Instruction: Generate impression based on findings.

Input: This exam is limited in the evaluation of multiple myeloma without contrast. THORACIC SPINE: There is slightly heterogeneous T1 signal within the C7 vertebral body that is only partially imaged on this exam. There is an unchanged questionable focus of signal abnormality within the T2 vertebral body. There are minimal degenerate changes including small disc bulges at T5-T6, T6-T7, and T8-T9 without significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is an unchanged left-sided perineural cyst at T12 and L1 that narrows the left T12-L1 and L1-L2 neural foramen. LUMBAR SPINE: There is unchanged grade 1 retrolisthesis of L2 on L3 and a slightly worsenned grade 1 anterolisthesis of L5 on S1. There is an infiltrating lesion within the L4 body that was previously hyperintense and on T2 and is now hypointense. There is new T2 hyperintensity within the L2 and L3 vertebral bodies centered at the endplates that is most likely degenerative as well as a non-specific focus of T2 hyperintensity within the L3 vertebral body. There is an unchanged left perineural cyst at the S2-S3. There is a subcentimeter right renal cyst and a left renal cyst that measures approximately 56 mm, previously 35 mm. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is multilevel disc dessication and disc height loss. L1-L2: There is mild facet arthropathy and ligamentum flavum thickening without significant spinal canal, or neural foraminal narrowing.L2-L3: There is a mild disc bulge as well as facet arthropathy and ligamentum flavum thickening. There is markedly worsened endplate degenerative and disc changes. These findings result in new severe bilateral neural foramen narrowing but no significant spinal canal stenosisL3-L4: There is a mild disc bulge as well as facet arthropathy and ligamentum flavum thickening that results in unchanged severe bilateral neural foramen stenosis but no significant spinal canal stenosis.L4-L5: There is a mild disc bulge as well as facet arthropathy and ligamentum flavum thickening. There is unchanged moderate bilateral neural foramen stenosis and no significant spinal canal stenosis..L5-S1: There is a disc bulge as well as disc uncovering and severe facet arthropathy. There is unchanged mild bilateral neural foramen narrowing and mild spinal canal stenosis.

Output: 1.Lesions within the C7 and L4 vertebral bodies are compatible with the diagnosis of multiple myeloma. There are non-specific foci of signal abnormality within the T2 and L3 vertebral bodies. The L4 lesion changes are suggestive of treatment effects. No evidence of acute fracture. 2.Multilevel lumbar spine degenerative changes have somewhat progressed, most prominently at L2-L3, and result in multilevel neural foramen stenosis.3.A large left renal cyst has increased in size and further characterization with ultrasound is suggested.


Instruction: Generate impression based on findings.

Input: Reason: 71 year old with rectal cancer. History: NA Overall image quality: GoodPELVIS:UTERUS, ADNEXA: Expansion of the endometrial canal to 38 mm (701:26)BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Yes: 8 mm (901:40), about 2 mm from the circumferential resection margin. Another prominent node, 9 mm, about 1 mm or less from the superficial resection margin (901:44).Lymph nodes outside the mesorectal fascia: Yes, but nonspecific, along the external iliac chain and right pelvic sidewall, all less than a centimeter.BOWEL, MESENTERY: Rectal Tumor:Size: 2.7 x 2.7 x 4.9 cm (image 25/series 701), 601:34, 2001:30Tumor appearance on T2-weighted images: Slightly hyperintense with areas of even more increased T2 hyperintensity, likely small areas of necrosis. There may be extension outside of the serosa/mild desmoplastic reaction (601:46).Tumor location: Lower and mid rectum(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): Approximately 4.7 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Approximately 2.6 cm (701:26) Circumference of the rectum involved: Near completeRelationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): Separate from, with preserved fat planesMRI T-stage: T3Tumor Distance to Mesorectal Fascia: 1.7 cm (image 39/series 901).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T3 rectal cancer as above. At least 1 mesorectal lymph node is located within 1 mm of the circumferential resection margin as above.2. Expansion of the endometrial canal to 38 mm suspicious for endometrial cancer given patient's age. Recommend gynecology consult.


Instruction: Generate impression based on findings.

Input: Ms. Hollie is a 55 year old female with a personal history of right breast mastectomy in 2007 for IDC and left breast reduction treated with chemotherapy. Family history of breast cancer in two paternal aunts. She has no current breast complaints. Patient is status post mastectomy of the right breast. There is no abnormal enhancement seen in the right reconstructed breast or axillary region.There is minimal background parenchymal enhancement noted in the left breast. There is no abnormal enhancement seen in the left breast or axillary region.

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


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: h/o meningioma s/p resection History: surveillance Post left high parietal craniotomy status.Focal encephalomalacia at the left post central gyrus, possible related to prior surgery, unchanged.Multifocal T2/FLAIR high signal intensities on bilateral periventricular white matter, unchanged.There is no abnormal enhancement on this scan including surgery site. No evidence of acute ischemic or hemorrhagic lesion.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. Postoperative no unusual finding, specifically, no evidence of residual or recurrence of mass on the left parietal lobe.2. Focal left post central gyrus encephalomalacia and non specific small vessel ischemic disease, unchanged since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 54-year-old male. Please evaluate thyroid cancer. Pathology results of recent thyroid biopsy consistent with papillary thyroid carcinoma. BRAIN: Limited intracranial images demonstrate no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. No abnormal postcontrast enhancement no evidence of parenchymal or leptomeningeal metastases within limited intracranial images.Re-demonstration of the postoperative changes of a bilateral antrostomy, middle turbinectomy, partial ethmoidectomy and osteotomy of the sphenoidal sinus wall.There is unilateral mucosal thickening of the left maxillary sinus, the ethmoidal air cells the left frontal sinus, and the left sphenoidal sinus, with inspissated and bubbly secretions, consistent with sinus disease.NECK SOFT TISSUES:The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid and submandibular glands are unremarkable. Thyroid gland is normal in size and with a focal regions of hypoattenuation within the superior poles of the right and left thyroid glands. The soft tissues/cartilage surrounding thyroid glands are unremarkable. There are multiple, non-pathologically sized lymph nodes in the neck.The cervical and visualized upper thoracic spine demonstrates a hypoattenuating focus within the T1 vertebral body is nonspecific and may represent a hemangioma, metastasis less likely but cannot be excluded, further evaluation with MRI may be considered as clinically indicated.Bilateral neck vasculature is patent. Mild cervical spine degenerative change, most prominent at C5-6 level with no evidence of canal stenosis.LUNG APICES:Lung apices are clear bilaterally.

Output: 1. Abnormal thyroid with focal hypo-attenuating lesions as described above without adjacent soft tissue/cartilage abnormality.2. Scattered small lymph nodes in the neck soft tissue. They are not considered pathological based on size criteria. 3. Small focal hypoattenuating lesion within the T1 vertebral body, most likely represents a hemangioma, metastasis is less likely but cannot be excluded, further evaluation with MRI may be considered as clinically indicated.4. Stable postsurgical changes of sinus surgery with residual sinus disease as described above.


Instruction: Generate impression based on findings.

Input: 11-year-old male with syrinx cervical and thoracic spine, yearly evaluation, history of Chiari decompression. Evaluate for changes to syrinx. Cervical spine: Again seen are stable postsurgical changes related to Chiari decompression with intact biphasic CSF flow through the foramen magnum anterior and posterior to the spinal cord. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic Spine: Syrinx in the upper thoracic spinal cord is unchanged measuring up to 5 mm in maximal width. The thoracic vertebral bodies are appropriate in overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no evidence of spinal canal or neural foraminal stenosis.

