancement with associated non-enhancing branching structures which likely represent occluded portal vein branches. No focal lesion at the apex of this abnormality is evident.Normally distended gallbladder without gallstones. 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: Incompletely evaluated dependent interstitial opacity in the lung bases may reflect atelectasis.

Output: Bilobar liver lesions are compatible with metastatic disease.Basilar opacity may represent atelectasis/aspiration.


Instruction: Generate impression based on findings.

Input: Female, 66 years old. Left scapula mass, evaluate for fracture. There is soft tissue prominence about the scapula correlating to a mass seen on outside MRI. The scapula itself appears essentially normal, although there are perhaps small lucencies about the inferior neck of the glenoid. We see no fracture.

Output: Mass arising from the left scapula is much better seen on the outside MRI study. We see no fracture.


Instruction: Generate impression based on findings.

Input: Left lower extremity radicular symptoms. Evaluate for spinal canal stenosis. Sagittal alignment is notable for 2 mm of anterior subluxation of L4 relative to L5, which is degenerative in nature. The vertebral bodies are preserved in height. Small fat-containing lesion is present at L4 vertebral body and is most compatible with a hemangioma. Two small lesions that are T1-hypointense, T2/STIR-hyperintense in L3 and L5 vertebral bodies may represent atypical hemangiomas. Additionally, there is type II degenerative signal change in the marrow subjacent to the anterior superior and inferior endplates of T12. There is lumbar disc desiccation and mild height loss, sparing L1-L2 disc. Multilevel degenerative facet disease is most pronounced in the lower lumbar spine at L4-L5 and L5-S1. The spinal canal is relatively preserved other than small ventral indentations by degenerative discs as described below. The conus medullaris is normal in signal and shape. The tip of the conus lies at L1-L2 level.T11-T12: Included only on sagittal imaging but there is no spinal canal stenosis and only mild bilateral foraminal stenosis.T12-L1 and L1-L2: There is mild facet arthropathy and ligamenta flava thickening but no spinal canal or neural foraminal stenosis.L2-L3: Disc bulge along with moderate facet arthropathy and ligamenta flava thickening result in minimal, if any, spinal canal stenosis and mild biforaminal stenosis without displacement of the nerve roots.L3-L4: Disc bulge flattens the anterior aspect of the thecal sac. Along with moderate facet arthropathy and ligamenta flava thickening, they result in mild central spinal canal stenosis. There is also left more than right mild-to-moderate subarticular recess and neural foraminal stenosis, without nerve displacement.L4-L5: There is a disc bulge that is eccentric to the right with a foraminal/extraforaminal component. There is also severe facet arthropathy with joint effusions as well as ligamenta flava thickening, with focal T2-hyperintensity on the left side, and possibly a small ligamentum flavum cyst. Combined, these result in mild central and right more than left subarticular recess stenoses. There is also moderate left and moderate-to-severe right neural foraminal stenoses with abutment of the of the extraforaminal segment of the right L4 nerve root by the disc.L5-S1: There is a left paracentral disc protrusion superimposed on bulging which posteriorly displaces and deforms the traversing left S1 nerve root. Severe left and moderate right facet arthropathy with subchondral cysts and tiny joint effusions along with bilateral ligamenta flava thickening result in left more than right moderate neural foraminal stenoses.

Output: 1.Multilevel spondylosis is most pronounced at L5-S1 where there is a left paracentral disc protrusion compressing the traversing left S1 nerve root. Severe left and moderate right facet arthropathy result in left more than right moderate neural foraminal stenosis as well.2.Degenerative disc and facets at L4-5 result in right more than left neural foraminal and subarticular recess stenoses as described above.3.Degenerative disease at the other levels is less pronounced as described above.


Instruction: Generate impression based on findings.

Input: 43-year-old female with ankle pain and fracture of the lateral malleolus. Assess deltoid competency and for medial talar lesion. TENDONS: The extensor and flexor tendons appear intact. The peroneal tendons appear intact. LIGAMENTS: There is complete rupture of the anterior tibiofibular ligament. There is associated cortical irregularity along the lateral aspect of the tibial plafond which is suspicious for an avulsion fracture of the distal tibia. There is also rupture of the posterior tibiofibular ligament. There is increased signal abnormality within the distal tibiofibular syndesmosis. The deltoid ligament appears intact. The lateral collateral ligament complex appears intact. ARTICULAR SURFACES AND BONE: There is a fracture of the distal fibula at the level of the tibiotalar joint with slight medial displacement of the distal fracture fragment. There is cortical irregularity of the lateral aspect of the tibial plafond suspicious for an avulsion fracture of the distal tibia. There is also a linear focus of signal abnormality traversing the posterior malleolus suspicious for a nondisplaced fracture.Note is made of an osteochondral defect along the medial aspect of the talar dome which measures 1.2 cm in the AP dimension and 0.8 cm in the transverse dimension. There is associated 1 to 2 mm of cortical depression of the talar dome. There is fluid signal intensity surrounding this defect which is consistent with an unstable lesion. The osseous fragment demonstrates low signal intensity on T1 and T2-weighted images suggestive of sclerosis/osteonecrosis. There are cysts within the bone underlying this lesion which suggests that this finding may be chronic in etiology. Focus of increased signal abnormality within the anterior calcaneus appears most consistent with a benign vascular remnant. ADDITIONAL

Output: 1. Distal tibia and fibula fractures with associated injury/disruption of the distal tibiofibular syndesmotic complex as described above. The deltoid ligament appears intact, as clinically questioned.2. Findings suggestive of a chronic appearing unstable osteochondral defect along the medial aspect of the talar dome, with reference measurements provided above.


Instruction: Generate impression based on findings.

Input: Newly diagnosed prostate cancer. 3+4 disease right middle lobe. Patient is part of study. PELVIS:PROSTATE:Prostate Size: 2.4 x 4.2 x 2.0 cmPeripheral Zone: Mild patchy increased T1-weighted signal intensity of the peripheral zone likely represents recent biopsy. This limits evaluation.There is an approximately 8 x 6 mm focus of restricted diffusion (series 703/184) associated with T2 weighted hypointensity (series 501/10) in the right lateral base/mid gland, suspicious for prostatic adenocarcinoma.Note is made of a mid-gland paramedial T2-weighted hypointensity and mild restricted diffusion which is inseparable from the central zone.Additional smaller foci of T2 weighted hypointensity are noted without definite associated restricted diffusion or abnormal enhancement.Central Gland: Mild changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 8 mm focus in the right base/mid gland is suspicious for prostatic adenocarcinoma.No evidence of extraprostatic extension or enlarged pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 63 years, Male, right upper extremity motor and sensory deficits, lower extremity weakness. Evaluate for progression of metastatic disease.. Again seen is evidence of diffuse intracranial metastatic disease with numerous small lesions scattered throughout the brain. Many of these lesions appear mildly larger. For example a right superior frontal gyrus lesion measures 8 x 9 mm previously 6 x 6 mm. A lesion involving the lateral aspect of the left precentral gyrus measures 4 mm previously 3 mm. No new lesion is definitively appreciated. There is susceptibility effect associated with several of the lesions lesions compatible with blood products and more conspicuous in the interval although these changes may be in part related to technique differences with the current study done on 3 Tesla and prior on 1.5 Tesla. There are foci of microhemorrhage involving the bilateral cerebellar hemispheres with minimal vasogenic edema which are new since prior and correspond to sites of small metastatic lesions.There is no evidence of acute infarct. No significant intracranial mass effect associated with the subcentimeter lesions. There is patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter as well as in the pons similar to prior likely reflective of chronic small vessel ischemic disease. There are chronic lacunar infarcts involving the left basal ganglia including the caudate head and putamen. Ventricles are not significantly changed in size. Enhancing lesion involving the right lateral occipital bone with soft tissue extension is again seen measuring approximately 31 x 22 mm similar to prior. Enhancing focus involving the left mandibular condyle measuring 14 x 12 mm is stable to minimally more prominent. Additional osseous metastatic foci including the clivus and left occipital condyle are also stable to minimally more conspicuous in the interval. Small scattered enhancing foci in the scalp are again noted such as in the left parietal scalp and involving the left temporalis muscle and may also represent represent metastases. There is diffuse opacification of the right mastoid air cells and to a minimal degree on the left, grossly similar to prior. Mild right maxillary sinus mucosal thickening also similar to prior.

