Instruction: Generate impression based on findings.

Input: Right face and arm hypo-aesthesia. There is an area of susceptibility and encephalomalacia in the right cerebellum. Other scattered punctate foci of susceptibility are present within the inferior cerebellum, left more than right, as well as a few additional punctate foci supratentorially, especially along the basal ganglia, including the posterior limb of the left internal capsule. There are scattered foci of abnormal T2 hyperintensity in a periventricular and subcortical white matter distribution. The thalami are unremarkable, however. The ventricles and basal cisterns are symmetric, but prominent, compatible with diffuse parenchymal volume loss. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. The orbits are unremarkable.

Output: 1. Chronic right cerebellum infarct with associated hemosiderin deposition and scattered cerebral white matter probable chronic small vessel ischemic disease, but no evidence of acute infarction. 2. Scattered foci of susceptibility representing hemosiderin deposition within the inferior cerebellum and bilateral basal ganglia, including the posterior limb of the left internal capsule, which may represent hypertensive microhemorrhages.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Contrast opacified the midcarpal joint, as well as the scapholunate and lunotriquetral intervals. No contrast entered the radiocarpal joint. Please refer to the subsequent MRI report for further information.Exposure time: Two minutes 8 seconds

Output: Successful injection of contrast into the midcarpal joint space. I see no findings to suggest a scapholunate ligament tear on this study.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other intervertebral disc degeneration, lumbosacral regionClinical question: Patient with chronic but advancing degree of lower back pain, evaluate for disk herniationSigns and Symptoms: Patient with advancing lumbar pain and LRE radicular pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. Patient motion partially obscures visualization of the spinal canal.At L5-S1 there is loss of disc space height, disc desiccation and endplate reactive change associated with a diffuse disc bulge and mild to moderate bilateral facet ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. The exiting nerve roots within the neural foramina are surrounded by fat. There is moderate bilateral facet and ligamentum flavum hypertrophy at this level. There is partial effacement of the fat at the lateral recess bilaterally at this level. This is stable compared to the prior exam.At L4-5 there is loss of disc space height, disc desiccation and anterior subluxation of L4 and L5. There are endplate reactive changes present at this level. There is marked bilateral facet and ligamentum flavum hypertrophy present at this level. There is effacement of fat surrounding the left-sided exiting nerve roots associated with disc material and facet hypertrophy resulting in encroachment of the left-sided exiting nerve roots within the left neural foramen. There is effacement of the fat at the lateral recess bilaterally at this level associated with some crowding of the nerve roots within the thecal sac and overall a moderate degree of spinal stenosis. These findings appear stable compared to the previous exam.At L3-4 since the prior exam the patient has developed a broad-based central disc extrusion. Some disc material extrudes behind the L3 inferior endplate. There is associated moderate facet hypertrophy at this level. The facet hypertrophy is worse on the left compared to the right side. There is now crowding of the nerve roots at this level and overall a moderate degree of spinal stenosisAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral facet and ligamentum flavum hypertrophy at this level. There is crowding of the nerve roots at this level and mild to moderate spinal stenosis. There is accumulation of epidural fat present which contributes to the narrowing of the thecal sac at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.At T10-T11 there is a disc bulge present without significant compromise to the spinal canal.

Output: 1.Since the prior exam the patient developed a disc extrusion at L3-4 with new moderate spinal stenosis.2.Since the prior exam or epidural fat has accumulated and is a result of there is now mild to moderate spinal stenosis at L2-3.3.There are multilevel degenerative changes present in lumbar spine which are worse at L4-5 where there is a moderate degree of spinal stenosis and subluxation of L4 on L5 as well as encroachment of the left-sided exiting nerve roots within the neural foramen which is stable since the prior exam.4.There is mild to moderate spinal stenosis at L5-S1 which is stable when compared to prior exam.5.The examination is degraded by patient motion which can obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Invasive squamous cell carcinoma of the supraciliary ridge treated with chemoradiation. There are post-treatment findings in the left supraciliary region. There is a persistent mild patchy, ill-defined enhancement in the left supra-orbital subcutaneous tissues with extension into the left orbital roof, traversing the frontal bone along the lateral aspect of the left frontal sinus with slight epidural extension, and extraconal left orbital extension. The right orbit is unremarkable. There is a small left maxillary sinus retention cyst.

Output: Persistent nonspecific patchy enhancement at the site of the treated squamous cell carcinoma centered in the left supraciliary ridge region.


Instruction: Generate impression based on findings.

Input: Evaluate for cord compression, myelopathic symptoms, prior ACDF. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Schmorl's node involving the superior endplate of T3 is again seen. Alignment is maintained. Bone marrow signal is benign. Again seen are postsurgical changes of ACDF at the C5-C6 level with solid osseous fusion. There is no obvious cord signal abnormality, although motion degradation on the STIR and T2 sequences limit optimal evaluation.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes as described below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a disc osteophyte complex which is associated with mild to moderate spinal canal stenosis. There is moderate right neural foraminal stenosis related to uncovertebral hypertrophy. Left neural foramen is patent. No significant change since prior.C4-5: There is a disc osteophyte complex which is associated with moderate spinal canal stenosis. There is uncovertebral hypertrophy with with moderate to severe right-sided neural foraminal stenosis. There is mild left neural foraminal stenosis. No significant change since prior.C5-6: No significant compromise to the spinal canal. There is mild right and minimal left neural foraminal narrowing. C6-7: Previous seen left-sided disc extrusion has decreased with mild residual effacement of the left ventral thecal sac. There is no significant spinal canal stenosis at this level. Minimal narrowing of the neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina. Right-sided facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine with mild to moderate C3-C4 and moderate C4-C5 spinal canal stenosis, which is similar to prior from 2/27/2015. 2. Prior ACDF at C5-C6 with solid osseous fusion.3. Neural foraminal stenosis at multiple levels, worst at the right C4-C5 level.4. Previously seen disc extrusion at the left C6-C7 level has nearly resolved.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:2/7/1958)Reason: PREOP STEALTH MRI, to be done at 6am in CCD prior to surgery; PLEASE PAGE NEUROSURGERY RESIDENT TO PLACE FIDUCIALS History: left lower extremity numbness, known cavernoma w previous bleedPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is redemonstration of a hemorrhagic focus centered in the right precentral gyrus and motor area associated with heterogeneous enhancement and a popcorn-like appearance on T2 imaging. There is a profound signal loss surrounding this lesion. It is unchanged compared to the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are partially opacified. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Limited exam demonstrates cerebral cavernous malformation located in the right precentral gyrus. Examination is performed for stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: 23 year old male with a history of testicular cancer and EtOH abuse with liver lesion on recent CT examination. Evaluate for metastasis versus focal fatty liver. ABDOMEN:LIVER, BILIARY TRACT: Note is made of a wedge shaped area in the posterior right hepatic lobe with associated decreased enhancement relative to the liver parenchyma on arterial weighted post contrast sequences. However, there is also delayed enhancement in this area. These findings appear most consistent with a perfusion abnormality of the liver. No focal mass lesions are identified. No evidence of intra-or extrahepatic biliary ductal dilation.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: There is a 1.9 cm nodule with increased T2 signal abnormality in the left lower lobe, which is incompletely visualized/characterized on this examination, but is suspicious for metastatic disease. There is also a focus of fluid signal intensity in the retrocrural region anterior to L1 vertebral body measuring 1.8 x 1.3 cm (13; series 3). There is no associated enhancement on post contrast enhanced sequences.