Output: 1. Stable postsurgical changes of Chiari decompression with appropriate CSF flow. 2. Syrinx in the upper thoracic spinal cord is unchanged.


Instruction: Generate impression based on findings.

Input: 61 years, Male, status post craniotomy for tumor resection.. There are interval postsurgical changes of left temporal craniotomy for resection of a large enhancing mass centered within the left temporal lobe. There has been resection of majority of the tumor with residual enhancing tumor superior medial to the resection cavity involving the left periatrial region, where it is inseparable from the ependymal surface of the left lateral ventricle, along the inferior aspect of the resection cavity where it involves the dura abutting the petrous temporal bone, as well as minimal nodular component along the superior aspects of the resection cavity. There is also small amount of residual tumor medial to the resection cavity involving the medial left temporal lobe. There is polypoid herniation of the left uncus through the tentorium which was also present previously and is also involved with tumor. Extensive surrounding vasogenic edema is similar to prior.There is restricted diffusion compatible with cytotoxic edema/infarct along the resection cavity margin as well as a relatively larger area involving the left posterior temporal lobe extending into the occipital lobe. Again seen is an extra-axial fluid collection along the left cerebral convexity with effacement of the adjacent cerebral sulci, measuring approximately 16 mm in thickness, overall not significantly changed in size. Additional expected postsurgical changes include small volume pneumocephalus and blood products filling the resection cavity as well as moderate degree of scalp edema. Effacement of the left lateral ventricle is also similar to prior. The degree of left-sided uncal herniation with mild mass effect on the cerebral peduncle is stable to minimally improved. Rightward midline shift measures 11 mm measured at the level of the foramen of Monro which is also similar to prior.There is mild mucosal thickening throughout the paranasal sinuses. There is deformity of the left medial orbital wall likely related to chronic blowout fracture which is again seen.

Output: 1. Interval postsurgical changes of subtotal resection of a large solid and partially necrotic mass centered within the left temporal lobe with areas of residual tumor as detailed above.2. Subdural collection along the left cerebral convexity is again seen measuring up to 16 mm in thickness.3. Persistent mass effect including rightward midline shift and left uncal herniation as above.4. Cytotoxic edema/infarct surrounding the resection cavity and extending into the posterior left temporal and occipital lobes.


Instruction: Generate impression based on findings.

Input: Right forearm mass. Suspect lipoma. Evaluate for nature of mass. A marker was placed along the radial aspect of the proximal forearm. Deep to this marker is a fatty mass centered in the mid forearm between the brachioradialis and extensor carpi radialis longus muscles. The mass is approximately 4.7 x 2.4 cm in transverse dimension and approximately 10 cm in longitudinal dimension. It displaces the brachioradialis muscle laterally. The radial artery and what I believe to be the superficial branch of the radial nerve course along the anterior margin of the mass. A couple of thin septations traverse the mass but I see no dominant nonadipose element. Osteoarthritis affects the elbow and wrist.

Output: Forearm lipoma as above.


Instruction: Generate impression based on findings.

Input: Intermittent right greater than left weakness (upper and lower extremities) with LOC, and concern for top of the basilar syndrome. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate focus of susceptibility effect in the left caudate head, which may represent a chronic microhemorrhage. There are also minimal nonspecific foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA: There is no evidence of significant steno-occlusive lesions or aneurysm within the limits of MRA.

Output: 1. No evidence of acute intracranial hemorrhage, acute infarction, or mass lesions.2. No evidence of significant steno-occlusive lesions or aneurysm within the limits of MRA.


Instruction: Generate impression based on findings.

Input: 91 years, Male, ongoing headaches. Evaluate for new CNS lesions. Lacunar infarcts. Stable carcinoid tumor of the duodenum. No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. There is global parenchymal loss, commensurate with patient's age. Prominence of the CSF spaces in the posterior fossa likely related to mega cisterna magna. Several foci of T2/FLAIR hyperintensity are again seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There are multiple scattered foci of susceptibility effect including a relatively larger focus in the right lateral occipital lobe (with subtle hyperdensity of CT suggestive of mild mineralization) as well as a small focus in the left cerebellar hemisphere which are unchanged. Tiny punctate focus is seen in the left parietal white matter which was not seen on prior study which may be related to differences in technique. These lesions are compatible with chronic microhemorrhages. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. There is mild mucosal thickening involving the paranasal sinuses. Bone marrow signal and extracranial soft tissues are otherwise unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Mild to moderate chronic small vessel ischemic changes.3. Multiple foci of susceptibility effect likely related to chronic microhemorrhages are grossly unchanged allowing for differences in technique. There is a relatively larger focus of chronic hemorrhage in the right lateral occipital lobe which is unchanged since 2009.


Instruction: Generate impression based on findings.

Input: 36-year-old female with multiple cystic lesions in the body and tail of the pancreas ABDOMEN:LIVER, BILIARY TRACT: Findings reflect loss of signal in liver on in phase imaging compared to out of phase imaging suggestive of iron deposition. Hepatomegaly present. Diffusely decreased T2 signal in liver.SPLEEN: Subcentimeter T2 hyperintense cyst in the spleen. Diffusely decreased T2 signal in spleen.PANCREAS: The main pancreatic duct is normal in caliber. There are numerous T2 hyperintense cystic lesions in the head/uncinate process, body, and tail of the pancreas some of which are subcentimeter. A previously identified pancreatic head/uncinate process cystic lesion measures 12 x 11 mm, previously 13 x 9 mm (series 901, image 22). This lesion measured 11 x 8 mm on MR dated 4/2/2014. An additional reference pancreatic body lesion is septated and measures 18 x 13 mm, previously 17 x 10 mm (series 901, image 34). A third pancreatic tail lesion is not significantly changed dating back to 4/2/2014, now measuring 6 mm, previously 7 mm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous scattered bilateral T2 hyperintense cysts in the kidneys. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume ascites. Partially imaged presumed pedunculated uterine fibroid is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination due to lack of IV contrast. 2.Relatively stable cystic lesions in the pancreas as described above, likely side-branch type IPMNs.3.Moderate volume ascites, hepatomegaly and evidence of hemosiderosis noted.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with spinal metastases, neck pain. Signs and symptoms: Neck pain Nonenhanced CT of the cervical spine:Previously described on prior MRI of the cervical spine with the study the lesion to the vertebral body of C5 is not identified on this study. There is subtle low attenuation of C7 vertebral body consistent with patient's known metastatic lesion. There is no evidence of fracture of this vertebrae and the alignment of vertebral column is unremarkable.Nonenhanced CT of thoracic spine:The alignment the vertebral column is within normal limits. Examination identifies previously detected metastatic lesion to T1 with mild compression deformity and minimal bulge of vertebrae into the spinal canal. There is no involvement of the pedicle of T1. The alignment remains intact. Mild compression deformity of vertebral body of T5 along its superior aspect and the internal lytic changes. There is no definitive involvement of the pedicles of T5. No definitive evidence of any additional lytic changes of vertebral column is detected.No definitive metastatic lesion to the facets of the pedicles of vertebral column.Nonenhanced CT of the lumber spine:The alignment of vertebral column is unremarkable. No definitive for the study kidneys to the lumber spine is detected.No evidence of central spinal stenosis or neural foramina compromise.There is very subtle low-attenuation involving S2 vertebral body however been no distinct destruction of the cortex or any perispinal soft tissue abnormality. Possibility of metastatic disease cannot be entirely ruled out.

Output: 1.Multiple metastatic disease to the thoracic spine and a suspected metastatic lesion to as to as detailed.2.There is mild compression fracture of T1 and T5 and mid no involvement of the pedicles of T1 or T5.The alignment of the vertebral column throughout the spine remains normal.


Instruction: Generate impression based on findings.