Output: 1. Compared to MRI dated 9/21/2016, there is mild progression of diffuse intracranial metastatic disease with several lesions appearing larger or more conspicuous. Also noted is mild interval increase in small amount of blood products associated with the metastases. No significant edema or mass effect associated with the numerous subcentimeter lesions.2. Osseous and scalp metastases are again seen and stable to minimally more prominent.3. Chronic left basal ganglia infarcts.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with small cell lung cancer, status post 4 cycles of carbo etoposide. A 4 x 3 mm cortically based focus of enhancement within the left pre-central gyrus is new from prior. This lesion induces mild local edema but no significant mass effect. Two additional 2-mm foci of cortically based enhancement on either side of the left post-central sulcus are also new from prior. These two lesions, however, induce no detectable edema. No additional enhancing lesions are seen. Scattered small foci of white matter T2 signal abnormality are similar to prior. No significant mass effect is detected. No evidence of intracranial hemorrhage is seen. The ventricles are normal in size and morphology.Conventional aortic branching is seen. The origins of the great vessels are patent. The right internal carotid artery is completely occluded at the bifurcation. No flow related signal is seen until the communicating segment where reconstitution occurs. The left ICA is severely narrowed at the bifurcation (at least 70% by NASCET criteria) but shows normal caliber beyond the bifurcation. The cervical vertebral arteries are prominent bilaterally, relatively symmetric in caliber, and free of significant stenosis. These findings are unchanged from prior.A 5 x 3 mm aneurysm arises between the origins of the right P1 segment and SCA. An additional 4 x 2 mm aneurysm arises from the left MCA bifurcation. Both lesions are unchanged. There may be a 2 to 3 mm aneurysm arising from the ACOM artery, but this is not entirely well seen due to technical issues. As above, the right ICA shows no evidence of flow until the communicating segment where reconstitution occurs. From this point, the ICA and subsequent MCA branches show relatively normal caliber. The remainder of the intracranial circulation is free of significant stenosis.

Output: 1.A 4-mm cortically based enhancing focus within the left pre-central gyrus, causing mild local edema, is highly suspicious for metastatic disease. Two additional 2-mm enhancing lesions on either side of the left post-central sulcus are also very suspicious for metastases. All three lesions are new from the prior exam.2.Complete occlusion of the right ICA is seen at its origin from the bifurcation. No flow is seen until the communicating segment intracranially where reconstitution does occur. Relatively normal caliber vessels are seen distal to this point suggesting adequate collateralization. Findings are unchanged from prior.3.Severe stenosis of the left ICA is seen at its origin from the bifurcation. Findings are unchanged from prior.4.Intracranial aneurysms are seen arising from the distal basilar artery and the left MCA bifurcation. There may be a small aneurysm arising from the ACOM artery, but this could be artifactual.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. There is widespread heterogeneously enhancing tumor along the right cerebral convexity, measuring up to 8 mm in thickness, with mild mass effect upon the underlying brain. There is tumor along the left parietal convexity that measures up to 4 mm in thickness. There is diffuse smooth linear dural enhancement beyond the tumors, which is likely reactive. In addition, there is mild right frontoparietal leptomeningeal enhancement and T2 hyperintensity. There are minimal scattered cerebral white matter T2 hyperintense foci. There is no evidence of acute infarct or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are several enhancing lesions in the skull and in the C2 vertebra. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there are enlarged and heterogeneous bilateral upper cervical lymph nodes.

Output: 1. Bilateral cerebral convexity dural metastases, right greater than left, with underlying right frontoparietal leptomeningeal enhancement, which may be reactive or less likely represents carcinomatosis.2. Multiple osseous lesions likely represent metastases.3. Bilateral upper cervical lymphadenopathy likely represents metastatic disease as well. Dedicated imaging of the neck may be useful for further evaluation.4. No evidence of brain parenchymal metastases.


Instruction: Generate impression based on findings.

Input: Male 3 years old with new esotropia, rule out mass/lesion/abscess MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1. The orbits are within normal limits in appearance.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 42 year old female with hypertension. Woke up this a.m. with togue and lip laceration and sore left shoulder. Concern for new onset of seizure Images at the level from a magnum demonstrate increased soft tissue density and is believed to represent Chiari malformation.This examination is otherwise unremarkable. No evidence of hydrocephalus, hemorrhage, midline sure or any edema is detected.Follow up exam and MRI is recommended.

Output: Chiari malformation and otherwise unremarkable CT of brain.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with dizziness. Assess for metastases. History of breast cancer. Extensive thick, and in some areas nodular, leptomeningeal enhancement is evident throughout the cerebellar fissures with modest associated parenchymal edema. Leptomeningeal enhancement also coats the tectum.Supratentorially, scattered sulcal enhancement is seen, most notably along the medial and anterior right temporal lobe, and along the anterior left temporal lobe where the enhancement is more nodular and in contact with the overlying dura. Mild leptomeningeal enhancement is seen along the proximal sylvian fissures, within the interpeduncular cistern, along the fifth cranial nerves and seventh/eighth cranial nerves bilaterally, and questionably along the optic apparatus and sella.Parenchymal edema is most evident within the posterior fossa and in the left anterior temporal lobe. There is likely some effacement of the fourth ventricle, but elsewhere no significant mass effect is detected. The supratentorial ventricular system remains within normal limits for size.No evidence of significant intracranial hemorrhage is seen. No abnormal fluid collections are detected.

Output: Extensive leptomeningeal enhancement is seen, most severely affecting the posterior fossa but with scattered areas supratentorially with involvement of several cranial nerves.Given the history of breast cancer, leptomeningeal carcinomatosis is felt to be the most likely underlying etiology.


Instruction: Generate impression based on findings.