Output: 1.Focal area in the posterior right hepatic lobe with imaging characteristics most consistent with a perfusion abnormality. No convincing evidence of metastatic disease involving the liver.2.Left lower lobe nodule is incompletely visualized/characterized but consistent with the stated history of metastatic disease. 3.Nonspecific retrocrural cystic lesion along the anterior L1 vertebral body which appears slightly increased in size when compared to the prior CT examinations, and may be postoperative in nature, although metastatic adenopathy cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:6/16/1952)Reason: Evaluate for spinal stenosis or lumbar disc disease causing radiculopathy on the right and leg weakness on the left. History: Sciatica pain right leg and left leg weakness with bilateral hip flexor weakness noted.PROVIDER/ATTENDING NAME: DIONNE J. BLACKMAN DIONNE J. BLACKMAN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Incidental note is made of fatty filum terminale.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a disc bulge at this level. There is also mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a disc bulge at this level. There is a Schmorl's node at this level. There is T2 signal hyperintensity along the posterior periphery of the disc at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a large cystic lesion in the left renal bed measuring 7 cm diameter and are not entirely included on this exam which is a associated with a fluid fluid level. It is attached to the inferior pole of the left kidney.

Output: 1.There are mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.2.There is a large left-sided renal cyst present which is not entirely included on this exam. It has a fluid fluid level within it suggesting possible blood products. Although most likely represents a cyst because it is not entirely included exam and it exceeds 6 cm in diameter, additional imaging may help confirm this. This is an incidental finding3.There is a fatty filum terminale present.


Instruction: Generate impression based on findings.

Input: 19-year-old female with left hip pain. Evaluate for labral pathology. ACETABULAR LABRUM: There is linear increased signal abnormality which traverses the anterior superior labrum that fills with intra-articular gadolinium, indicating a tear of the acetabular labrum at the 2 o'clock position.ARTICULAR CARTILAGE AND BONE: No frank CAM deformity is identified. The alpha angle measures approximately 54 degrees.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance. ADDITIONAL

Output: Anterior superior acetabular labral tear.


Instruction: Generate impression based on findings.

Input: 69-year-old male with hypertension, diabetes, and esophageal carcinoma, transhiatal esophagectomy Pulmonary Artery: Technically good study. No pulmonary embolism noted to the subsegmental level.MEDIASTINUM AND HILA: There has been interval subxiphoid pericardial drain placement. The drain traverses the distal transverse colon and enters the pericardial sac from a trans-diaphragmatic location (image 32/99). There is a moderately sized pericardial effusion of water density at this time. The right atrium is dilated, a mid LAD stent is present.Again noted are findings compatible with a gastric pull-up containing fluid, air and debris. There is no enteric contrast leak into the mediastinum. Calcified right hilar and mediastinal lymph nodes consistent with prior granulomatous infection.LUNGS AND PLEURA: There is a loculated left pleural effusion with peripheral pleural enhancement and associated internal adhesions suggestive of inflammation. Small associated loculated component within the major fissure on the left. Associated left lower lobe atelectasis. Trace right pleural effusion.Stable biapical pleural scarring with calcification. A reference right-sided, pleural-based nodule has decreased in size measuring 5 x 5 millimeters (22/111). A pulmonary micronodule in the left apical posterior segment is stable.CHEST WALL: No suspicious osseous lesions.UPPER ABDOMEN: An ill-defined area of hypodensity within segment two of the liver (91/111) is present. This is not a dedicated evaluation of the hepatic parenchyma. A metastasis cannot be excluded. Therefore, either a triphasic CT or dedicated hepatic MRI recommended. Multiple bilateral renal cysts.

Output: 1. Interval placement of subxiphoid pericardial drain that traverses the distal transverse colon and anterior diaphragm. Findings have been verbally relayed, images have been reviewed with the clinical service at the time of dictation. Moderate pericardial effusion, water density at this time.2. Low-density lesion of segment two hepatic parenchyma raising question of metastasis. Further investigation with either triphasic CT or dedicated hepatic MRI is advised.3. Near complete resolution right pleural effusion. Loculated left pleural effusion with peripheral enhancement and possible internal adhesions.


Instruction: Generate impression based on findings.

Input: 18-year-old male status post crani for tumor. Evaluate tumor resection. There are postsurgical changes of a left posterior frontoparietal craniotomy extending across the midline. There is normal signal intensity of the adjacent superior sagittal sinus. There is a surgical resection cavity in the left precentral gyrus which demonstrates internal mixed signal intensity consistent with serosanguineous blood products. There is no enhancement identified within the cavity, although note that the presence of blood products may obscure subtle enhancement. The cavity measures up to 15 mm x 11 mm (series 601, image 6) with minimal surrounding edema. There is a small amount of what likely represents hemorrhagic CSF underneath the craniotomy flap which is 4 mm in thickness and is in expected postsurgical finding. There is a small amount of anterior frontal pneumocephalus also an expected postprocedural finding. There is no new mass lesions or areas of abnormal enhancement or mass effect. There are persistent air-fluid levels within the bilateral maxillary sinuses containing frothy content similar to prior MRI study. There is patchy opacity of the mastoid air cells with normal signal intensity of the middle ear cavity.

Output: 1. Expected postsurgical changes as described above with resection cavity containing serosanguineous blood products with no significant mass effect. The surgical cavity demonstrates no enhancement however note that the absence of blood products may obscure subtle enhancement. 2. Persistent air-fluid levels within the bilateral maxillary sinuses containing frothy content similar to prior MRI study and is compatible with sinusitis.


Instruction: Generate impression based on findings.

Input: Status post resection of skull based meningioma on 4/8/14. There are postoperative findings related to right pterional craniotomy for resection of a planum sphenoidal tumor. There is a small amount of persistent residual dural enhancement in the right paraclinoid region. There is no evidence of intracranial hemorrhage or acute infarct. There are a few scattered nonspecific foci of cerebral white matter T2 hyperintensity. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The orbital contents are unremarkable.

Output: Postoperative findings with what may represent small amounts of residual tumor in the right paraclinoid region.


Instruction: Generate impression based on findings.

Input: Alzheimer versus multiple sclerosis versus depression: memory problems dating for 3 years, MOCA of 8. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is slight interval increase in the extent of the scattered cerebral and pontine white matter T2 hyperintense lesions. There has also been interval increased prominence of the ventricles, particularly the lateral and third ventricles, as well as the sulci. There is a prominent jet of cerebrospinal fluid flow in the third ventricle. 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. There is mild staphylomatous deformity of the globes.

Output: 1. Slight interval increase in the extent of the scattered supratentorial and infratentorial white matter T2 hyperintense lesions, which may represent chronic small vessel ischemic disease, perhaps superimposed on demyelinating lesions.2. Interval increased prominence of the ventricles, particularly the lateral and third ventricles, as well as the sulci, which may be due to cerebral volume loss, although a superimposed component of normal pressure hydrocephalus is a consideration. 3. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: There are enhancing lesions in the T4, T5, T6, T7, and T8 vertebral bodies. The vertebral body T7 demonstrates mild concavity of the superior endplate and there is irregularity of the T8 vertebra. The spinal cord appears normal. There is no evidence of spinal or neural foraminal stenosis. There are bilateral pleural effusions, right larger than left and associated compressive atelectasis. There are bilateral renal cysts.

Output: 1. Metastatic disease involving the T4, T5, T6, T7, and T8 vertebrae with a compression fracture of the T7 vertebra and perhaps the T8 vertebra. 2. Bilateral pleural effusions, right larger than left and associated compressive atelectasis. Please refer to the recent chest CT report for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no restricted diffusion to suggest acute infarct. No evidence of intracranial hemorrhage. There is T2/FLAIR hyperintensity involving the left anterior temporal lobe with focal dilatation of the adjacent left anterior temporal horn. There is mild volume loss including the left hippocampus.There are multiple foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. No intracranial mass or evidence of mass effect. No abnormal parenchymal or meningeal enhancement. Major flow voids are preserved. Remainder of the brain and extracranial soft tissues are unremarkable. There is mild patchy opacification of the bilateral ethmoid sinuses as well as the left maxillary sinus. Mild mastoid air cell opacification.