Input: 50 year old man with history of head and neck SCC with recent follow up chest CT which was suggestive of possible coronary sinus thrombosis. He was referred for cardiac MRI with contrast for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 57 ml/m2 (normal range: 74+/-15), the LVEDV is 120 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19), the LV mass index is 42 g/m2 (normal range 85+/-15), and the LV mass is 90 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is no obvious thrombus in the coronary sinus. Perhaps the CT finding represents a motion artifact or the thrombus has migrated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSee recent CT for lung findings. 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. There is no obvious thrombus in the coronary sinus. Perhaps the CT finding represents a motion artifact or the thrombus has migrated.2. Normal LV size and systolic function (LVEF 66%) without evidence of underlying fibrosis, inflammation, or infiltration. 3. Normal RV size and systolic function (RVEF 60%).4. Normal biatrial dilation.


Instruction: Generate impression based on findings.

Input: facial numbness, possible stroke No evidence of acute ischemic or hemorrhagic lesion.The right mastoid shows fluid collection which could imply possible mastoiditis. If clinically indicated, ENT consultation and dedicated temporal bone CT scan can be considered for further evaluation.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate segmental signal loss on bilateral paraclinoid segments and proximal left MCA M1 segment on MIP images. Source image review shows linear signal void lesions were seen within the lumen which degraded MIP signal. These linear signal loss likely represent flow artifacts but may represent segmental intra luminal filling defects such as luminal irregularity or intra luminal blood clots. Thus, if clinically indicated, CT angiography can be considered for further anatomical evaluation. The proximal left MCA M1 segment lesion could represent early development of sickle cell disease related moyamoya syndrome, thus follow up MRA is recommended.Otherwise, vertebrobasilar system appears to be normal, bilateral PCAs are fetal origin, Acom artery is patent and bilateral ACAs and right MCA appear to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Likely represent artifacts for bilateral paraclinoid ICAs' segmental signal decrease. Anatomical vascular imaging such as CTA can be considered if clinically indicated.3. Subtle luminal narrowing of the left MCA proximal portion which may indicate early development of the Moyamoya syndrome, thus follow up MRA is recommended.


Instruction: Generate impression based on findings.

Input: Metastatic pulmonary adenocarcinoma, evaluate for metastasis. Please examination is obtained for MRI brain fusion protocol for treatment planning limited to 3-D T2 and 3-D post gadolinium T1-weighted sequences. No abnormal parenchymal or meningeal enhancement is appreciated to suggest metastatic disease. There are scattered foci of T2 hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. No intracranial mass or mass effect. No hydrocephalus. No midline shift or herniation. No extra-axial collections. Extracranial soft tissues are grossly unremarkable.

Output: Please note examination was obtained with limited sequences prior MRI brain fusion protocol, which is suboptimal. Nevertheless there is no evidence of intracranial metastatic disease. No abnormal parenchymal or meningeal enhancement, intracranial mass, or mass effect.


Instruction: Generate impression based on findings.

Input: 20 years Male (DOB:9/21/1996)Reason: Patient with CNS vasculitis to evaluate disease progression History: Follow upPROVIDER/ATTENDING NAME: KAREN B ONEL KAREN B ONEL The patient status post left parietal and right frontal craniotomies.There are multiple small foci of enhancement scattered in the left hemisphere the brain and to a lesser degree right hemisphere some which are associated with susceptibility effect negative of microhemorrhage. Included are basal ganglia bilaterally. The lesions predominantly in the left temporal and occipital lobes were also present in the frontal lobes, parietal lobes and temporal lobes and occipital lobes bilaterally.Some foci of encephalomalacia are redemonstrated in the left parietal lobe and the right parietal lobe and left occipital lobe.There is T2 and FLAIR signal hyperintensity present along the anterior aspect of the brainstem at the level of the medulla which was also present on the prior exam. This involves more the left than the right medulla. This is stable compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an opacity in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Couple nodules are redemonstrated in the left parotid gland and right parotid gland which could represent lymph nodes. It has not changed since the prior exam

Output: 1.Since the prior examination patient has developed multiple hemorrhagic lesions throughout both hemispheres but involving the left hemisphere more than the right and predominantly within the left temporal lobe and left occipital lobe. Given the patient's prior clinical history of CNS vasculitis. This can be explained on the basis. Contrast enhancement suggests that these could be in the subacute phase2.There is redemonstration of multiple foci of encephalomalacia in the left frontal lobe, left parietal lobe, right parietal lobe.3.There is redemonstration of a lesion within the medulla which is also stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Known right breast cancer, presents for I-SPY 2 MRI #5. There is heterogeneous fibroglandular tissue and moderate background parenchymal enhancement noted bilaterally. Multiple simple and septated cysts are again identified in both breasts.The index mass at the 10:00 position of the right breast, posterior depth, measures 2.0 x 2.1 x 2.2 cm (AP x LR x CC, previously 2.0 x 2.1 x 2.2 cm). The right breast mass at the 12:00 position measures 0.6 x 0.7 x 0.8 cm (previously 0.6 x 0.7 x 0.7 cm). A third mass, anterior to the index mass, which does not contain a clip measures 0.9 x 1.0 x 0.8 cm (previously 0.9 x 1.1 x 0.7 cm). Other scattered enhancing foci and non-mass enhancement remain in the right breast, with total disease extent measuring 6.5 x 3.2 x 5.8 cm (previously 7.0 x 3.2 x 5.7 cm), which is without significant overall change. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.

Output: No significant interval change in size of known, multifocal right breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male 81 years old Reason: eval adrenal hemorrhages History: as above ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Fatty infiltration of the pancreas.ADRENAL GLANDS: Bilateral adrenal hemorrhage with a right adrenal gland measuring 2.4 x 1.8 cm and the left adrenal gland measuring 2.5 x 1.6 cm. On the subtraction images, no specific evidence for underlying tumor as there is no enhancement.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight decrease in the size of the adrenal hemorrhage. No specific evidence for underlying lesion.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer to the brain with whole brain directed therapy. Follow-up lesions. There is redemonstration of two well demarcated lesions within the left anterior frontal lobe and left inferior cerebellar hemisphere measuring approximately 7 mm and 9 mm, respectively, (image 14, series 501 and image 6, series 501) which are unchanged in size. These lesions demonstrate more conspicuous high T2 signal and minimal high T1 signal without appreciable enhancement, which is similar to the prior study. The left cerebellar hemispheric lesion demonstrates a punctate faint focus of susceptibility. No new lesions are identified. The brain parenchyma is otherwise unremarkable. There is no acute infarct or hemorrhage. The ventricles and basal cisterns are unchanged in size. There is no midline shift or herniation.

Output: 1. No significant change in size or appearance of two lesions within the left anterior frontal lobe and left inferior cerebellar hemisphere, which presumably represent treated metastatic lesions. 2. No new lesions are identified.


Instruction: Generate impression based on findings.

Input: 35-year-old female with history of erosive sinusitis and Wegener's. Saddle nose.IMAGE ACQUISITIONS: Non-infused CT of the sinuses. Extensive bone destruction including the fovea ethmoidalis, ethmoid air cells, and medial wall and floor of the left orbit is again demonstrated, but not significantly changed in comparison with the previous exam. Thinning of the right lamina propecia also again noted. Complete opacification of the frontal, sphenoid and maxillary sinuses. Opacification of the remnant right maxillary sinus and right frontal sinus is slightly increased. Soft tissue extension to the orbit was noted previously and is again seen, with extension of granulation tissue and mass effect on the extraocular muscles. It does extend to the level of the inferior orbital foramen, although foramen has not changed in appearance since the previous exam to suggest further erosion. Extension through the fovea ethmoidalis as noted with a slight bulge superiorly could be evaluated with brain MRI clinically warranted.