Input: History of HCV cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Findings of iron deposition. Nodular cirrhotic liver morphology with hypertrophy of the left and caudate lobes. Normally distended gallbladder. No intrahepatic or extrahepatic biliary ductal dilatation. No specific stigmata of portal hypertension. No arterial enhancing focus or suspicious lesion. Patchy peripheral enhancement in segment 5 without a focal lesion. Simple appearing cyst in the lateral segment of the left hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is mildly prominent to the level of the ampulla without a discrete lesion. No pancreatic parenchymal atrophy or focal lesion.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: Cirrhosis without a discrete suspicious lesion or stigmata of portal hypertension.Mild nonspecific prominence of the main pancreatic duct to the level of the ampulla without a focal lesion evident.


Instruction: Generate impression based on findings.

Input: History of kidney mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. Segment 7 and segment 2 subcentimeter hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several subcentimeter cysts. In the anterior cortex of the left renal inferior pole there is a mildly exophytic enhancing lesion measuring 1.4 x 1.3 cm (series 3/26), unchanged. The lesion demonstrates small foci of macroscopic fat compatible with an angiomyolipoma. 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 left kidney lesion measuring 1.4 cm compatible with an angiomyolipoma.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, history of metastatic prostate cancer, with L2 compression fracture. Assess for metastases. Thoracic:Artifact from orthopedic hardware obscures the T11 and T12 vertebral bodies. Elsewhere, no concerning marrow replacement is seen. A region of T2 bright and mildly T1 bright signal within the T7 vertebral body probably represents a hemangioma.The spinal cord shows normal signal intensity and morphology throughout. No areas of significant spinal canal stenosis seen. The intervertebral disks are preserved. No significant foraminal narrowing is detected.Lumbar:Artifact from orthopedic hardware obscures the L1 vertebral body.A compression deformity of the L2 vertebral body is seen with up to 60% loss of height. This occurs in the context of a broad region of abnormal marrow replacement involving the entirety of the L2 vertebral body. On older lumber spine exams, there was evidence of a smaller region of marrow replacement at this site which has grown progressively over time.Elsewhere, no new areas of progressive marrow replacement are seen.As on prior examinations, the dura is thickened dorsally. Interposed between the dura and the cauda equina, multiple T2 hyperintense fluid collections are redemonstrated, predominantly situated dorsally and dorsolaterally extending throughout the lumbar spine region. Although these have changed slightly in conformation, they are not significantly increased in overall size.These collections contribute to a crowding of the cauda equina nerve roots which is similar to that noted previously. The visualized conus is unremarkable.L1-L2: Progressive loss of disk height and some disk bulging perhaps related to compression of the L2 vertebral body. The spinal canal is narrowed due to the intrathecal collections as above. Foramina are patent. L2-L3: Mild diffuse disk bulge, ligamentum flavum hypertrophy, and facet joint arthropathy. Intrathecal fluid collections result in central spinal stenosis, which is unchanged.L3-L4: Mild diffuse disk bulge, ligamentum flavum hypertrophy, and facet joint arthropathy. Intrathecal fluid collections result in central spinal stenosis, which is unchanged.L4-L5: Mild to moderate diffuse disk bulge, ligamentum flavum hypertrophy, and facet joint arthropathy, which have increased since the previous exam. Intrathecal fluid collections result in central spinal stenosis, which is unchanged. Mild bilateral neural foramina narrowing.L5-S1: Mild diffuse disk bulge, ligamentum flavum hypertrophy, and facet joint arthropathy. Intrathecal fluid collections result in central spinal stenosis, which is unchanged. Mild neural foramina narrowing, left greater than right.

Output: 1.A new compression deformity is evident at L2 at the site of a previously seen suspected metastatic deposit. There is approximately 60% loss of vertebral body height but no significant bony retropulsion.2.Elsewhere, no new or concerning areas of marrow replacement are seen. The remaining vertebral bodies demonstrate preservation of height.3.No significant spinal canal or neuroforaminal stenosis in the thoracic spine.4.Degenerative disk disease, and persistent subarachnoid or subdural collections in the lumbar region, contribute to multilevel spinal canal stenosis and crowding of the cauda equina, not significantly changed from prior.


Instruction: Generate impression based on findings.

Input: History of prostate cancer scheduled for robotic-assisted laparoscopic prostatectomy. Evaluate for nerve sparing approach. PELVIS:PROSTATE:Prostate Size: 3.1 x 4.7 x 4.4 cm.Peripheral Zone: There is a left para medial lesion centered in the mid gland with extension into the apex and base measuring up to 1.6 x 1.0 cm in cross-section demonstrating restricted diffusion (series 603/284) and low T2-weighted signal intensity (series 401/69). The lesion extends approximately 2.4 cm in the craniocaudal dimension (series 501/20)Central Gland: Mild changes of benign prostatic hyperplasia. Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left peripheral zone lesion has a broad base of abutment with the prostatic margin with bulging at the apex (series 901/15) and suspected nodular extra-prostatic extension (series 401/62). BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large left peripheral zone lesion with broad-based abutment with the prostatic margin with suspected extracapsular extension near the left neurovascular bundle. No enlarged pelvic lymphadenopathy is identified.


Instruction: Generate impression based on findings.

Input: Male 72 years old Reason: liver lesion History: liver lesion ABDOMEN:LIVER, BILIARY TRACT: Liver has mildly widened fissures and hypertrophy of the caudate compatible with chronic liver disease. There is a multilobular mildly T2 hyperintense lesion involving the right hepatic lobe representing a conglomerate lesion composed of several smaller lesions. The conglomerate mass measures 7.6 x 6.4 cm. The lesion involves segments 5, 6, and 7 and portion of the lesion also extends into the inferior margin of segment 8. There is a small satellite subcentimeter lesion in segment 8.The lesion does not show arterial enhancement greater than background liver. It shows slightly delayed enhancement. There is enhancing tumor thrombus within the anterior branch of the right portal vein with extension to the portal venous bifurcation. The lesion also causes obstruction of the right hepatic intrahepatic duct about the level of the portal venous bifurcation causing mild right intrahepatic biliary ductal dilatation. The left hepatic duct and common hepatic ducts are normal in caliber.Biliary sludge in the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There are small portacaval lymph nodes. Malignant involvement is possible.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 7/6/2016 07:00:00)RIGHT HEPATIC LESION: 7.6 x 6.4 cm (Image -1, Series 8).

Output: 1.Dominant right hepatic lobe lesion with invasion into the right anterior branch of the portal vein with tumor thrombus extending almost up to the level of the portal venous bifurcation.2.Compression of the right intrahepatic biliary tree due to tumor. Causing mild intrahepatic biliary ductal dictation on the right.3.The imaging features of the lesion suggests a poorly differentiated carcinoma or cholangiocarcinoma. It does not have the expected arterial enhancement of a conventional HCC. An atypical HCC which is poorly differentiated or a cholangiohepatoma are possible.4.Intrahepatic metastases with satellite lesion in the superior aspect of segment 7.


Instruction: Generate impression based on findings.