Output: 1. No evidence of acute infarct. Gliosis involving the left anterior temporal lobe with adjacent dilatation of the left anterior temporal horn which is favored to be on an ex vacuo basis. Left anterior temporal gliosis may be related to remote trauma, infarct, or other injury. There is much less likely possibility of a benign intraventricular cystic lesion such as neuroglial cyst given the adjacent parenchymal FLAIR abnormality and mild volume loss. 2. Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 52 years Female (DOB: 1/5/1964)Reason: Please do CSF flow study at foramen magnum History: eval Chiari malformation, compare to prior studiesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. A Chiari I malformation present. The cerebellar tonsils extend approximately 7 mm below the level of the foramen magnum. There is no evidence for syrinx within the cervical spinal cord on this exam. There is biphasic flow at the level of the foramen magnum which is stable compared to the prior exam..At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Findings are compatible with Chiari I malformation. There is no associated syrinx appreciated. There is no significant CSF flow obstruction appreciated on this exam.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:8/28/1952)Reason: evaluate for structural abnormality History: new onset headache in setting of cancer historyPROVIDER/ATTENDING NAME: SANDRA LYNN ROSE SANDRA LYNN ROSE The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. There is redemonstration of a couple T2 and FLAIR hyperintense focus along the left centrum semiovale. There is redemonstration of a couple T2 and FLAIR hyperintense lesions in the brainstem.Since the prior exam patient has accumulated new foci in the subcortical white matter of the left medial parietal lobe measuring 12 mm adjacent to the intraparietal sulcus and another one in the left middle frontal gyrus measuring 9 mm. These are associated with adjacent sulcal widening and focal volume loss. There is no associated contrast enhancement or any susceptibility effect.There is some vague enhancement along the frontal bones adjacent to the frontal sinuses adjacent to theNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cyst in the right maxillary sinus. Prior mucosal thickening in the frontal sinuses has cleared since prior exam. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.Incidental note is made of hyperostosis frontalis interna.

Output: 1.Since the prior exam patient developed new small lesions in the left parietal lobe and left frontal lobe. There is suspected to be vascular related.2.There is redemonstration of a couple periventricular white matter lesions in the left centrum semiovale as well as a couple punctate lesions in the brainstem which are also likely vascular related. Please note that the predominance of lesions in the left hemisphere raise the question of possible left carotid disease. Please correlate with clinical findings.3.There is some and vague enhancement adjacent to the frontal sinuses bilaterally. This is nonspecific and could be inflammatory in nature. However, it is nonspecific and could represent something other than inflammatory reaction.4.No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: cT4bN0 small cell neuroendocrine carcinoma of nasopharynx/sinus with extension to the skull base, who received cisplatin/etoposide and concurrent radiation. FACE: There are post-treatment findings in the nasopharyngeal and sinonasal regions with a defect in the exosurface of the clivus, which demonstrates diffuse enhancement, as well as prominent mucosal thickening in the bilateral maxillary sinuses and to a lesser extent in the anterior ethmoid cavity. There is diffuse hyperenhancement of the nasopharyngeal mucosal space, but no evidence of discrete mass lesions or significant cervical lymphadenopathy based on size criteria. There is a wide left mandibular molar extraction cavity containing probable granulation tissue. BRAIN: There is a new enhancing nodular lesion in the left inferior colliculus that measures up to 7 mm. There is also new diffuse thickening and hyperenhancement of the pituitary infundibulum, measuring up to 5 mm in diameter. In addition, there is abnormal diffuse leptomeningeal enhancement along the superior cerebellum in the region of the midline and along the bilateral Sylvian fissures and anterior temporal poles, as well as perhaps along the inferior brainstem and cervical spine cord. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Post-treatment findings in the nasopharyngeal and sinonasal regions without evidence of measurable mass lesions in the treatment bed. 2. Interval appearance of a subcentimeter enhancing nodular lesion in the left posterior midbrain, thickening and hyperenhancement of the pituitary infundibulum, and leptomeningeal enhancement along at least the superior cerebellum in the region of the midline, bilateral Sylvian fissures, and anterior temporal poles. Differential considerations include metastatic disease with leptomeningeal carcinomatosis versus an inflammatory process such as sarcoidosis, for example.


Instruction: Generate impression based on findings.

Input: Female, 14 years old. Lateral subluxation of patella. Knee instability. MENISCI: The menisci appear normal.ARTICULAR CARTILAGE AND BONE: There are rounded foci of heterogeneous subchondral signal intensity within the lateral femoral condyle, likely representing the site of microfracture of the osteochondral lesion seen on the prior outside study. There is mild edema and cyst formation in the adjacent marrow. The signal intensity of the overlying articular cartilage is heterogeneous, but we see no frank fluid-filled defect. The remaining articular cartilage appears normal. Subjectively the femoral trochlea is shallow superiorly with asymmetry of the facets (lateral > medial) suggesting mild trochlear dysplasia. Currently, patellofemoral alignment is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. A thin irregular low signal intensity structure can be followed from the vicinity of the abductor tubercle to the superomedial patella which may represent the medial patellofemoral ligament; however, given its irregular appearance, we cannot exclude scar tissue in the vicinity of the of the ligament from old injury. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. Portions of the lateral retinaculum are not well seen, likely due to prior release. The tibial tubercle-trochlear groove distance is approximately 18 mm which is borderline abnormal. The Insall-Salvati ratio is 1.2 which is within normal limits.ADDITIONAL

Output: 1.Findings of mild femoral trochlear dysplasia and borderline elevated tibial tubercle-trochlear groove distance as well as irregularity of the medial patellofemoral ligament; these findings may be associated with patellofemoral instability.2.Surgical changes of lateral femoral condyle microfracture.


Instruction: Generate impression based on findings.

Input: Further assessment of a sellar mass. Pituitary MRI: The sella is expanded by a heterogeneous mass that measures up to 3.5 cm. The mass demonstrates predominantly peripheral enhancement and contains areas that are T1 and T2 hyperintense superiorly. The suprasellar component of the tumor exerts mass effect upon the optic chiasm. The tumor protrudes into cavernous sinuses, left greater than right. There is effacement of the sphenoid sinuses by the expanded sella.Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. There are nonspecific scattered T2 hyperintense cerebral white matter foci that may reflect mild chronic microvascular ischemia. There is no midline shift or herniation. A small retention cyst is present in the left maxillary sinus. Mild ethmoid mucosal thickening is also nonspecific. There are bilateral lens implants.Brain MRA: The sellar and suprasellar mass abuts the cavernous internal carotid arteries, with partial encasement on the left side. The mass also abuts and mildly displaces the A2 segments of the anterior cerebral arteries. There is no evidence of significant steno-occlusive lesions. There is a prominent ACOM complex that measures up to 2 mm in width. Otherwise, there is no evidence of saccular cerebral aneurysms.

Output: 1. The sellar and suprasellar mass may represent a craniopharyngioma versus a pituitary adenoma with cystic change and hemorrhage.2. The sellar and suprasellar mass abuts the cavernous internal carotid arteries, with partial encasement on the left side, but no evidence of significant stenosis. 3. A prominent ACOM complex that measures up to 2 mm in width likely represents dysplasia rather than a true saccular aneurysm. Nevertheless, this may be follow via CTA or MRA to ensure stability.


Instruction: Generate impression based on findings.

Input: Female, 32 years old, with Chiari malformation status post decompression, history of spinal AVM resection. Although the history indicates prior Chiari decompression, no definite related surgical changes are seen. If a suboccipital craniectomy was performed, the amount of bone removed was small. The posterior arch of C1 remains in place.The cerebellar tonsils descend up to 5 mm below the level of the foramen magnum. However, they are not particularly peglike in morphology and there seems to be adequate surrounding CSF space. On cine flow imaging, robust biphasic CSF flow is seen both dorsally and ventrally through the foramen magnum.Postoperative findings are again seen consistent with laminotomy from approximately T11-12 through L2-3. The distal conus and nerve roots of the cauda equina in this area are closely opposed to the dorsal thecal sac which may indicate tethering or adhesions. However, the appearance of these findings is unchanged. No evidence of any new or discrete lesion is seen. The nerve roots of the distal cauda equina also demonstrate a somewhat clumped morphology but this too is unchanged. Please note that a portion of the lower thoracic spine was inadvertently omitted from axial T2 imaging, though the relevant postoperative areas are included.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. No significant compromise of the spinal canal or neural foramina is detected. A small central disc protrusion at T8-9 is unchanged.