Output: Stable extensive erosive sinus disease. Extension into the left orbit and into the fovea ethmoidalis are stable findings.


Instruction: Generate impression based on findings.

Input: Prostate cancer status post prostatectomy with elevated PSA PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Status post prostatectomy.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Status post prostatectomy without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: PITUITARY:There is interval decrease in the size of the pituitary lesion along the right aspect of the gland measuring up to 6 mm CC x 5 mm ML today compared to 9 x 7 mm previously. The lesion is T2 hyperintense today compared to the prior exam where it was T2 isointense to gray matter but enhances somewhat more than it did previously. The pituitary stalk is no longer deviated. Small focal upper convex to the along the superior surface of the pituitary gland anteriorly is unchanged in size and configuration. There is no significant mass effect on the optic chiasm. There is symmetric enhancement of the bilateral cavernous sinuses without evidence of invasion.BRAIN: There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The right vertebral artery flow void is felt to be present but not well-visualized, likely secondary to hypoplasia. The skull and extracranial soft tissues are unremarkable.

Output: Interval decrease in pituitary lesion size, with change in imaging characteristics as described above.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is abnormal signal and morphology of the posterior horn of the medial meniscus which extends into the posterior horn/body junction. The anterior horn is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild diffuse thinning of the articular cartilage of the medial compartment with areas of partial-thickness loss of posterior femoral condyle. No discrete full-thickness defects are identified within the medial compartment. Similar although less severe changes are also noted in the lateral and patellofemoral compartments. A small cystic focus is noted within the lateral tibial plateau posteriorly.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex but predominantly horizontally oriented tear of the posterior horn of the medial meniscus.2. Mild diffuse thinning of the tricompartmental articular cartilage which is most evident medially.


Instruction: Generate impression based on findings.

Input: Redemonstrated are multiple foci of susceptibility abnormality consistent with multiple cerebral cavernous malformations. A lesion along the anterior surface of the left pons has again increased in size, now measuring up to 10 mm (utilizing axial T2), previously 5 mm. There is a new, 3 mm focus of T2/susceptibility hypointensity within the right posterolateral pons, which was not present on the comparison study. Neither demonstrate perilesional edema. Other supratentorial and infratentorial lesions are not significantly changed. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is an unchanged 12 mm wide extra-axial CSF space overlying the medial right cerebellar hemisphere, which may represent an arachnoid cyst versus minimally prominent cisterna magna, unchanged in appearance. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Redemonstrated are multiple foci of susceptibility abnormality consistent with multiple cerebral cavernous malformations. A lesion along the anterior surface of the left pons has again increased in size, now measuring up to 10 mm, previously 5 mm. There is a new, 3 mm focus of T2/susceptibility hypointensity within the right posterolateral pons, which was not present on the comparison study. Neither demonstrate perilesional edema. Other supratentorial and infratentorial lesions are not significantly changed.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with left-sided weakness, evaluate for extent of stroke, acute versus subacute versus chronic. A moderately sized area of infarction in the right inferior cerebellum demonstrates no evidence of restricted diffusion, but neither is there frank encephalomalacia and the parenchyma appears to be mildly edematous. Also noted is hemosiderin staining within the infarct suggesting petechial blood product.Scattered foci of mildly restricted diffusion are seen within the left frontal white matter, the right splenium of the corpus callosum, and scattered through the right posterior temporal and occipital lobes. These areas show mild corresponding FLAIR signal abnormality but no significant edema or generalized mass effect.On diffusion-weighted images, there is a generalized hyperintensity involving the left anterior temporal lobe structures. This does not correlate to any clear signal abnormality on the other sequences.A right parietal approach ventricular catheter is seen with its tip crossing the midline and terminating within or along the left frontal horn. There is a thin, 3 mm subdural collection and/or dural thickening along the anterior right cerebral hemisphere. This produces no significant generalized mass effect.Scattered patchy foci of T2 hyperintensity are seen elsewhere in the cerebral hemispheres, the brainstem and the left cerebellum. Small chronic infarcts are noted within the left cerebral hemisphere. The ventricles are normal in size and morphology.On dedicated MRA imaging, no significant stenosis or occlusion is seen within the major intracranial vascular structures. Both PICAs are at least partially visualized but this is approaching the technical limits of the exam. No aneurysms are detected.

Output: 1.A moderately sized infarct of the right inferior cerebellum shows imaging characteristics suggesting a subacute time course. There is likely petechial hemorrhage associated with this infarct, but no frank hematoma.2.Scattered small areas of restricted diffusion are seen in both hemispheres as described above compatible with acute ischemic lesions.3.Generalized diffusion hyperintensity within the anterior left temporal lobe is seen but there is no corresponding abnormality on the other fMRI sequences. This finding may therefore be artifactual. Such findings can however be seen in the context of recent seizure activity.4.A ventricular shunt device is in place. Also noted is a thin right cerebral subdural collection and/or dural thickening. Correlation with prior history is suggested.5.Unremarkable MRI evaluation of the brain.


Instruction: Generate impression based on findings.

Input: Reason: patient has enlarging mass in her left buttock, near anus, History: enlargement over one year grape-sized to 4cm PELVIS:UTERUS, ADNEXA: The uterus is anteverted and anteflexed. There is thickening of the uterine junctional zone measuring up to 12 mm. The endometrial stripe is within normal limits. No adnexal lesions are identified.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy is identified within the pelvis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No masses or lesions are identified within the perirectal and perianal soft tissues within the field-of-view (please note that the field-of-view does not include the lateral thighs lateral to the femurs).OTHER: No significant abnormality noted.

Output: 1.No evidence of perianal or perirectal mass within the field-of-view.2.Thickening of the uterine junctional zone which can be seen with adenomyosis, recommend correlation with clinical symptoms.


Instruction: Generate impression based on findings.

Input: 66-year-old male with acute brainstem infarct. Evaluate for further swelling/progression of infarct. There is no evidence of intracranial hemorrhage or midline shift. There is increased hypodensity in the left cerebellar region consistent with an evolving infarct. An area of hypodensity on a single image in the right cerebellar hemisphere is identified. There is a previously described area of encephalomalacia on the image inferior to this slice. This could represent volume averaging versus an additional area of infarct. If clinically indicated, an MRI could be considered for further evaluation.The ventricles and basal cisterns are normal in size and figuration. There is opacification of the ethmoid air cells and mucoperiosteal thickening in the bilateral maxillary and sphenoidal sinuses.