Input: BAV Left VentricleThe left ventricle is normal. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 133 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 50 ml (normal range 47+/-19). 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. Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 132 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 61 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve is bicuspid and opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. SOV 304cm Asc Ao 2.8-3.0 cm Ao Arch 2.5 Desc Ao 1.9 cm There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Bicuspid AV with out significant AS or AR and no evidence for aortopathy2. Normal LV and RV systolic function.


Instruction: Generate impression based on findings.

Input: 73 year-old female with a history of stage IIIC fallopian tube cancer. She underwent surgical staging in May 2006. She received IP Cisplatin followed by 5 cycles of IP carboplatin and IV Taxol completed in October 2006. She has been without evidence of disease since that time, and her CA 125 has been within normal limits. She has been treated for recurrent inflammatory lesions of the brain (atypical lymphoid infiltrates) responsive to oral steroids. There is new punctate enhancement in the cervical spinal cord, with additional punctate lesions suggested within the mid to left medulla. These findings may be related to the patient's prior inflammatory process in this region. There are stable postbiopsy findings in the left cerebellum with associated susceptibility artifact, likely related to chronic hemosiderin deposition. There is focal mildly increased ill-defined T2 signal in the left ventral pons and pontomedullary junction region, as well as a small focus of susceptibility artifact, not significantly changed since prior. Minimal scattered punctate foci of increased T2 signal in a periventricular distribution are also not significantly changed, and are nonspecific but commonly seen in the setting of chronic small vessel ischemic disease. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small amount of fluid within the left mastoid air cells, as well as partial opacification of the bilateral ethmoid air cells and maxillary sinuses, with bilateral maxillary sinus air-fluid levels again seen, although improved from prior.

Output: 1. New punctate enhancement in the cervical spinal cord, with additional equivocal punctate lesions suggested in the middle. These findings may be related to the patient's prior inflammatory process in this region. Close imaging surveillance is suggested.2. Stable postbiopsy findings in the left cerebellum.3. Unchanged appearance of a focus of abnormal signal in the left pons, which may represent posttreatment changes or an underlying vascular malformation.4. Persistent opacification of the paranasal sinuses with air-fluid levels, although improvement is noted.


Instruction: Generate impression based on findings.

Input: Brain MRI on 2/26/16 showed an incidental 4 mm wide T1 hyperintense nodule superior to the pituitary gland. There is redemonstration of a small T1 hyperintense focus posterior and superior to the pituitary gland, alongside the neurohypophysis. The pituitary infundibulum is intact. The anterior pituitary gland is unremarkable. The optic apparatus and cavernous sinuses are unremarkable.

Output: Redemonstration of a small T1 hyperintense focus posterior and superior to the pituitary gland may represent a prominent dorsum sella versus less likely a Rathke cleft cyst.


Instruction: Generate impression based on findings.

Input: T4N2, WHO type III, nonkeratinizing EBV+ nasopharyngeal cancer, status post treatment. Orbits: The globes, ocular adnexa, optic nerves, and orbital fat are unremarkable, without evidence of intraorbital mass lesions. There are post-treatment findings in the nasopharyngeal region, where there is mild soft tissue swelling and associated persistent enhancement of the central skull base, but no measurable residual tumor in the soft tissues. Neck: There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter. The major cervical flow voids are grossly intact. There are secretions and mucosal thickening in the bilateral maxillary and ethmoid sinuses. There is bilateral tympanomastoid opacification. There is fluid within the bilateral mastoid air cells.

Output: 1. Post-treatment findings in the nasopharyngeal region without evidence of measurable tumor progression in this area and no evidence of intraorbital lesions. 2. Persistent enhancement of the central skull base is likely related to treatment-effects at the site of previous tumor infiltration.3. No evidence of significant cervical lymphadenopathy.4. Persistent bilateral otomastoid effusions, which may be attributable to Eustachian tube dysfunction and/or mastoiditis.5. Persistent evidence of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Female; 61 years old. Reason: eval pancreatitis / obstruction History: acute pancreatitis ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter focus of arterial hyperenhancement in the right hepatic lobe near the dome without the washout or corresponding lesion on T2-weighted images, most likely due to transient perfusional differences (series 1502/537). No suspicious hepatic lesions. Status post cholecystectomy. Mild central intrahepatic bile duct dilation. New mild dilation of the common bile duct measuring up to 11 mm with no distal obstructing lesion evident, though stenosis at the level of the ampulla of Vater is a possibility.SPLEEN: No significant abnormality noted. Patent splenic vein. PANCREAS: Interval resolution of acute pancreatitis. New dilation of the main pancreatic duct in the dorsal pancreatic head measuring up to 8 mm with no distal obstructing lesion evident, though stenosis at the level of ampulla of Vater is a possibility. The degree of dilation is similar to ERCP images from 1/29/15, but new since prior MRI on 12/8/14. Note is made of normal caliber accessory pancreatic duct in the ventral pancreatic head and normal caliber main pancreatic duct in the body and tail of the pancreas. The accessory pancreatic duct is seen draining into a small superior accessory ampulla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable atrophic native kidneys with scattered small cysts.Stable renal allograft in the right iliac fossa, again partially visualized. Stable large circumscribed cystic collection in the right lower quadrant abuts the renal allograft.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes are not enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Interval resolution of acute pancreatitis.2. New mild dilation of the common bile duct and main pancreatic duct in the dorsal pancreatic head without evidence of distal obstructing lesion, though stenosis at the level of the ampulla is a possibility. Of note, there is pancreatic ductal variant anatomy, further detailed above.


Instruction: Generate impression based on findings.

Input: Epilepsy, complex partial seizures. Assess for structural abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses.

Output: No evidence of potential seizure foci.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Traumatic brain injury, evaluate pituitary. Brain: There are numerous scattered foci of high T1 signal and susceptibility effect within the right inferior frontal, left basal ganglia, and left frontal, temporal, and insular lobes with associated vasogenic edema, as well as small areas of restricted diffusion in the left insular and basal ganglia. There is also edema in the left posterior corpus callosum, hypothalamus, left more than right, left thalamus, posterior limb of the right internal capsule, and midbrain. There are also scattered foci of susceptibility effect in the midbrain, pons, and right basal ganglia. There are small subdural hematomas along the bilateral cerebral convexities, measuring up to 3 mm in thickness. There is no midline shift or herniation. There is mild effacement of the left lateral ventricle. There is a mega cisterna magna. The major cerebral flow voids are intact. Mucosal thickening of the right maxillary sinus is noted. The orbits are grossly unremarkable. The multiple skull fractures are better depicted on the prior CT. There is a 10 mm thick left scalp hematoma and bilateral tympanomastoid fluid, with T1 hyperintense components suggestive of blood products.Pituitary: The pituitary gland is not enlarged and demonstrates an intact posterior bright spot and homogeneous enhancement. The infundibulum also appears to be intact.

Output: 1. Interval evolution of stigmata related to supratentorial and infratentorial diffuse axonal injury and hemorrhagic contusion with mild medialization of the left uncus. 2. Interval evolution of the small bilateral cerebral convexity subdural hemorrhages.3. Multiple skull fractures are better delineated on the prior CT.4. Edema related to traumatic brain injury is present within the hypothalamus, but the pituitary and infundibulum appear to be intact.