Output: 1.Findings are seen compatible with a Chiari I malformation as the cerebellar tonsils do descend up to 5 mm below the level of the foramen magnum. However, tonsillar morphology is within normal limits and there is no evidence of crowding or significant effacement of the CSF spaces. Adequate biphasic flow is seen ventrally and dorsally.2.Although the history indicates prior Chiari decompressive surgery, definitive postoperative findings are not identified. Perhaps a very small suboccipital craniectomy was performed. The posterior arch of C1 remains in place.3.Postoperative findings are again seen in the lower thoracic and upper lumbar spine related to treatment for a spinal AVM. Tethering of the conus and cauda equina to the dorsal thecal sac is unchanged. Likewise, clumping of the more distal cauda equina nerve roots is unchanged and may reflect the sequela of prior arachnoiditis. No new lesions are seen.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation, gait problem, acute ischemic stroke. No evidence of acute ischemic or hemorrhagic lesion.Multifocal patch high signal intensities on periventricular white matter on FLAIR imaging indicate nonspecific small vessel ischemic disease. In particular, the lesion on the right posterior periventricular white matter showed susceptibility artifacts on the mesial aspect indicating prior ischemic lesion with hemorrhagic transformation.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. Prominent nodular and linear enhancing structures were seen on the left caudate head (series 1101, images 17/31) and right internal capsule (series 1101, images 17/31)and right caudate head (series 1101, images 16/31) indicate prominent venous structure or small developmental venous anomaly.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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Moderate degree nonspecific small vessel ischemic disease.3. Possible chronic ischemic infarction with focal hemorrhagic transformation on the right periventricular white matter posterior aspect.4. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Ms. Paulas is a 53 year old female with biopsy proven IDC of the left breast treated with neoadjuvant chemotherapy. She presents today for bracketed wire localization of the left breast for preoperative surgical guidance. On review of the prior studies, there is a biopsy marker clip and few residual calcifications identified in the left lateral breast. Per recent MRI, the biopsy marker clip is just lateral to the area of non-mass enhancement, felt to be mammographically correlated with the calcifications. This area will be bracketed with two wires for preoperative surgical guidance.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, two 5 cm Kopans needles were placed bracketing the biopsy marker clip/calcifications. On orthogonal mammography, adequate positioning of the needles were confirmed after adjusting depth so the needle tips were approximately 2cm deep to the center of the target. Two spring wires were then deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Kromrey performed the procedure under direct supervision of Dr. Sheth, who was present during the procedure at all times.

Output: Successful needle localization of the left breast biopsy marker clip/calcifications.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Sphenoethmoidal encephalocele and cleft palate. Reassessment. Compared to the postoperative September 2015 CT scan, the large midline sphenoethmoidal encephalocele has recurred. The encephalocele has reexpanded and now has a component that bulges into the upper aspect of the posterior nasal cavity. This component measures 14 mm at the base and 13 mm in height and is slightly smaller than on the preoperative MRI from April 28, 2015 where it measured 16 mm x 13 mm and was abutting the tongue. There is unchanged relative thickening of the posterior wall of this component of the encephalocele which may represent the floor of the third ventricle. The optic chiasm is probably part of this thickening laterally. The sphenoid bone is deformed. Soft tissue thickening along the anterior aspect of the deformed sphenoid body probably represents deformed pituitary tissue, with a stretched infundibulum. The acute postoperative changes in the frontal region have evolved. There is cystic encephalomalacia in the right frontal lobe anteriorly. The brain shows complete agenesis of the corpus callosum and associated colpocephaly, which remain unchanged. There is no acute infarct. Small foci of susceptibility effect are present deep to the frontal craniotomy flap. Otherwise, there is no acute intracranial hemorrhage. The major intracranial vascular flow voids are preserved. There is unchanged large palatal cleft , which also involves the maxillary alveolar ridge. There is hypertelorism and suggestion of midface hypoplasia. There is poor tissue contrast enhancement but there is no definite abnormal intracranial contrast enhancement.While the mastoid effusions have resolved, new fluid intensity is now present in the maxillary sinuses, worse on the left.

Output: 1.There is recurrence of the sphenoethmoidal midline encephalocele with herniation into the posterior nasal cavity.2.Multiple other structural abnormalities are described above, including a large palatal cleft, hypertelorism and midface hypoplasia, as well as agenesis of the corpus callosum.


Instruction: Generate impression based on findings.

Input: Knee pain Radiographs of the knee appear normal with no specific findings to account for the patient's pain. The right knee also appears normal on the standing views.

Output: Normal radiographic appearance of the left knee with no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer History: see aboveBiopsy 4/15/2016: Right base and mid, Gleason 7. Left mid, Gleason 6 PELVIS:PROSTATE:Prostate Size: 4.0 x 2.7 x 3.6 cmPeripheral Zone: 1.3 x 0.7 cm lesion in the right mid gland peripheral zone and base is dark on T2/ADC with diffusion restriction (601/17). On precontrast images, there is hemorrhage within the peripheral zone however, this region is spared. No evidence of early enhancement.Additional areas of low T2 signal throughout the peripheral zone corresponding to sites of hemorrhage, likely from prior biopsy.Central Gland: Multiple BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: Irregularity of the capsule adjacent to the lesion in the right mid gland raises the suspicion fracture capsular extension (601/14).BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the right peripheral zone of the mid gland and base is suspicious for prostate adenocarcinoma.2.Irregularity in the adjacent capsule raises the suspicion of extracapsular extension.3.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other malignant lymphomas, unspecified site, extranodal and solid organ sites. Other malignant lymphomas, unspecified site, extranodal and solid organ sitesClinical question: Brain metastasesSigns and Symptoms: Head pressure and numbness over the jaw The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no MRI evidence for CNS lymphoma.


Instruction: Generate impression based on findings.

Input: 48-year-old female with known multiple brain metastases and concern for herniation. Redemonstrated are multiple enhancing brain lesions with associated surrounding edema, some of which abut the dural surface. The largest is again seen in the left frontal lobe just deep to the superior frontal sulcus which measures 2.6 x 2.4 cm (series 1201, image 126). There is some susceptibility abnormality indicating intratumoral hemorrhage. The associated vasogenic edema is marked and causes 1 cm of focal rightward subfalcine herniation. A second relatively large intraparenchymal lesion adjacent to the floor the left middle cranial fossa is more heterogeneously enhancing and has more susceptibility abnormality indicating more intratumoral hemorrhage. This lesion also has associated adjacent vasogenic edema, with complete effacement of the left temporal horn. The associated mass-effect results in asymmetric widening of the left ambient cistern and minimal medial displacement of the left uncus. Midline shift to the right measures 6 mm. There is also partial effacement of the remaining left lateral ventricle and third ventricle is not visualized. The right lateral ventricle is slitlike.Other smaller lesions are present in the right parieto-occipital region, posteromedial right temporal lobe in the periatrial location, and the left cerebellar hemisphere. Smaller lesions are seen in the medial right brachium pontis as well. Even smaller lesions are suggested scattered along the gray-white junction diffusely.There is lobulated mucosal thickening within the maxillary sinuses bilaterally. There are no enhancing lesions involving the calvarium.

Output: Multiple supratentorial and infratentorial enhancing lesions consistent with metastatic disease. The largest is in the left frontal lobe with extensive associated vasogenic edema. There is 6 mm rightward midline shift and findings of early uncal herniation.


Instruction: Generate impression based on findings.

Input: 53 year old patient with a lytic lesion in the T10 vertebral body. History of transitional cell urothelial carcinoma . Now with T10 lytic lesion. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the right pedicle and transverse process vertebral lytic lesion.