Output: Evolving cerebellar infarct. Area of hypodensity in the right cerebellar hemisphere on a single image may represent volume averaging or an additional area of infarct. An MRI may be considered for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Male 23 years old Reason: evaluation of angiomyolipomas on Afinitor History: tuberous sclerosis EXAMINATION: MR renal protocol with and without contrast. ABDOMEN:LIVER, BILIARY TRACT: Gallbladder stones without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Reference exophytic lesion in the left mid kidney (series 501 image 16) currently measures 1.76 x 1.31 cm, previously 17.8 x 1.7 cm with same T2 hypointensity signal compared to 11/06/2015. This lesion does not demonstrate enhancement or fat on in and out of phase images.The lesion in the mid/inferior pole of the left kidney again demonstrates fat on in and out of phase imaging and currently measures 1.46 x 10.2 cm (series 501 image 19) slightly decrease in size when compared with 11/06/2015.Again multiple T1 and T2 hypointense lesions are noted in the kidneys bilaterally, which may represent hemorrhagic cysts, also T2 hyperintense renal cysts are noted bilaterally, measuring up to 2.43 cm in the inferior pole of the right kidney, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Exophytic lesion in the mid left kidney minimally decreased in size compared to prior examination and does not contain fat. Recommend continued follow up of this lesion.2.Angiomyolipoma in the mid/inferior pole of the left kidney also decreased in size.3.Numerous bilateral renal cysts.4.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 34-year-old female with cerebral cavernous malformations. There are 5 lesions within the left cerebral hemisphere which have a "popcorn" appearance of mixed signal characteristics on T1 and T2 weighted images, significant surrounding susceptibility artifact and are mildly enhancing, with T2 hemosiderin rims. The 2 largest are located along the body lateral ventricle and along the deep sylvian fissure. There are 2 smaller lesions in the basal ganglia on the left and a small lesion in the left mesial temporal lobe. There is no T2/FLAIR hyperintensity associated with these lesions. Additionally, there are numerous foci of susceptibility artifact throughout the left frontal and temporal lobes as well as a single focus of susceptibility artifact on the right at the level of the anterior commissure. These foci of susceptibility artifact are not associated with discrete lesions. There are curvilinear, enhancing structures within the left basal ganglia where there is enhancement of dilated medullary veins compatible with at least three discrete DVAs on the left. A right parietal DVA is also present.There is mild volume loss in the left cerebral hemisphere with ex vacuo dilatation of the left lateral ventricle. The cranium is smaller on the left compared to the right indicating that this cerebral atrophy is chronic. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.The 5 left cerebral hemisphere lesions are compatible with cerebral cavernous malformations and have evidence of hemosiderin staining from prior microhemorrhage. 2.Additional areas of susceptibility artifact throughout the left frontal and temporal lobe and on the right at the level of the anterior commissure indicate additional areas of hemorrhage that are not associated with visible cavernous malformation.3.Bilateral DVAs as described above.


Instruction: Generate impression based on findings.

Input: Right visual loss, recent atypical Guillain Barre syndrome treated with IVIG. Orbits: There is focal T2 hyperintensity and enhancement along the orbital segment of the right optic nerve. The rest of the optic nerves and other orbital contents are otherwise unremarkable bilaterally. 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 skull and scalp soft tissues are grossly unremarkable. There are left maxillary sinus and right nasopharyngeal retention cysts.

Output: 1. Findings suggestive of right optic neuritis.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Question of myelopathy: UMN signs in legs. At C5-6 and C6-7, there are posterior disc-osteophyte complexes that indent the spinal cord with high T2 signal and result in severe bilateral neural foraminal narrowing. At C4-5, there is a small posterior disc-osteophyte complex without significant spinal canal or neural foraminal narrowing. There is no significant degenerative spondylosis at C2 through C5 or C7-T1. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: Degenerative spondylosis at C5-6 and C6-7 with indentation of the spinal cord and what may represent edema or myelomalacia, as well as severe bilateral neural foraminal narrowing at these levels.


Instruction: Generate impression based on findings.

Input: Clinical question:status post syncope. Signs and symptoms:status post syncopal episode. Unenhanced head CT: There is no evidence of any acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci and folia of cerebellum and vermis are more pronounced than is expected for patient's stated age of 57 and are concerning for underlying volume loss. Please correlate with history and patient's risk factors.These findings were observed on prior MRI examination from 2010.Calvarium is intact.Visualized mastoid air cells, paranasal sinuses are unremarkable with the exception of small osteoma in the left anterior ethmoid sinus.Images through the orbits are unremarkable.

Output: No evidence of acute intracranial findings.


Instruction: Generate impression based on findings.

Input: Female, 18 years old, status post craniotomy for prior right temporal lobe low-grade glio-neuronal seizure focus resection. The right anterior temporal lobe resection cavity is stable in size and morphology. T2 hyperintensity within the surrounding parenchyma is also unchanged. No pathologic enhancement is seen within or adjacent to the cavity.No other areas of parenchymal signal abnormality, edema or mass effect are seen. No pathologic intracranial enhancement is detected. The ventricles are stable in size and morphology. Lobular mucosal thickening is demonstrated in the maxillary sinuses.

Output: Stable postoperative findings with no evidence of lesion recurrence.


Instruction: Generate impression based on findings.

Input: -year-old admitted with sepsis. Findings no unwitnessed fall. Assess for cervical spine injury. There is widening of intervertebral disk space at C5 -- C6 level. There is also slight retrolisthesis of C5 in respect to C6. Extensive irregularity and loss of bony density of the inferior half of C5 vertebrae and to a lesser degree of C6 vertebrae is noted. Although these findings may represent advanced degenerative disk disease with associated endplate changes possibility of an infectious process cannot be entirely ruled out. Further follow-up with an MRI examination with infusion is highly recommended. There are no old studies for comparison. The findings are not believed to be post traumatic. No distinct bony fractures identified. The bony density of the rest of the spine and the alignment remains unremarkable. Degenerative changes at other levels with hypertrophic spur formation is noted. Degenerative changes causes neural foramina compromise at C3 -- C4 on the right, C4 -- C5 bilaterally and C5 -- C6 bilaterally. Limited images of the apices of the lungs are unremarkable.

Output: 1.Findings at C5 -- C6 as detailed above. Further evaluation with an infused MRI is recommended to exclude an infectious process.2.No definitive evidence of fracture.3.Minimal retrolisthesis of C5 on C6. 4.5.


Instruction: Generate impression based on findings.

Input: Reason: eval for pathology, compressive process. Hx of left sided pain, hypersensitivity. History: above The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disk desiccation present.There is marrow replacement within the C3 vertebral body without expansion and without contrast enhancement. A recent CT scan indicates that there is some sclerosis associated with thisAt 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. There is loss of disk space height, endplate reactive changes, uncovertebral osteophytes and a disk bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is signal change in sclerotic change within the C3 vertebral body. The possibility this is unrelated to underlying pathology such as a metastatic neoplasm cannot be excluded. An atypical hemangioma it is an alternative explanation. Please correlate with clinical history.2.There are some mild degenerative changes present in the cervical spine without significant compromise to the spinal canal or neural foramina .3.Findings were discussed with Dr Mok.


Instruction: Generate impression based on findings.

Input: 25-year-old male with history of ornithine transcarbamoylase deficiency as well as seizures, increased spasticity, and shuffling gate. There is no evidence of intracranial hemorrhage or mass. Diffusion weighted imaging of the anterior frontal lobes is somewhat limited due to extensive pneumatization of the frontal sinuses; however, no definite restricted diffusion is evident. There is slightly increased symmetric focal encephalomalacia affecting the bilateral frontal and parietal lobes in the juxtacortical zones, with associated gyriform cortical and subcortical increased T2 signal in these regions. These findings are superimposed on a background of diffuse leukoencephalomalacia, which is not substantially changed from the prior exam. The signal and morphology of the bilaterally hippocampi is unremarkable. There is no abnormal intracranial enhancement. There is marked ex vacuo dilatation of the lateral ventricles and moderate ex vacuo dilatation of the third ventricle, appearing similar to the prior examination. There is no midline shift or herniation. There are bilateral maxillary mucous retention cysts, increased from the prior exam. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1.Slightly increased focal symmetric encephalomalacia affecting the bilateral frontal and parietal lobe cortical zones, suggestive of prior infarction, perhaps watershed in nature, superimposed on a background of diffuse leukoencephalomalacia. These findings may be related to the patient's ornithine transcarbamoylase deficiency.2.Unchanged ex vacuo dilatation of the lateral and third ventricles.3.No intracranial mass, hemorrhage or acute infarction.


Instruction: Generate impression based on findings.