Instruction: Generate impression based on findings.

Input: 90 year old female with recurrent IDC on left chest wall. Personal history of left breast mastectomy in 2010 for IDC. Status post left mastectomy.No enhancing lesions are seen in the left mastectomy bed or left chest wall.On T2 weighted images, there are no discernible masses in the left chest wall.There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancyBIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: Malignant neoplasm of connective and other soft tissue of upper limb, including shoulder, right humerus lesion. History: Malignant neoplasm of connective and other soft tissue of upper limb, including shoulder, right humerus lesion. There is deformity and linear decreased signal abnormality within the subcutaneous tissue along the anterior and lateral aspect of the proximal and mid humeral diaphysis likely representing postsurgical scarring/postsurgical change. Note is made of multiple foci of increased signal abnormality on fluid sensitive sequences within the cortex along the anterior aspect of the mid diaphysis of the humerus which demonstrate minimal enhancement on postcontrast sequences. While these findings may represent a combination of postsurgical change/granulation tissue and post radiation therapy change, the possibility of residual or recurrent tumor cannot be completely excluded. There is additional enhancement within the subcutaneous tissues of the surgical bed which may also represent postsurgical change/granulation tissue versus small foci of residual disease. There are multiple foci of signal void in the surrounding area presumably representing postsurgical change. No additional bone marrow signal abnormality is identified. There is a small amount of fluid within the glenohumeral joint. Although this examination was not protocoled for detailed evaluation of the rotator cuff, there is a high riding humeral head and apparent complete tear of the supraspinatus with retraction to the level of the glenohumeral joint. There is also nonspecific increased signal abnormality within the deltoid and teres minor on fluid sensitive sequences which could represent subacute denervation.

Output: Multiple foci of enhancing signal abnormality within the subcutaneous tissue along the anterior aspect of the mid diaphysis of the humerus, as well as within the anterior cortex of the humerus, may represent a combination of postsurgical change/granulation tissue and post radiation therapy change, however, the possibility that these findings represent small foci of residual or recurrent tumor cannot be excluded.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of prostate cancer. Gleason 6 right base medial. Gleason 6 left base medial. PELVIS:PROSTATE:Prostate Size: 4.7 x 5.6 x 3.5 cm.Peripheral Zone: Interval increase in size of a left mid gland paracentral peripheral zone T2 hypointense focus now measuring 8 x 5 mm (series 608, image 404), previously 6 x 4 mm when using similar measurement technique. Background T2 hypointense striated appearance noted. There are additional rounded T2 hypointensities (to a lesser degree compared to the prior lesion) in bilateral mid gland peripheral zones with corresponding mild low signal on ADC map not significantly changed when compared to the prior exam.Central Gland: Severe degree benign prostatic hypertrophySeminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension is evident.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: There is a 17 x 13 mm enhancing focus in the left femoral neck that is nonspecific and unchanged since the prior exam.OTHER: Colonic diverticulosis without evidence of diverticulitis.

Output: 1.Suspicious focus in the left mid gland peripheral zone has increased in size since the prior exam.2.No significant change in additional rounded T2 hypointensities with corresponding low signal on ADC map in bilateral mid gland peripheral zones.


Instruction: Generate impression based on findings.

Input: Female, 35 years old. Reason: r/o goiter History: hypothyroid RIGHT LOBE MEASUREMENTS: 5.9 x 1.9 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.4 x 1.9 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture without focal lesion.LEFT LOBE: Heterogeneous echotexture. An echogenic region in the left lower pole measures 0.9 x 0.4 x 0.6 cm, with possible hypoechoic rim likely correlates with the echogenic nodule seen on prior imaging, and is decreased in size and prominence from that exam.ISTHMUS: Heterogeneous echotexture without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. Right level 3 lymph node measures 0.7 x 0.2 x 0 .9 cm, with a fatty. A left level 3 lymph node measures 0.8 x 0.3 x 2.4 cm, with a fatty hilum. A left level 4 lymph node measures 0.9 x 0.5 x 1.0 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid with a left lower pole echogenic region which is likely decreased in size and prominence from prior exam. No cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 59 years old. Reason: mass eval History: mass There is a spiculated, ossified mass in the popliteal fossa which corresponds to ossification of a lipoma on recent outside MRI. The ossified component of the mass is just over 4 cm. The knee otherwise appears normal for age.

Output: Ossified mass in the popliteal fossa represents an ossified lipoma.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with worsening radicular back pain. A scoliotic curvature of the lumbar spine does not seem to have significantly changed from prior. There may be a trace retrolisthesis of L4 relative to L5, also unchanged. Vertebral body height is preserved. No worrisome marrow replacement or evidence of marrow edema is seen.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable.Multilevel degenerative disc disease is seen in the lumbar spine. Loss of disc height is most conspicuous at L1-2, L2-3, and L5-S1. Additional level specific findings are as follows:L1-2: Progression of degenerative disc disease with further loss of disc height and disc bulging as well as a larger right paracentral/foraminal disc protrusion. Mild facet hypertrophy is seen. No significant generalized spinal canal stenosis is evident though there is effacement of the right lateral recess. Mild right foraminal narrowing is unchanged. L2-3: Progressive degenerative disc disease with further loss of disc height and disc bulging as well as a new right paracentral/foraminal disc protrusion. This causes effacement of the right lateral recess. Hypertrophy of the right facet has progressed. Overall there is a mild generalized spinal canal stenosis which has progressed. Mild right foraminal narrowing is unchanged. L3-4: Bilateral facet hypertrophy and ligamentum flavum thickening. Mild disc bulging/disc uncovering. Mild generalized spinal canal narrowing, unchanged. No significant foraminal narrowing. L4-5: Bilateral facet hypertrophy, progressed. Findings suggestive of prior surgery with probable laminectomy on the left. Progressive disc bulge with annular fissuring. Mild to moderate generalized spinal canal stenosis not significantly changed from prior. Moderate bilateral foraminal narrowing mildly progressed. L5-S1: Facet hypertrophy. Bulging disc. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. No significant interval changes.

Output: 1.Mild interval progression of degenerative findings at several levels as above.2.No areas of high-grade spinal canal stenosis. The most significantly stenotic level appears to be L4-5 where there is evidence of prior surgery.


Instruction: Generate impression based on findings.

Input: 10 years Male (DOB:12/29/2005)Reason: chronic daily headaches, increased with valsalva. Evaluate for malformation of craniocervical junction History: headachesPROVIDER/ATTENDING NAME: CAROL J. MACMILLAN CAROL J. MACMILLAN The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are rounded inferior tip seen extend approximately 3 mm below the level of the foramen magnum. There is biphasic CSF flow at the level of the foramen magnum. There is no ventriculomegaly appreciated.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: The cerebellar tonsils are low lying. There does not appear to be significant spinal fluid obstruction.


Instruction: Generate impression based on findings.

Input: Persistent Dizziness, worsening when head tilt back. There is no evidence of significant steno-occlusive lesions in the major neck or imaged intracranial arteries. In particular, there is appropriate enhancement of the vertebral and basilar arteries.