Output: T10 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Clinical question: Preoperative planning for craniotomy/tumor resection. Signs and symptoms: Preop planning. Pre- and post enhanced Stealth brain MRI:Examination demonstrates multiple dural based well-demarcated enhancing tumors bilaterally in supratentorial space. The largest lesion is in right high convexity anterior frontal measuring approximately at 33 x 26 x 30 mm in size. There is buckling of the adjacent brain parenchyma without detectable edema. There is underlying bony thickening. Findings consistent with a meningioma.Right mid frontal dural based meningioma along the inner table of right frontal bone measure at 20 x 18 x 14 mm in size.A right high convexity parietal dura is enhancing meningioma measuring at 25 x 22 x 19 mm size.A right posterior frontal falcine meningioma demonstrates slight extension through the falx to the left. This lesion measures 19 x 27 x 23 mm in size. Subtle associated mass effect without parenchymal edema is noted. A tiny left posterior parietal high convexity meningioma measuring approximately 9 x 6 mm is present.A tiny left posterior parietal occipital junction dural based meningioma measuring 8 mm at the base and 4 mm in height.A left occipital falcine meningioma measures 10 x 5 mm in size is noted.A tiny right sided meningioma arising from the greater ring of the sphenoid and measuring at 7 x 4 mm size.An enhancing intracanalicular schwannoma on the left measuring 7.4 mm in length and 4 mm in AP axis is present. The finding minimally bulges into the left cerebellopontine angle cistern and does not reach the depth of the left IAC.None of the lesions demonstrate any appreciable edema. Ventricular systems remain within normal size and without deviation of midline. Multiple foci of T2 hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres without enhancement are noted. Although nonspecific the findings could however represent mild chronic small vessel ischemic strokes.

Output: 1.Multiple bilateral supratentorial dural based meningiomas as detailed/measured above. The larger lesions demonstrate regional mass effect on the adjacent parenchyma however without evidence of parenchymal edema or midline shift. There is no significant change since prior exam from 4-13-152.A left intracanalicular schwannoma measuring at 7.4 x 4 mm as detailed.3.Findings suggestive of mild chronic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion. The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.LUMBAR SPINE

Output: 1.No evidence of spinal epidural abscess.2.Redemonstration of sequela of prior discitis/osteomyelitis at L4-L5 with mild vertebral body height loss and significant endplate irregularity. 3.Interval slight increased enhancement along the posterior aspect of the right L3-L4 facet is favored to be degenerative in etiology. No new focal abnormal signal or enhancement within the facet joint itself.4.Overall, stable appearance of spondylotic changes along the lower lumbar spine with up to moderate left foraminal narrowing at L5-S1. Persistent impingement of exiting left L5 nerve root.5.Redemonstration of sequela of previous left sacroiliitis.


Instruction: Generate impression based on findings.

Input: There is stable mild stepwise retrolisthesis of C2 on C3 and minimal of C3 on C4. The cervical spine is otherwise in normal alignment, with the exaggerated cervical lordosis. The vertebral body and disk heights appear similar, with multi level disc narrowing, slightly progressed at C4-C5 posteriorly compared to the prior MRI. There is now moderate disc narrowing at C2-C3, progressed since previous exam. No worrisome focal marrow signal abnormality is appreciated.The spinal cord is of normal caliber. There is no significant cord signal abnormality, although there is questioned subtle central T2 hyperintensity within the upper cervical cord from the lower C3 level to the upper C4 level on axial images. Sagittal images appear to suggest more extensive central cord abnormality down to the C5-C6 level although this is not confirmed on axial imaging.C2-3: There is uncovering of the disc. There is also minimal ligamentum flavum thickening.C3-4: Uncovering of the disc with a mild superimposed diffuse posterior osteophyte disc complex as well as left greater than right uncovertebral hypertrophy, with moderate to severe left and moderate right foraminal stenosis. There is mild spinal canal stenosis.C4-5: Stable disc osteophyte complex with slight left-sided prominence and left greater than right uncovertebral hypertrophy. There is mild to moderate central spinal canal stenosis, mild to moderate right and moderate to severe left neural foraminal stenosis. There is also left-sided facet arthropathy. There is mild ligamentum flavum thickening.C5-6: Disc osteophyte complex which abuts the right ventral cord and uncovertebral hypertrophy. There is mild central spinal canal stenosis. There is moderate to severe left and moderate right foraminal stenosis. Left facet arthropathy is also noted, along with minimal ligamentum flavum thickening.C6-7: Stable minimal disc osteophyte complex and uncovertebral hypertrophy. There is no significant central spinal canal stenosis. There is also moderate to severe right and moderate left foraminal stenosis.C7-T1: There is no significant disk pathology or stenosis.There is mild mucosal thickening in the visualized maxillary sinuses bilaterally. Extensive age-related brain volume loss is partially visualized.

Output: 1. Compared to prior MRI, slight interval progression of overall mild to moderate multilevel spondylotic changes, including degenerative grade 1 retrolisthesis of C2 on C3 and C3 on C4. Up to mild-moderate central spinal canal stenosis at C4-C5 and several levels of high-grade foraminal narrowing as detailed above.2. No significant cord signal abnormality, with minimal questioned very subtle central T2 hyperintensity within the cord along the upper cervical spine, predominantly at the C3-C4 level, which could represent very trace prominence of the central spinal canal within the cord or may simply be artifactual.


Instruction: Generate impression based on findings.

Input: 82 years Female (DOB:9/12/1933)Reason: SAH history, source of bleeding not identified History: h/o SAHPROVIDER/ATTENDING NAME: JAMES R BRORSON JAMES R BRORSON MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small.. The posterior communicating arteries are tiny. The vertebral arteries are similar in size. The anterior inferior cerebellar arteries appear to predominate over the posterior inferior cerebellar arteries.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 60-year-old status post neoadjuvant therapy for triple negative breast cancer. Evaluate tumor response and axillary response. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There has been an overall interval decrease in the volume of abnormal right breast enhancement. However, a component of enhancement in the nipple and retroareolar region is increased/new. Currently, there is discontinuous non-mass enhancement extending from the nipple to the posterior depth of the right outer breast. Today this measures 8.0 x 2.2 x 7.0, previously 4.3 x 6.3 x 9.1 cm. A small focus is stable in the medial right breast. Right axillary lymphadenopathy is decreased, with the biopsied reference node measuring 1.1 cm, previously up to 1.7 cm. No suspicious enhancement is seen in the left breast. Stable left breast foci are noted superiorly. Lateral scarring from prior left lumpectomy is noted. No abnormal lymph nodes are identified in the left axillary region.A port-a-cath projects in the left upper chest wall.

Output: Overall decrease in volume of abnormal right breast enhancement, though a component of enhancement near the nipple is increased on this exam. Decreased right axillary adenopathy. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with meningioma, assess for growth. No significant interval change is seen in the size of a dural based mass along the left greater sphenoid wing which measures approximately 33 x 18 mm in the axial plane. As before, this lesion posteriorly displaces the anterior temporal lobe, but there is no evidence of parenchymal edema.No diffusion restriction is seen. Numerous scattered foci of FLAIR hyperintensity are demonstrated in the cerebral hemispheres, not significantly changed. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.Stable meningioma along the left greater sphenoid wing.2.Scattered small parenchymal lesions most likely representing chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 39 year old man with history of Alport syndrome, renal failure referred for evaluation of aortic root and aortic valve. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 237 ml (normal range 142+/-34), the LV end systolic volume index is 45 ml/m2 (normal range 25+/-9), the LVESV is 94 ml (normal range 47+/-19), the LV mass index is 106 g/m2 (normal range 85+/-15), and the LV mass is 223 g (normal range 164+/-36). There is mild concentric left ventricular hypertrophy. 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 mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVEDV is 206 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 89 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and is tri-leaflet. There is mild to moderate (qualitative) central aortic regurgitation (regurgitant fraction 18%).Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Aorta dimensions as below:SOV: 46mm x 49mm x 47mmSTJ: 48mm x 48mmAscending Aorta: 42mm x 42mmAortic Arch: 33mm x 33mmDescending Thoracic Aorta: 24mm x 25mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall amount of peritoneal fluid is noted. Significantly decreased liver T2 Star value is suggestive of liver iron overload . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 60%. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.3. Moderate aortic root dilation (dimensions above).4. Mild to moderate (qualitative) central aortic regurgitation (mild by regurgitant fraction of 18%).