Input: Left knee pain and swelling. History of prior ACL reconstruction. MENISCI: The lateral meniscus appears intact. There is complex multidirectional tearing with fragmentation involving the posterior horn of the medial meniscus which has progressed compared to the prior examination. There is blunting of the body of the medial meniscus. The anterior horn of the medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Postsurgical changes of ACL reconstruction are present. Bone marrow signal intensity is otherwise within normal limits. There is mild diffuse thinning of the tibiofemoral articular cartilage without focal full-thickness defects. The previously described full-thickness cartilage defect of the lateral tibial plateau is not seen on this examination. There is moderate thinning and degeneration of the articular cartilage of the patellofemoral compartment without focal full-thickness defects.LIGAMENTS: The fibers of the ACL reconstruction graft appear grossly intact. The PCL is intact. The collateral ligaments are intact. EXTENSOR MECHANISM: Aside from postsurgical changes of quadriceps tendon harvest, the extensor mechanism is within normal limits.ADDITIONAL

Output: 1.Complex tearing and fragmentation of the posterior horn of the medial meniscus, progressed from prior.2.ACL graft appears intact.3.Additional findings as described above.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is a linear acute infarct involving the right centrum semiovale/coronal radiata. There is a punctate acute infarct in the left superior parietal lobule. There is an additional punctate acute infarct in the anterior right parahippocampal/fusiform gyrus. Tiny focus of hemorrhage seen in the right posterior frontal infarct. There is a 7 x 5 mm T2 hypointense old hemorrhage with susceptibility effect in the left middle cerebellar hemisphere on series 401 image 8. Additional scattered punctate foci of susceptibility effect are seen within the right and left frontal lobes.There is extensive periventricular and subcortical white matter T2 signal abnormality likely are presenting advanced chronic microvascular ischemic changes. There is an old right cerebellar hemisphere infarct with encephalomalacia. There is bilateral ethmoid and sphenoid sinus mucosal thickening with trace bilateral maxillary sinus mucosal thickening.MRA BRAIN: There is motion degradation of the source images somewhat limiting evaluation. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are grossly unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: There is mild motion artifact limiting evaluation. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of high grade stenosis (less than 50% by NASCET criteria bilaterally at the carotid bulbs). Both vertebral arteries are patent. There is limited visualization of the origins of the vertebral arteries due to artifact, however they appear grossly patent. The great vessel origins are otherwise intact.

Output: 1.Three small to punctate acute infarcts in the bilateral supratentorial brain as described above. Tiny focus of hemorrhage is also noted within the acute infarct in the right centrum semiovale.2.No flow limiting intracranial stenosis or aneurysm.3.No flow limiting stenosis in the neck.4.Multiple foci of susceptibility most compatible with chronic microhemorrhages, most prominent in the left middle cerebellar peduncle.5.Advanced chronic microvascular ischemic changes.Findings regarding acute infarcts were discussed with Dr. Cejas from Neurology over the telephone at 10:07 AM today.


Instruction: Generate impression based on findings.

Input: Assess for NMO flare: New pins/needles sensation. There has been marked interval decrease in the extent of the T2 hyperintensity and swelling in the upper thoracic spinal cord, now limited to the T3-4 level. Likewise, the associated abnormal enhancement has virtually resolved. There is no evidence of new spinal cord lesions. There is no evidence of intraspinal abnormal enhancement or mass lesions. There is lack of cervical lordosis, but no spondylolisthesis. The rest of vertebral column alignment is within normal limits. There is a small posterior disc osteophyte complex at C3-4, which nearly abuts the spinal cord. The vertebral body and disc space heights are preserved. There is a probable small hemangioma in the C3 vertebra. The vertebral bone marrow signal is otherwise unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Marked interval decrease in the extent of the inflammatory lesion in the upper thoracic spinal cord.2. A small posterior disc osteophyte complex at C3-4 nearly abuts the spinal cord.


Instruction: Generate impression based on findings.

Input: Male, 87 years old, with lesion to the head, squamous cell carcinoma. An ulcerated, enhancing mass is evident centered upon the left frontal scalp and subgaleal tissues. This lesion measures up to 38 mm in the transverse plane, up to 54 mm in the sagittal plane, and up to 16 mm in thickness.This lesion does invade the marrow space of the adjacent frontal bone. The inner cortex of the calvarium may be mildly thinned and some places, but no definite evidence of extension beyond the inner cortex is seen. The underlying dura remains thin and enhances normally. No evidence to suggest intracranial tumor extension is seen. No pathologic parenchymal or extra-axial enhancement is detected. Patchy periventricular T2 hyperintensity is evident, likely related to chronic microvascular ischemic disease. No restricted diffusion is seen.There is no evidence to suggest significant intracranial hemorrhage. No abnormal extra-axial fluid collections are detected. Ventricles and sulci are prominent indicating generalized parenchymal volume loss.

Output: An ulcerated tumor of the left frontal scalp is demonstrated compatible with the stated history of squamous cell carcinoma.This lesion does infiltrate the subjacent frontal bone with some thinning of the inner cortex of the calvarium, but no definite tumor extension beyond the inner cortex.No evidence of brain parenchymal metastatic disease is seen.


Instruction: Generate impression based on findings.

Input: 70-year-old male with back pain and abnormal CT For purposes of numbering, the lower-most level containing a well-formed disc is considered to be L5/S1. With this numbering nomenclature, there is L5 transitional anatomy, and the lower-most level containing ribs is T11. This is the same nomenclature utilized for the two comparison lumbar spine CT exams.There is normal lordotic curvature and alignment of the lumbar spine. The vertebral body heights are preserved. A chronic left L4 pars defect is better demonstrated by prior CT technique. No other fracture or destructive osseous lesion is seen.There is disc desiccation as well as mild disc height loss involving the L3-4 level and moderate disc height loss involving the L4-5 and L5-S1 levels. The paraspinal soft tissues are unremarkable.T12-L1 and L1-L2: No neural foraminal or spinal canal stenosis. These findings are unchanged.L2-L3: Mild disc bulge. Mild facet arthropathy. No spinal canal stenosis. Mild bilateral neural foraminal stenosis. These findings are unchanged.L3-L4: Diffuse annular disc bulge, moderate facet arthropathy, and ligamentum flavum hypertrophy. Moderate central, marked bilateral lateral recess, and moderate bilateral neural foraminal stenosis. These findings are unchanged.L4-L5: Evidence of prior partial laminectomy, at least on the left if not bilaterally. There is diffuse annular disc bulge with a superimposed right paracentral disc extrusion which extends below the disc level. There is also severe facet arthropathy and ligamentum flavum thickening. There is moderate to severe central, moderate to marked left lateral recess, marked right lateral recess, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis. These findings are unchanged.L5-S1: Mild disc bulge, severe facet, and severe arthropathy of the articulation between the L5 vertebral body and the sacral ala. No significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis with abutment and flattening of bilateral S1 nerve root sheath origins. These findings are unchanged.

Output: 1.For purposes of numbering, the lower-most level containing a well-formed disc is considered to be L5/S1. With this numbering nomenclature, there is L5 transitional anatomy, and the lower-most level containing ribs is T11. This is the same nomenclature utilized for the two comparison lumbar spine CT exams.2.L2-L3: Mild bilateral neural foraminal stenosis, unchanged.3.L3-L4: Moderate central, marked bilateral lateral recess, and moderate bilateral neural foraminal stenosis, unchanged.4.L4-L5: Moderate to severe central, moderate to marked left lateral recess, marked right lateral recess, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis, unchanged.5.L5-S1: Mild bilateral neural foraminal stenosis with abutment and flattening of bilateral S1 nerve root sheath origins, unchanged.


Instruction: Generate impression based on findings.