Output: No evidence of significant steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: possible demyelinating disease with paresthesias. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are 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 are minimal posterior disc-osteophyte complexes are C4-5 and C5-6 without no significant spinal canal or neural foramen stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of demyelinating lesions in the brain or cervical spinal cord.2. No evidence of intracranial or cervical spine mass lesions.


Instruction: Generate impression based on findings.

Input: Other hallucinations [R44.2], Reason for Study: ^Reason: phantosmia, history of brain issue in 1980s, eval for smell pathway lesions History: phantosmia There is ovoid shape well circumscribed intra axial lesion on the left pre central gyrus. The lesion has thin low signal intensity rim on T2 with internal multiple compartmentalized high signal intensity. The size of the lesion is about 5mm x 6mm x 4mm on T2 images and it shows significant susceptibility artifacts on Gradient echo image indicating the diagnosis of cavernous malformation. There is no evidence of surrounding edema.There is no other susceptibility lesion seen on this scan.There is no evidence of acute ischemic lesion.Underlying brain shows multiple scattered bihemispheric high signal intensity lesions on T2/FLAIR indicating non specific small vessel ischemic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on bilateral ethmoid sinuses and retention cysts on the right frontal sinus and bilateral maxillary sinuses.

Output: 1. Left pre central gyrus cavernous malformation as described above.2. No acute ischemic lesion on this scan.3. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 27 years, Female, increased deep tendon reflexes, loss of pin in arms and thorax, fatigue. Evaluate for multiple sclerosis. BRAIN: Brain parenchyma appears within normal limits without findings to suggest demyelinating disease in the brain. No evidence of parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. CERVICAL SPINE: Examination is mildly motion degraded however no convincing cord signal abnormality is seen to suggest demyelinating disease. The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE: Examination is mildly motion degraded however no convincing cord signal abnormality seen to suggest demyelinating disease. The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: Brain, cervical, and thoracic MRI studies are within normal limits without findings to suggest demyelinating disease.


Instruction: Generate impression based on findings.

Input: History of pancreas mass status post resection- Pancreatic intraductal papillary mucinous neoplasm 10/09/2013. Peutz-Jeghers polyposis syndrome ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from a distal pancreatectomy. Anterior to the pancreatic body there is a peripherally thick-walled enhancing lesion measuring approximately 2.6 x 1.7 cm demonstrating intermediate to high T2 weighted signal hyperintensity. This corresponds to the previously seen lesion measuring 1.5 x 2.2 cm on the 5/30/2015. The lesion appears slightly increased in size, irregular in margin and now extends anteriorly into the lesser sac and abuts the stomach. There is no mural nodularity of the cyst wall. In the distal pancreatectomy bed there is an intrinsically T1 hyperintense fluid collection demonstrating no post contrast enhancement suggestive of a postprocedural benign fluid collection, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small umbilical hernia containing nonobstructed small bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The pancreatic body cystic lesion demonstrates mild interval increase in size, new irregular contour and peripheral thick walled enhancement. It now extends anteriorly into the lesser sac and abuts the stomach. Differential considerations include post-aspiration inflammatory changes and neoplasm.


Instruction: Generate impression based on findings.

Input: 46 year old with personal history of left breast cancer status post lumpectomy in 2014 and radiation therapy. Multiple benign biopsies in both breasts. No current breast related complaint. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted in the right breast, and marked parenchymal enhancement is noted in the left breast.Post-surgical seroma is present at posterior 12:00 position in the left breast. Diffuse skin thickening, trabecular engorgement and edema with diffuse parenchymal enhancement is seen in the left breast, due to recent radiation treatment.In the right breast, there are three marker clips. Parenchymal enhancing pattern is about the same as previous.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Post-radiation and surgical changes in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cardiac arrest, cause unspecified Altered mental status, unspecifiedClinical question: basilar artery stenosis s/p PEA arrest and worsening neuro examSigns and Symptoms: unresponsive, blown pupil, no corneal reflex The CSF spaces are appropriate for the patient's stated age with no midline shift. Foci of diffusion restriction are present along the lateral aspect of the right middle cerebellar peduncle and the anterior aspect of the medulla bilaterally. This was also present on the prior exam. There are new patchy foci of diffusion restriction present along the peripheral and inferior aspect of the cerebellar hemispheres right more than left.A small infarction the left occipital lobe identified in 9/22/2015 exam is not readily identified on the current exam however because it is too small to identify in this location.Normal vascular flow voids are present in the distal carotid arteries, and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Flow voids of the distal vertebral arteries and the basilar artery are diminished.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.New foci of infarction are present in the inferior aspects of the cerebellar hemispheres bilaterally which involve the right cerebellar hemisphere more than the left cerebellar hemisphere.2.There is redemonstration of lacunar infarcts in the pons and medulla.


Instruction: Generate impression based on findings.

Input: Esthesioneuroblastoma status pot resection with SIADH prior resection, now with low sodium again. Face: There are post-operative findings related to right medial maxillectomy and right anterior and posterior ethmoidectomy. There is no significant change in the enhancement within the right frontoethmoid treatment bed with small areas of low T2 signal. There is persistent mucosal thickening in the right maxillary sinus. There is no evidence of measurable tumor in the treatment bed. There is leftward nasal septal deviation. There are findings related to right dacryocystorhinostomy, but the orbits are otherwise grossly intact. There is a subcentimeter Thornwaldt or nasopharyngeal retention cyst.Brain: There is no evidence of intracranial extension of tumor. There is an unchanged prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable and there is no evidence of acute infection or 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.

Output: 1. FINdings related to right sinonasal surgery with a persistent small area in the right superior anterior ethmoid surgical bed that has some features that resemble the original tumor, but is otherwise nonspecific. Perhaps PET would be useful for further evaluation.2. No evidence of intracranial tumor.


Instruction: Generate impression based on findings.

Input: 46 year old female patient with stage III melanoma. Re-evaluate disease status following immunotherapy intolerance (colitis). There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged minimal scattered cerebral white matter T2 hyperintensity. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. A T1 and T2 hyperintense lesion within the left parietal skull is unchanged and likely represents a hemangioma. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: History of acoustic schwannoma status post chest SRS. Signs and symptoms: Surveillance. Pre- and post enhanced MRI of IAC:Examination redemonstrate an expansile schwannoma within the left internal auditory canal and with significant expansion into the left cerebellopontine angle cistern. Similar to prior exam the mass demonstrates intense enhancement and with a small focus of hypoenhancement in its cerebellopontine angle segment.Similar to prior exam the tumor occupies entire left IAC and with resultant significant expansion.The largest transaxial dimensions of the entire tumor measures at 25 x 27 mm compared to prior study remeasurement of 22.7 x 27 mm.The widest AP axis of the left internal auditory canal measures at 14 mm compared to prior study measurement of 12.5 mm. There is also suggestion of slight further bony remodeling of the dorsal edge of the left IAC. Constellation of above findings/measurements suggests subtle interval increased size of lesion and closer follow-up is recommended.