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with headache. Assess for mass. Scattered foci of periventricular, subcortical and brainstem T2 hyperintensity are seen, a nonspecific finding but one which most likely reflects chronic microvascular ischemic disease.No evidence of parenchymal edema or mass effect is detected. No pathologic intracranial enhancement is seen. No abnormal extra-axial collections are noted. The ventricles and sulci are mildly prominent, particularly in the temporal regions, suggesting underlying volume loss

Output: 1.No evidence of any intracranial mass lesion or other acute finding to account for the patient's headaches.2.Temporal predominant volume loss is an incidental finding. Correlation with clinical findings is suggested to determine the significance, if any, of this finding.


Instruction: Generate impression based on findings.

Input: 50-year-old female with right upper quadrant abdominal pain. Evaluate for hepatic or biliary disease. ABDOMEN:LIVER, BILIARY TRACT: No enhancing hepatic lesion. Few scattered subcentimeter hepatic cysts are noted. No intra or extrahepatic biliary ductal dilatation. No cholelithiasis, gallbladder wall thickening, pericholecystic fluid, or evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of edema or peripancreatic inflammatory changes. No pancreatic ductal dilatation.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: No evidence of hepatic or biliary etiology to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Dizziness. History of neurosarcoidosis. Evaluate for progression There are no areas of abnormal signal or enhancement. Specifically, the previously seen punctate focus of enhancement along the posterior-medial aspect of the left superior frontal gyrus is no longer clearly evident. There is no evidence of intracranial hemorrhage, mass or acute infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. There is minimal mucosal thickening in the paranasal sinuses. The orbits are unremarkable. There is a subcentimeter nasopharyngeal retention cyst.

Output: The lesion in the left superior frontal gyrus region is no longer evident. No evidence of new stigmata of neurosarcoidosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Medullary thyroid carcinoma on clinical trial, history of pneumothorax, follow up examination for assessment of response CHEST:LUNGS AND PLEURA: There are persistent, widespread bilateral pulmonary micronodules, predominantly confluent. The reference conglomerate identified from the prior study has not significantly changed, measuring 35 x 25 mm on coronal image 28/57 ( 28 x 36 mm previous).The left pneumothorax has slightly increased, appearing to have further retracted from the chest wall.MEDIASTINUM AND HILA: The reference right paratracheal node currently measures 8 x 13 mm on image 34/153 (14 x 9 mm on previous). The right thyroid lesion (6/153) and right jugular lymphadenopathy (5/153) are unchanged.Stable calcified left hilar nodes. The heart size remains normal, without pericardial effusion.CHEST WALL: Multiple small sclerotic foci within the lumbar spine and mixed sclerotic and lytic lesion in the vertebral body of T1 are stable.Of particular note, there is a paucity of subcutaneous fat.ABDOMEN:LIVER, BILIARY TRACT: There is arterially enhancing lesion measuring 9 x 9 mm at the capsule of the posterior segment of the right hepatic lobe (84/153). This extends beyond the hepatic contour and is concerning for metastasis rather than hemangioma. The previous described low density, ill-defined lesion is again noted in the posterior hepatic lobe (81/153), also suspicious for metastasis.SPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: There is prominence of the pancreatic head which currently measures 34 mm in AP dimension on image 124/153. As compared to 26 mm on the prior study. Therefore, this raises question of enlarging conglomerate of peripancreatic lymph nodes or metastatic involvement with the pancreatic head. Further evaluation of this and of the hepatic lesions may be obtained with a dedicated MRI or triphasic CT abdomen.No intraperitoneal ascites appreciated.BOWEL, MESENTERY: No significant abnormality noted.

Output: 1. Metastatic thyroid carcinoma, predominantly stable.2. Arterially enhancing lesion in posterior hepatic lobe. Enlarging soft tissue density in the region of the pancreatic head. Both findings may be further characterized with dedicated abdominal MRI or triphasic CT.3. Slightly increased left pneumothorax.


Instruction: Generate impression based on findings.

Input: Female, 13 years old, with new neck pain, history of pseudotumor cerebri, with shunt. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement or edema is seen. The paraspinal soft tissues and ligamentous structures are unremarkable.The cerebellar tonsils terminate above the level of the foramen magnum. The CSF space at the foramen magnum is widely patent. The visualized spinal cord shows normal signal intensity and morphology. No focal parenchymal lesions are detected. No epidural abnormalities are seen.The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is detected.

Output: Unremarkable evaluation with no specific findings to account for the patient's neck pain.


Instruction: Generate impression based on findings.

Input: 56 year old female with a history of hypertension and episodes of dizziness. There is no evidence of acute intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. Incidental note is made of a dysmorphic pituitary fossa without evidence of focal mass lesion in the expected region of the pituitary gland. If the patient has symptoms consistent with a pituitary abnormality further evaluation with a dedicated MRI examination could be considered for further characterization. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are clear.

Output: 1. Dysmorphic pituitary fossa without evidence of focal mass lesion. If the patient has symptoms suggestive of pituitary pathology, further evaluation with a dedicated MRI examination could be considered for further characterization. 2. No acute intracranial abnormality. No evidence of acute intracranial hemorrhage or mass.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Male 47 years old Reason: bilateral shoulder pain, concern for rotator cuff pathology. ROTATOR CUFF: The supraspinatus tendon and muscle are within normal limits. The infraspinatus tendon and muscle are within normal limits. The teres minor tendon and muscle are within normal limits. Apparent thickening of the subscapularis tendon is likely due to redundancy due to internal rotation of the humeral head, but we see no tear.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is trace fluid within the subacromial subdeltoid bursa which may not be of clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint. Within the limitations of this non-arthrographic study the glenoid labrum appears intact. There is apparent thickening and redundancy of the anteroinferior capsule which is again likely related to artifact due to internal rotation of the humeral head. There is a small cyst at the anterior aspect of the humeral head.BICEPS TENDON: Evaluation of the long head of biceps tendon is limited by internal rotation of the humeral head and lack of intra-articular contrast but we see no gross abnormality. RIGHT SHOULDER:

Output: 1. Bilateral acromioclavicular joint osteoarthritis.2. No rotator cuff tear.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: r/o lateral meniscus pathology History: right knee pain MENISCI: There is marked degeneration and degenerative tearing of the anterior horn and body of the lateral meniscus with portions of the body of the meniscus extruded laterally along the lateral aspect of the lateral femoral condyle. There is also degeneration and superficial fraying of the posterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the weightbearing surface of the medial femoral condyle above the anterior horn of the medial meniscus. There is full-thickness articular cartilage degeneration affecting the lateral tibiofemoral compartment with large areas of weightbearing surface of the lateral femoral condyle and lateral tibial plateau completely devoid of articular cartilage. There is degenerative subchondral signal abnormality in the surrounding area. There are tricompartmental osteophytes. The femoral trochlea appears shallow superiorly which may reflect mild femoral trochlear dysplasia. There is thinning of the patellofemoral articular cartilage.LIGAMENTS: The distal fibers of the ACL appears thinned which may reflect chronic partial thickness tearing. The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis of the knee most pronounced along the lateral tibiofemoral compartment with additional focal articular cartilage defects along the medial femoral condyle. There is associated marked degeneration and degenerative tearing of the lateral meniscus as described above.2. Small joint effusion and Baker's cyst.3. Probable chronic partial-thickness tearing of the distal fibers of the ACL.


Instruction: Generate impression based on findings.

Input: Pancreatic tail mass on CT. Evaluate for changes/abnormality. ABDOMEN:LIVER, BILIARY TRACT: There are numerous bilobar T2 hyperintense lesions the majority of which are subcentimeter, von Meyenburg complex (few show thin rim enhancement) versus hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: There is a 1.1 x 0.7 cm T2 hyperintense cystic lesion within the superior aspect of the pancreatic body, may represent sidebranch IPMN. Within the pancreatic tail there is a 3.1 x 2.5 cm enhancing lesion, isointense to the spleen on T1 and T2 sequences, and follows splenic contrast enhancement, compatible with a splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate hiatal hernia.