Input: There is a small cystic lesion involving the pineal gland which measures 5 x 8 x 4 mm. There is smooth enhancement involving the dependent aspect of the gland posteriorly. There is susceptibility effect which may be related to mineralization.There is a tiny left parietal developmental venous anomaly. Brain parenchyma is otherwise unremarkable without evidence of intracranial mass or mass effect. No evidence of infarct or hemorrhage. No hydrocephalus. No extra-axial collections. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: Small cystic lesion involving the pineal gland described above statistically likely represents a pineal cyst. No significant associated mass effect. Comparison can be made to prior imaging if made available. Brain parenchyma is otherwise within normal limits with small left parietal developmental venous anomaly again noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of left retromolar trigone treated with CRT and salvage surgery, with recent biopsy proven tumor recurrence. There are post-treatment findings in the left upper neck and aerodigestive tract region. There is an infiltrative mass in the left oral cavity and masticator space with involvement of the left retromolar trigone, left floor of mouth, left oral tongue, posterior left buccal region along the pterygomandibular raphe, left medial pterygoid muscle, and left mandible. Overall, the tumor measures up to approximately 5 cm. There is no evidence of significant cervical lymphadenopathy. However, there are mildly prominent upper mediastinal lymph nodes. The remaining major salivary glands are unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is a small amount of fluid within the left mastoid air cells. The cervical spine is intact. The imaged intracranial structures and orbits are grossly unremarkable.

Output: Findings compatible with tumor recurrence involving the left oral cavity and masticator space. No evidence of significant cervical lymphadenopathy. However, the assessment is limited by the lack of intravenous contrast administration.


Instruction: Generate impression based on findings.

Input: 60-year-old female status post fall, 2/28 with head trauma and negative CT head now with dizziness. No prior history of dizziness. Rule out subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Scattered diffuse white matter hypodensities consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered. No cortical stroke is seenThe ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate.


Instruction: Generate impression based on findings.

Input: Clinical question: Resolution of cervical diskitis and acute right osteomyelitis. Signs and symptoms: Cervical diskitis and vertebral osteomyelitis status post IV antibiotics. Pre-and post enhanced cervical MRI:Examination demonstrate interval complete resolution of T2 and T2 stir hyperintensity signal changes consistent with bone marrow edema of the vertebral bodies of C3 and C4. There is also no evidence of additional T2 hyperintensity of the intervertebral disk spaces. Trace faint enhancement of the disk space at C3 -- C4 is identified. There is no detectable abnormal epidural, leptomeningeal or perispinal soft tissue enhancement.Foramen magnum is unremarkable.C2 -- C3 demonstrate no spinal stenosis or neural foraminal compromise. C3 -- C4 demonstrate advanced disk disease with near complete loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes however results in flattening and posterior displacement of the cord and moderate central spinal stenosis as well as significant right and moderate left neural foraminal compromise.C4 -- C5 demonstrate advanced disk disease and loss of disk height, ventral hypertrophic changes and possible a central disk protrusion at this level results in significant mass effect and posterior displacement of the cord and central spinal stenosis. Significant bilateral neural foraminal compromise is also present. This appearance remains fairly similar to prior exam. There are punctate and linear foci of cord T2 hyperintensity similar to prior exam and consistent with cord myelomalacia. This finding is most noticeable at C4 -- C5 however it extends beyond this level.C5 -- C6 demonstrate mild to moderate disk disease and loss of disk height, broad-based bulging disk and a tiny central disk protrusion at this level results in significant flattening deformity and posterior displacement of the cord and moderate central spinal stenosis as well as significant bilateral neural foraminal compromise.C6 -- C7 demonstrate moderate to advanced disk disease and loss of disk height bulging disk and a central disk protrusion, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in significant bilateral neural foraminal compromise and moderate central spinal stenosis.C7 -- T1 demonstrate asymmetric right-sided moderate facet hypertrophic changes and moderate bilateral ligamentum flavum hypertrophy with resultant significant right neural foraminal compromise and no central spinal stenosis.Pre-and post enhanced thoracic MRI:Examination demonstrate normal anatomical alignment of vertebral column. There is no detectable abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges. Multi-level degenerative changes with tiny ventral hypertrophic change and bulging disks results in multilevel mild effacement of ventral subarachnoid space, however without evidence of spinal stenosis at any level. Mild neural foraminal compromise in mid to lower thoracic spine without significant change since prior exam.

Output: 1.Examination demonstrate interval resolution of bone marrow edema at C3 and C4 vertebral bodies without residual enhancement. Very subtle trace residual enhancement at C3 -- C4 disk level is detected. Cervical cord myelomalacia without interval change since prior exam as detailed. Very advanced degenerative changes of cervical spine with resultant multilevel significant central spinal stenosis and bilateral neural foraminal compromise as detailed per level above.2.Pre and post enhanced MRI of thoracic spine demonstrate no evidence of abnormal enhancement. No evidence of central spinal stenosis. Mild to moderate degenerative changes of cervical spine without significant change since prior exam as detailed above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hereditary hemorrhagic telangiectasia Arteriovenous malformation, site unspecifiedClinical question: Please evaluate for cerebral AVMsSigns and Symptoms: HHT screening 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, brainstem 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.

Output: 1.There is no evidence for intracranial arteriovenous malformation.2.Periventricular, brainstem 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: 72 year old female with a history of heart failure with reduced LV function, hypertension, s/p PVC ablation 10/18/16 of the basal anteroseptum. Referred for cardiac MRI for further evaluation Left VentricleThe left ventricle is moderately dilated and has mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 121 ml/m2 (normal range: 65+/-11), the LVEDV is 191 ml (normal range 109+/-23), the LV end systolic volume index is 62 ml/m2 (normal range 18+/-5), the LVESV is 98 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 68 g (normal range 114+/-24). There is mild hypokinesis of the basal anteroseptum. Previously demonstrated basal subendocardial delayed hyperenhancement has improved since last study. There is new focus of delayed hyperenhancement involving the basal anteroseptal portion of the LV, likely related to recent ablation procedure. The pre-contrast native myocardial T1 relaxation time is normal (~1000 ms). Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is mildly dilated and has low-normal reduced systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 101 ml/m2 (normal range 69+/-14), the RVEDV is 159 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall pleural effusions and basilar atelectasis. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated and has mildly reduced systolic function (LVEF 49%). There is mild hypokinesis of the basal anteroseptum. Previously demonstrated basal subendocardial delayed hyperenhancement has improved since last study. There is new focus of delayed hyperenhancement involving the basal anteroseptal portion of the LV, likely related to recent ablation procedure.2. The right ventricle is mildly dilated and has mildly reduced systolic function (RVEF 51%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate-severe chronic small vessel ischemic changes. More focal areas of chronic encephalomalacia is seen along the right frontal parietal region and the right occipital lobe, where there is minimal susceptibility likely representing chronic hemosiderin deposition. Postcontrast images are limited by patient motion. There is no definite pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.There is absence of the right internal carotid artery flow void within the provided field-of-view except for the supraclinoid portion which may be related to collateral flow. However contrast enhancement is noted in the right carotid on the postcontrast images without significant intrinsic T1 hyperintensity. Normal flow-voids are otherwise demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild scattered mucosal thickening in the maxillary sinuses.CERVICAL SPINE

Output: 1. No acute infarct. Moderate-severe chronic small vessel ischemic changes, advanced for the patient's stated age, with scattered areas of chronic infarct.2. Nonvisualization of the majority of the right internal carotid artery flow void within the field-of-view except for the very distal vessel, although enhancement is seen on post contrast images suggesting a component of collateral flow and likely chronic more proximal high-grade stenosis or near occlusion of the right internal carotid artery origin. Dedicated imaging of the neck vasculature may be obtained as clinically indicated for comparison may be made to prior outside imaging.3. Motion limited cervical spine exam. Essentially near complete fusion of C4 through C7 with focal likely adjacent level disease at C3-C4 resulting in moderate-severe central spinal canal stenosis as well as severe bilateral foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Female 22 years old with ileal Crohn's disease. Assess for active disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an approximately 10 cm segment of terminal ileum with mild enhancement and minimal striation but no surrounding fat stranding with an overall improved appearance compared to the previous exam. There is no dilation of the proximal small bowel, fistula or abscess. No additional sites of acute or chronic inflammation are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an approximately 10 cm segment of terminal ileum with mild enhancement and minimal striation but no surrounding fat stranding with an overall improved appearance compared to the previous exam. There is no dilation of the proximal small bowel, fistula or abscess. No additional sites of acute or chronic inflammation are identified.BONES, SOFT TISSUES: No findings to suggest perianal fistula.OTHER: No significant abnormality noted.