Output: Revisualization of a large left intracanalicular and cerebellopontine angle schwannoma as detailed/measured above. Findings suspicious of mild interval increased size of lesion as detailed/measured above.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, history of previous left parotidectomy, currently with left periparotid salivary fistula. Evidence of partial left parotid resection is seen. The skin of the resection bed is slightly retracted with underlying scar tissue. Imaging parameters are not adequate for assessment of fine parotid parenchymal detail. Given that limitation, no definite sialocele or other fluid collection is seen. The exact location of the reported salivary fistula cannot be determined. Mildly prominent veins are noted within the parotid glandular parenchyma.The remaining salivary glands are unremarkable. The aerodigestive mucosa is smooth and free of mass lesions. No pathologic adenopathy is identified. Bone marrow signal characteristics are within normal limits.

Output: Findings are seen compatible with partial left parotid resection. Within the limitations of protocol technique, no clear evidence of any sialocele or other periparotid fluid collection is seen. The location of the reported salivary fistula is not accurately visualized.If further imaging is warranted clinically, the patient could return for dedicated parotid imaging at 3T and with microscopy coil sequences.


Instruction: Generate impression based on findings.

Input: Chiari, syrinx, follow-up evaluation. Cervical spine:Postoperative changes of Chiari decompression with tonsillar descent appears similar to the prior exam. A fourth ventricle stent appears grossly unchanged from the prior exam. Cervicomedullary kinking is unchanged. Vertebral body heights and disc spaces are maintained. Alignment is anatomic. Benign marrow signal. Syrinx extending from the foramen magnum into the thoracic spine similar in size and appearance to the prior exam measuring 2 x 1.5 mm at C4-C5, previously 2 x 1.5 mm, and 2 x 2 mm at C7-T1, previously 2 x 2 mm. No significant spinal or neural foraminal stenosis.Thoracic spine:There is levoscoliosis of the upper thoracic spine and dextroscoliosis of the lower thoracolumbar spine. Mild straightening of the thoracic spine. Vertebral body heights and disc spaces are intact. Benign marrow signal. Syrinx extends from the cervical spine to the T10-T11 level and is unchanged in distribution and size measuring up to 4.0 x 3.5 cm at the T3-T4 level. No significant spinal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Stable post Chiari decompression changes. No significant change in size and extent of cervicothoracic syringohydromyelia compared to 4/2015.


Instruction: Generate impression based on findings.

Input: Reason: SL pain after reconstruction History: pain. BONES: There is tubular signal abnormality noted within the scaphoid and lunate likely representing the site of a prior orthopedic screw. There are tiny foci of signal abnormality within the distal pole of the scaphoid which may represent small degenerative cysts of questionable significance.LIGAMENTS: Contrast is noted within the radiocarpal joint. There are foci of low signal intensity within the radiocarpal joint which could represent a combination of metallic susceptibility artifact from prior surgery and synovitis. Contrast extends into the scapholunate interval via a defect of the membranous portion of the ligament, but the contrast does not extend beyond the scapholunate interval into the remainder of the midcarpal joint. The dorsal fibers of the scapholunate ligament appear intact. We see no findings to suggest disruption of the lunotriquetral ligament.TRIANGULAR FIBROCARTILAGE COMPLEX: There is mild intrasubstance signal of the triangular fibrocartilage suggesting mild degeneration, but we see no gadolinium filled tear.TENDONS: There is gadolinium within the tendon sheath of the second and third dorsal compartment tendons which is iatrogenic. The flexor and extensor tendons appear intact. ADDITIONAL

Output: 1. Surgical changes of scapholunate ligament reconstruction. There is a defect of the membranous portion of the scapholunate ligament, but dorsally the ligament appears intact.2. Possible mild synovitis of the radiocarpal joint.


Instruction: Generate impression based on findings.

Input: Male, 44 years old, with paresthesias and history of MS. Evaluate for progression. Brain:Accurate comparison with the prior examination is compromised due to technical differences in the scans. Within this limitation, the following observations are made.Numerous scattered T2 hyperintense lesions are evident within the periventricular regions, the juxtacortical regions, brainstem and the posterior fossa. Most of these lesions are moderately to markedly T1 hypointense. Lesions are better visualized on the present examination. There are no obviously new or growing lesions, though subtle changes will likely not be appreciated.No evidence of significant generalized edema or mass effect is seen. Brain parenchymal volume is generally preserved. No abnormal extra-axial fluid collections are detected. The ventricular system is normal in size and morphology.Spine:Please note that there is no prior spine imaging available for comparison.A segment of abnormal T2 signal is evident affecting the left aspect of the spinal cord spanning the C3 and C4 vertebral bodies. The cord in this area demonstrates volume loss.There are numerous additional small foci of pathologic spinal cord signal in all areas of the visualized spinal cord. However, no additional areas of significant cord atrophy are demonstrated. No epidural abnormalities are suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow edema or replacement is seen. The intervertebral discs are preserved with no evidence of significant spinal canal or foraminal stenosis.

Output: 1.Innumerable lesions are evident within the brain compatible with demyelinating disease. Technical differences prevent accurate comparison with the prior examination. No obvious new or growing lesions are seen, though subtle changes would likely not be appreciated.2.Numerous foci of pathologic signal abnormality are evident within the visualized spinal cord. The most conspicuous lesion is at C3-4 where there is associated spinal cord thinning indicating chronicity. No prior examination is available for comparison of the spinal cord lesions.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of squamous cell lung carcinoma. Evaluate for metastatic lesions. The bone marrow signal is diffusely heterogeneous without focal lesion. In the right parietal lobe there is a small area of encephalomalacia with adjacent edema extending to the lateral ventricle. There is no abnormal enhancement in this region. There are overlying soft tissue abnormalities demonstrating susceptibility and mild marginal enhancement, likely representing scarring from prior trauma or surgery. Additionally, there is a small area of T1 and T2 hypointense subgaleal thickening in the right superior parietal scalp, possibly representing a chronic subgaleal hematoma or fibrotic scarring. There are scattered foci of T2 hyperintensity within the periventricular and subcortical white matter which are nonspecific. There is no abnormal enhancement to suggest metastatic disease to the brain. The ventricular configuration is unremarkable. There is no evidence of ischemia. The basal cisterns are normal. There are small retention cysts within the right maxillary sinus. There is a small amount of fluid within the right sphenoid sinus. The mastoid air sows are clear. The orbits are unremarkable.

Output: 1.No evidence of metastatic disease in the brain.2.Heterogeneous bone marrow signal is nonspecific. Correlation with bone scan is recommended.3.Findings in the right parietal lobe and scalp may be postsurgical or post traumatic in etiology. Correlate with patient's clinical history.4.Scattered foci of white matter T2 hyperintensity likely represent chronic ischemic small vessel disease.


Instruction: Generate impression based on findings.

Input: Dermatomyositis and skin wound Again seen is diffuse subcutaneous and muscle edema consistent with known history of the dermatomyositis. Overall, these findings have improved from the prior exam. There is a soft tissue defect overlying the mid lateral thigh. The soft tissue defect does not extend beyond the subcutaneous fat. There is no discrete fistulous tract or fluid collection identified. The underlying marrow signal of the femur is normal.