Output: 1.Pancreatic tail mass previously identified on CT compatible with a splenule.2.Pacreatic body cystic lesion, may represent sidebranch IPMN.3.Moderate sized hiatal hernia.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:9/6/1951)Reason: eval for causes of AMS History: as above, hx of schizophreniaPROVIDER/ATTENDING NAME: TIEN S DONG TIEN S DONG The CSF spaces are appropriate for the patient's stated age with no midline shift. There are symmetric subdural effusions present which are probably related to brain atrophy.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are likely of little clinical significanceThere is a punctate T2 and FLAIR signal hyperintensity present along the anterior aspect of the right thalamus. There is no associated susceptibility effect or diffusion restriction appreciated.There are small parafalcine calcifications present which create some susceptibility artifact on diffusion-weighted imaging. These can be identified on the CT scan from 1/28/2016. One measures 12 x 6 mm and another one measures 19 x 6 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Small lesion along the right thalamus is suspected represent an old lacunar infarct. 2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is generalized brain atrophy present.


Instruction: Generate impression based on findings.

Input: 31 years, Female, Reason: 31 yo female with history of inflammatory bowel disease and perianal abscess. Assess for small bowel disease History: diarrhea, abdminal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of active inflammation or complications of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 33-year-old female with borderline ovarian tumor, endstage. Evaluate disease extent. Genital Herpes. CHEST:LUNGS AND PLEURA: Probable intrapulmonary lymph node at left major fissure.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Benign-appearing simple cyst in the peripheral right hepatic lobe.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: Multiple small lymph nodes are seen in the axial images. No significant lymphadenopathy. On the coronal images, pericaval elongated lymph nodes are seen with long axis of 2.5 cm. Cyst are present residual or latent.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine device in the endometrial canal. No specific adnexal abnormality on CT. MRI would be more sensitive. No adenopathy. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Probable intrapulmonary lymph node. IUD in the uterus. No specific adnexal abnormality.


Instruction: Generate impression based on findings.

Input: Neurosarcoid: cognitive decline. There is decreased diffuse leptomeningeal enhancement, nodular thickening and enhancement of the pituitary infundibulum and hypothalamus. However, the diffuse patchy bilateral cerebral white matter T2 hyperintensity has increased in extent. There is also prominence of the bilateral cerebral hemisphere medullary veins diffusely. In addition, there is gyriform susceptibility effect and T1 hyperintensity, as well as T2 hypointense white matter in the bilateral occipital lobes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged diffuse heterogeneity of the calvarium. There are postoperative findings to right transfrontal biopsy. The orbits are grossly unremarkable.

Output: 1. Interval progression of encephalopathy, but decreased leptomeningeal disease, with possible stigmata of superimposed seizure activity and subarachnoid hemorrhage in the occipital lobes that likely represent manifestations of neurosarcoidosis, although a concurrent infectious process is also a consideration.2. A minor contrast extravasation occurred at the right forearm IV site without clinically significant consequences.


Instruction: Generate impression based on findings.

Input: Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on this scan.Extensive non specific small vessel disease. No change since prior exam.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. The midline structures and cranial-cervical junction are normal. 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 the right ACA A2 segment aneurysm.Measured size of the aneurysm appears to be about 2.8mm x 3.6mm which is slightly bigger than prior scan (2.9mm x 3.2mm).There is no other aneurysm seen.No evidence of significant intracranial arterial luminal stenosis.

Output: Right ACA A2 segment aneurysm was redemonstrated.The size of aneurysm appears to be slightly bigger (3.0mm to 3.6mm), however, due to technical parameter differences and scan plane differences, this could be interpreted as no significant interval change since prior scan.


Instruction: Generate impression based on findings.

Input: History of DCIS, status post lumpectomy, MRI from 8/2015 showed BI-RADS 3 with recommendation for six-month follow-up. Patient presents for 6 month follow-up today. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Post lumpectomy changes noted in the left breast.No abnormal enhancement is seen in either breast. Stable focus of enhancement identified in the right breast 11:00 position anteriorly. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: There is a redemonstration of L5 left sided pars defect. Previous seen associated T2 hyperintensity/edema is less conspicuous suggestive of healing. Vertebral body heights and alignment are otherwise maintained. No evidence of spondylolisthesis. No spinal canal stenosis or neural foraminal compromise at any level. The conus medullaris is in normal position at the L1-L2 level. Paraspinous soft tissues are unremarkable.

Output: Compared to 8/4/2015, there is mild decrease in edema associated with the left L5 pars defect suggestive of healing. CT may better assess the bony healing.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 80 years Female (DOB:5/20/1936)Reason: nsclc History: nonePROVIDER/ATTENDING NAME: JYOTI D PATEL SUSAN B. GLICK The CSF spaces are appropriate for the patient's stated age with no midline shift. There is dural thickening associated with enhancement located adjacent to the right middle frontal gyrus is also present on prior examsNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is dural based lesion present adjacent right frontal lobe which is stable compared to previous exams and may represent a small meningioma.2.No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: Reason: Recurrent knee pain after medial menisectomy History: pain MENISCI: There is attenuation of the body and posterior horn of the medial meniscus compatible with the history of prior partial meniscectomy. There is vertically oriented signal abnormality within the peripheral half of the remaining posterior horn of the medial meniscus that extends to the tibial articular surface and is of intermediate signal intensity on the fat saturated T2-weighted images. This is compatible with a tear, although we cannot determine if this is a new tear or chronic tear in the absence of prior imaging studies. Much of the body of the medial meniscus is replaced with intermediate signal intensity on T2-weighted images that presumably represents degeneration, but we see no fluid-filled tear. The anterior horn appears intact. There is irregularity of the peripheral margin of the posterior horn of the lateral meniscus compatible with tearing, but again this may be chronic in etiology. There is globular mildly increased signal intensity within the body of the meniscus suggesting degeneration, but we see no fluid-filled tear.ARTICULAR CARTILAGE AND BONE: There is superficial fraying of the articular cartilage of the patella along the lateral facet, but we see no full-thickness articular cartilage defect. The remainder of the articular cartilage is within normal limits for age.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL

Output: 1. Surgical changes of partial medial meniscectomy. There is increased signal intensity within the posterior horn of the medial meniscus extending to the tibial articular surface compatible with a tear, although we cannot determine if this is a new or chronic tear without prior imaging studies.2. Irregularity of the peripheral aspect of the posterior horn of the lateral meniscus also compatible with tearing, although this may be chronic in etiology.3. Small joint effusion and Baker's cyst as described above.4. Mild superficial degeneration of the articular cartilage of the patella.


Instruction: Generate impression based on findings.

Input: Reason: C6 vertebral body lesion, no abnormality on CT scan, and only site of uptake on bone scan History: above Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the C6 vertebra. Post biopsy images do not demonstrate a hematoma

Output: C6 vertebral bone biopsy under CT guidance. A total of seven samples in three containers were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Male 78 years old Reason: elevated PSA- now with increasing velocity History: elevated PSA- now with increasing velocity. PELVIS:PROSTATE:Prostate Size: 4.3 x 4.8 x 2.9 cm.Peripheral Zone: The peripheral zone is heterogeneous and demonstrates ill-defined diffuse mildly T2 hypointense signal, more marked posteriorly and along the left side. This may represent underlying prostatitis. There is a small focus of abnormal T2 hypointense signal in the left mid gland and posterior laterally which is dark on ADC map and measures 0.5 x 0.4 cm (series 701, image 19). This is dark on the ADC map. This is suspicious for a focus of prostatic carcinoma.Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter focus of signal abnormality within the left peripheral zone in the mid gland which is suspicious for a focus of prostatic carcinoma.2.Diffuse mildly T2 hypointense signal throughout the peripheral zone which raises the possibility of background prostatitis.


Instruction: Generate impression based on findings.

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

Output: No evidence of intracranial mass, ventriculomegaly, or sinus disease.


Instruction: Generate impression based on findings.

Input: 79-year-old man with history of weight loss and dilated duct on CT. ABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic cysts are seen including a 15 mm T2 hyperintense lobulated simple cyst (301/16). The gallbladder is normal. There is smooth extrahepatic biliary ductal dilatation to the level of the ampulla measuring up to 8 mm. No intraluminal filling defect noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is dilated to the level of the ampulla. No parenchymal lesion is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No focal renal lesions seen.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: Smooth dilation of the common bile duct and pancreatic duct to the level of the ampulla, but no intraluminal filling defect or extrinsic mass identified.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord(198.3) [198.3] / Other malignant neoplasm without specification of site [199.1] / Malignant neoplasm of bronchus and lung, unspecified site [162.9] / Altered mental status [780.97], Reason for Study: ^ Motion artifact degraded image quality. There are multifocal ring-enhancing lesions on bilateral hemispheres including bilateral frontal lobe, left parietal lobe, left caudate nucleus, left insula cortex, left basal ganglia right temporal lobe and left occipital lobe. As well as cerebellar hemisphere indicating metastatic lesions. These lesions are associated with the surrounding edema. In particular, left occipital lobe lesion shows susceptibility artifacts on gradient echo imaging indicating hemorrhagic metastatic lesion.There is a relatively homogeneously enhancing well circumscribed mass on the sella turcica which compresses optic chiasm. The mass is measured about 24.5 mm x 34.1 mm x 32.8 mm. This masses consistent with pituitary macroadenoma.Underlying brain shows scattered high signal intensities on periventricular white matter on FLAIR imaging indicating nonspecific small vessel ischemic disease.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 paranasal sinuses and mastoid air cells are clear.

Output: 1.Multifocal enhancing lesions indicating metastatic nodules including hemorrhagic metastatic lesion on the left occipital lobe as described above.2. Pituitary macroadenoma (24.5 mm x 34.1 mm x 32.8 mm).3. Mild to minimal nonspecific small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 39 year old female with a known left IDC grade 3 presents for I-SPY 2 MRI study (pre-treatment). History of recent benign left breast biopsy at 6:00 position. There is scattered fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.A known cancer is identified at retroareolar region in the left breast as a large enhancing mass, measuring 41 x 45 x 45 mm (AP x LR x CC). The lesion extends into anterior skin and the nipple. 13 mm hematoma is present at middle 6:00 position in the left breast, from recent benign biopsy.Patchy area of strong parenchymal enhancement is heterogeneously seen in both breasts. No abnormal enhancement is seen in right breast. In the left axilla, there are at least 2 abnormally enlarged lymph nodes; the largest lymph node with a marker clip measures 30 x 18 mm (CC x LR). The biopsy result of this lymph node was benign.Mildly enlarged lymph nodes are present in the right axilla; however, none of them appears suspicious.

Output: 1. Biopsy proven left breast cancer, extending to the skin and nipple.2. No apparent suspicious lesions in the right breast, although there is strong, heterogeneous parenchymal enhancement. Right breast can be followed in the subsequent MRI studies according to I-SPY protocol. 3. Two enlarged lymph nodes in the left axilla. Recent biopsy of the largest lymph node was benign.4. No abnormal lymph nodes in the right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0], Reason for Study: ^Reason: AMS; r/o structural cause History: AMS The images wasn't only available T1-weighted sagittal sequence which shows significant metallic artifacts on the right side which degraded image quality especially mandibulofacial area.Since the metal was not recognized on free imaging screening, the examination was stopped for more detailed prescreening process.Therefore this examination is nondiagnostic.

Output: Premature termination of examination due to unexpected recognition of metallic artifacts.Non diagnostic examination


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right basal ganglia development venous anomaly and minimal nonspecific scattered cerebral white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration, aside from small left choroid plexus xanthogranulomas. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of elevated alkaline phosphatase. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Mild intrahepatic biliary ductal dilatation.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral perinephric stranding, likely chronic in etiology.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a 7 mm T1 hyperintense nodule located along the right lateral conal fascia with no appreciable enhancement.

Output: No suspicious hepatic lesions. 7 mm nonenhancing nodule located along the right lateral conal fascia is nonspecific, however it has been stable since June 2014 and likely benign.


Instruction: Generate impression based on findings.

Input: There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes which have mildly progressed in number. The ventricles and basal cisterns are unchanged, specifically there is no lobar specific atrophy pattern. Major flow-voids are preserved. Note is made of a probable pontine developmental venous anomaly, unchanged in appearance. Paranasal sinuses and mastoid cells are clear.

Output: 1.No evidence of acute infarct.2.Progression of chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 48 years, Male, multiple myeloma. Brain: Compared to prior postcontrast brain MRI dated 4/28/2016, there has been marked decrease in size of the previously seen left posterior frontal intraparenchymal mass which measures approximately 8 x 9 mm on the current study and 21 x 25 mm on 4/26/2016. The decrease in size was also evident on prior noncontrast brain MRI dated 7/28/2016. Mild residual edema noted on 7/28/2016 has further slightly decreased in the interval. Nodular leptomeningeal enhancement in the left frontal lobe seen on 4/28/2016 has resolved. Enhancing mass in the pineal region measuring 22 x 26 mm on 4/28/2016 is also no longer discretely appreciable. Right frontal ventriculostomy catheter terminating in the right lateral ventricle is again seen. Ventricles are not significantly changed in size. There is however edema as well as mild enhancement near the distal aspect of the right frontal ventriculostomy catheter which was also present on prior MRI from 10/10/2016 but not on 4/28/2016. There is no discrete mass in this region.Previous seen small enhancing lesion seen on 4/28/2016 involving the right superior frontal gyrus as well as along the undersurface of the cerebellar vermis are no longer present. Small foci of susceptibility in the bilateral frontal lobes are compatible with chronic blood products or mineralization related to treatment change.No new enhancing lesion or mass is evident to definitively suggest progression of disease. No evidence of acute infarct or acute hemorrhage. No midline shift or herniation. No extra-axial collections.Cervical spine: The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. There is no pathologic enhancement. STIR hyperintensity involving the C4 vertebral body adjacent to the basivertebral vein is nonspecific and similar to prior. There are mild degenerative changes including mild left C3-C4 neural foraminal stenosis. No high-grade spinal canal or neural foraminal stenosis is evident.

Output: 1. Multiple enhancing lesions in the brain have resolved or nearly resolved. There remains a 9 x 8 mm focus of enhancement involving the left precentral gyrus with susceptibility effect related to chronic blood products or mineralization related to treated lesion. No new or enlarging lesion to suggest progression of metastatic disease in the brain.2. Persistent edema and mild enhancement in the right posterior frontal lobe surrounding the ventriculostomy catheter, similar to 10/10/2016. Ventricles are stable in size without evidence of hydrocephalus.3. No appreciable myelomatous involvement in the cervical spine.


Instruction: Generate impression based on findings.

Input: There is a stable 6 mm ring-enhancing lesion in the superior gyrus of the right frontal lobe. Interval development of multiple satellite lesions with nodular and curvilinear somewhat cortically based enhancement are now present in this region. There is increased surrounding hyperintense T2/FLAIR signal compatible with worsening edema without significant mass effect, which would not be unexpected in posttreatment imaging. However, a 3 mm enhancing focus is more conspicuous in the region of previously demonstrated focal T2/FLAIR hyperintensity. There are also now a few satellite punctate foci of enhancement in this region as well. As suggested previously, the nonenhancing focus of T1 hypointensity/FLAIR hyperintensity in the left frontal lobe likely represents small vessel ischemic disease. Stable focus of susceptibility in the right frontal lobe compatible with microhemorrhage.The cortical sulci are in proportion to the cerebral ventricles. No intra-axial or extra-axial fluid collections are visualized. There is no midline shift or mass effect. The basal cisterns are visualized.

Output: 1.Stable ring-enhancing 6 mm lesion in the right superior frontal gyrus with new foci of surrounding nodular and curvilinear somewhat cortically based enhancement, with increased extent of FLAIR abnormality as well; differential includes true disease progression versus posttreatment effects. Continued follow-up is suggested.2.Interval increased enhancement of a 3 mm lesion in the right temporal lobe middle gyrus which was not reportedly treated, with a few new surrounding punctate foci of enhancement in the region of previously demonstrated FLAIR signal abnormality is suspicious for progressive metastatic disease.