Output: Improving subcutaneous and muscle edema. Soft tissue defect overlying the mid lateral thigh does not extend beyond the subcutaneous fat.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: eval for stroke History: right sided weakness Brain MRIMotion artifact degraded image quality.There is focal restricted diffusion at the left frontal lobe precentral gyrus indicating acute ischemic infarction without evidence of hemorrhagic conversion.Encephalomalacia with volume loss were seen on bilateral occipital lobes indicating chronic ischemic infarcts. On gradient echo imaging, there are multifocal skeletal susceptibility lesions involving bilateral occipital lobes and parietal lobes on the left with encephalomalacia indicating chronic petechial hemorrhagic lesions.Multifocal chronic small lacunar infarctions on bilateral basal ganglia. Patchy T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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 no evidence of significant (more than 50%) luminal narrowing on bilateral ICAs, MCAs and ACAs. There is no evidence of intracranial arterial aneurysm. Vertebrobasilar system appears to be normal. Neck MRANoncontrast enhanced neck MR angiogram demonstrates forward flow through bilateral cervical segment of internal carotid arteries and vertebral arteries. However, due to significant motion artifacts and the low signal to noise ratio, precise evaluation for bilateral common carotid arteries, bilateral carotid bifurcations, and bilateral vertebral artery ostia are not possible. In fact, the Neck MRA is non-diagnostic.

Output: 1. Acute ischemic infarction without evidence of hemorrhagic transformation involving left frontal lobe precentral gyrus.2. Chronic ischemic infarction with chronic petechial hemorrhages involving bilateral occipital and parietal lobes.3. Non specific small vessel ischemic disease. Multiple lacunar infarctions on bilateral basal ganglia.4. No evidence of significant intracranial arterial luminal stenosis. No intracranial arterial aneurysm.5. Non diagnostic Neck MRA.


Instruction: Generate impression based on findings.

Input: Evaluate pituitary gland: headaches. There is a T2 hypointense nodule between the anterior and posterior pituitary lobes that measures up to 6 mm. There is no mass effect upon the optic apparatus or cavernous sinuses. The rest of the intracranial contents are unremarkable.

Output: A T2 hypointense nodule between the anterior and posterior pituitary lobes that measures up to 6 mm may represent a Rathke cleft cyst or perhaps a hemorrhagic microadenoma.


Instruction: Generate impression based on findings.

Input: Female 47 years old Reason: eval meniscus, patellofemoral joint, prev ACL History: left knee pain MENISCI: The menisci appear intact with only mild intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is focal partial-thickness tearing of the articular cartilage of the medial facet of the patella, similar to prior study. The superior femoral trochlea appears slightly shallow superiorly, perhaps reflecting mild dysplasia, but the clinical significance is of this is uncertain. Articular cartilage of the tibial femoral compartment appears intact.LIGAMENTS: The patient has undergone ACL reconstruction with the graft appearing intact. Small ganglion along the tibial interference screw is of doubtful clinical significance. MCL tear seen previously has healed. LCL and PCL appear normal. There is a subcentimeter focus of low signal intensity along the anterior fibers of the ACL which could reflect focal fibrosis.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Surgical changes of prior ACL reconstruction with graft appearing intact.2.Focal degeneration of articular cartilage of the medial patellar facet.3.Normal appearing menisci; other findings as above.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign including fatty endplate changes at the L4-L5 level and edema involving the right aspect of the superior S1 endplate. The conus medullaris is normal in position.Multilevel degenerative changes are seen including disc desiccation at the L2-L3 and L3-L4 levels and significant loss of height at the L4-L5 and L5-S1 levels. Individual levels as below: L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge without significant spinal canal or neural foraminal stenosis.. No spinal canal or neural foraminal stenosis.L4-L5: Mild disc bulge without significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis L5-S1: Mild disc bulge with moderate right and mild left neural foraminal stenosis. No significant spinal canal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes throughout the lumbar spine without significant spinal canal stenosis at any level. There is up to moderate right L5-S1 neural foraminal stenosis which may be impinging on the right L5 nerve root.


Instruction: Generate impression based on findings.

Input: Ankle pain. Evaluate for stress fracture TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is a large bone infarction seen in the distal tibial metaphysis and epiphysis. It has the typical serpentine appearance ADDITIONAL

Output: Distal tibial bone infarction. No evidence of stress fracture


Instruction: Generate impression based on findings.

Input: Back pain, lumbar radiculopathy. Right back pain and right foot numbness. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy. .L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.L3-L4: Mild disc desiccation. No spinal canal or left neural foraminal stenosis. Minimal right neural foraminal narrowing. Bilateral facet arthropathy.L4-L5: There is a small right paracentral extrusion which is again seen with effacement of the right lateral recess and may be impinging on the descending right L5 nerve root. There is moderate degree of central spinal canal stenosis similar to prior. Advanced bilateral facet arthropathy and ligamentum flavum thickening and prominence of the epidural fat all contribute to the central spinal canal stenosis. Prominent right lateral osteophyte contacts and laterally displaces the right L4 nerve root without obvious impingement. There is mild narrowing of the bilateral neural foramina.L5-S1: Disc desiccation. No significant spinal canal or neural foraminal stenosis. Advanced bilateral facet arthropathy.Severe atrophy involving the left iliopsoas muscle is again seen which is nonspecific but may be related to disuse.

Output: Multilevel degenerative changes in the lumbar spine not significantly changed since 3/25/2013. Again noted is a right paracentral disc extrusion at the L4-L5 level which effaces the right lateral recess and suspected to be impinging on the traversing right L5 nerve root. There is also moderate central spinal canal narrowing at this level. Individual levels as detailed above.Advanced bilateral facet arthropathy at L4-L5 and L5-S1 may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, altered mental status. Assess for recurrent breast cancer. No evidence of parenchymal edema or any discrete mass or pathologic enhancement is seen to suggest the presence of intracranial metastatic disease.Numerous subcortical and periventricular foci of T2 hyperintensity are seen, a nonspecific finding which likely reflects chronic microvascular ischemic disease. No restricted diffusion is detected to suggest acute ischemia.No significant intracranial hemorrhage is suspected. There is a single small focus of susceptibility within the left frontal white matter which probably reflects chronic microhemorrhage. No abnormal extra-axial fluid collections are present. Ventricles are normal in size and morphology.

Output: 1.No evidence of intracranial metastases.2.Chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with metastatic colorectal adenocarcinoma to the cerebellum, planning examination for resection of recurrent tumor. Postoperative findings are seen compatible with suboccipital craniectomy. Eight rim-enhancing tumor within the left superior cerebellum has increased in size from the prior examination now measuring at least 24 x 15 mm in the axial plane, previously 11 x 10 mm. The degree of surrounding T2 hyperintensity has also increased. Within this enhancing lesion, there is an 8 mm focus of apparent cystic degeneration. Minimal linear enhancement is seen along the prior surgical trajectory, likely postoperative in nature. No definite new enhancing lesions are seen.

Output: Interval increase in size of a left superior cerebellar tumor.