Output: Mild, predominantly chronic changes of 10 cm of terminal ileum overall improved since the previous exam.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Punctate left maxillary sinus retention cyst is present and there is minimal ethmoid sinus mucosal thickening.

Output: Normal MRI of the brain.


Instruction: Generate impression based on findings.

Input: Slurred speech, left hand weakness Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few scattered 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. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Minimal retrolisthesis is seen at C3 on C4. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.There is mild congenital narrowing of the spinal canal with superimposed degenerative changes as described below: At C2-3 there is a small central disk protrusion with no significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.At C3-4 there is no significant change in disc protrusion and facet osteophytes as well as ligamentum flavum hypertrophy which results in moderate-severe stenosis of the spinal canal. The thecal sac is effaced and there is flattening of the cord which demonstrates normal signal. There is moderate left and mild to moderate neural foraminal stenosis. At C4-5 there has been no significant change in the moderate to severe canal stenosis as result of the central disk protrusion. The thecal sac is effaced and the cord is mildly deformed. The cord demonstrates normal signal. There is mild to moderate left and mild right neural foraminal stenosis. At C5-6 there is a central disk protrusion, uncovertebral, and facet joint arthropathy which result in moderate canal stenosis including thecal sac effacement. The cord demonstrates normal signal. There is moderate to severe right greater than left neural foraminal stenosis.At C6-7 minimal disc bulge without significant spinal canal stenosis. There is mild right neural foraminal stenosis. No significant left neural foraminal stenosis.At C7-T1 there is a mild disk bulge which does not result in significant compromise of the spinal canal. There is mild bilateral neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of acute infarct or intracranial mass effect. Minimal chronic small vessel ischemic changes.2. Multilevel degenerative changes in the cervical spine with moderate to severe spinal canal stenosis at C3-C4, C4-C5, and C5-C6. Overall appearance is not significantly changed since 7/3/2013. Associated cord deformity is also similar to prior without new cord signal abnormality. Multilevel neural foraminal stenosis also appears similar, worst at the C5-C6 level where there is moderate to severe stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with GBM, status post surgery, RT and now on TMZ. Compared to outside institution MRI exam. Signs and symptoms: GBM. Pre and post enhanced brain MRI:Examination demonstrates post operative changes of a right posterior temporal-parietal craniotomy. A surgical cavity with CSF signal intensity in the right superior gyral of posterior temporal lobe measures at approximately 25 x 20 mm similar to prior exam. Extensive surrounding FLAIR hyperintensity without appreciable mass effect also remains nearly identical to prior exam. On post enhanced images there is a linear inhomogeneous enhancement along the posterior surgical cavity wall which considering the technique difference between the 2 exam (current study with thin slices compared to OSH exam of 6 mm slice thickness) demonstrate no convincing evidence of change. There is however a well-demarcated thick focus of enhancement along the anterior inferior aspect of the surgical cavity measuring at 4.5 mm in thickness and 6 mm at the base along the cavity wall which is highly concerning for focus of recurrence or residual tumor. This finding is barely detected on prior exam on post enhanced series 11 image 11. Unremarkable exam otherwise for patient's stated age of 73 and without evidence of any new findings.

Output: 1.A focus of enhancement in the right posterior temporal surgical cavity wall (anterior- inferior) concerning for residual or recurrence tumor, measuring 6 x 4.5 mm with significant interval increase since prior study.2.Postoperative changes of tumor removal in the right posterior temporal with stable thin however irregular band of enhancement along the posterior surgical cavity wall which could represent postsurgical change or residual tumor. Further follow-up is needed for further assessment.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils extend 5 mm below the level of the foramen magnum, similar to the prior study, again with moderate crowding at this level. The brainstem is again displaced ventrally at the foramen magnum.Previously noted central T2 hyperintensity within the cord, compatible with a syrinx, is again noted beginning at the level of mid C4 extending to at least T2. The inferior extent of the syrinx is not imaged. The maximal transverse dimensions are unchanged, again measuring 3 x 2 mm (image 25, series 601) at approximately the lower C6 level. Overall, the syrinx is unchanged in size and configuration.Straightening of the cervical spine is likely positional. The vertebral column alignment is otherwise within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.Findings again compatible with Chiari I malformation. The cerebellar tonsils extend 5 mm below the level of the foramen magnum.2.No significant change in the imaged portion of the cervical syrinx, however the inferior extent is not imaged.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with known right breast cancer presents for further evaluation of a satellite lesion and intramammary lymph nodes detected on MRI dated 3/29/2016. A targeted right ultrasound was performed areas of clinical concern.In the upper outer quadrant of the right breast, superior to the index malignancy, there are two intramammary lymph nodes identified, correlating to the MRI. Both lymph nodes are normal in size measuring 5 mm and 6 mm, respectively. Both lymph nodes demonstrate normal morphology with hilar flow. These have been stable dating back to mammogram 2/4/2014.The known index malignancy in the upper outer quadrant, posterior depth is revisualized, with biopsy clip seen centrally. Immediately inferior and slightly lateral to the index malignancy there is a 5 x 5 x 6 mm oval mass with mild peripheral vascularity, consistent with the satellite lesion seen on MRI. This is seen approximately 1.4 cm inferior to the index malignancy.

Output: (1) Normal size and morphology right upper outer quadrant intramammary lymph nodes. (2) Approximately 1.4 cm inferior to the known index malignancy, an oval mass measuring up to 6 mm is identified correlating with the satellite lesion seen on MR. Management options for this lesion could include inclusion in a lumpectomy via ultrasound guided needle localization versus ultrasound guided biopsy and clip placement with subsequent localization of the biopsy clip at the time of surgery. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Volar wrist mass Within the volar soft tissues of the forearm is a well-circumscribed mass measuring 3.7 x 3 x 7.8 cm in the greatest transverse, AP, and craniocaudal dimensions. Within the mass are very thin septations but no solid nodular components and demonstrates fat signal intensity on all sequences. The mass also causes mild displacement of the median nerve which otherwise appears normal. The signal and caliber of the surrounding flexor musculature is normal. There is a mild amount of increased marrow signal intensity within the distal ulna near the ulnar styloid which is of uncertain clinical significance. The marrow signal intensity of the radius and ulna are otherwise normal. Although not tailored for the evaluation of the tendons, the flexor and extensor tendons appear grossly unremarkable.

Output: Soft tissue mass within the distal forearm demonstrates imaging characteristics most consistent with a lipoma. Note that contrast was not administered for this exam but there are no discrete nodular component identified.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collections are identified. Incidental note is made of prominence of the subarachnoid space along the vertex, which is unlikely to be of current clinical significance.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: No definitive findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Transient right-sided weakness and aphasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular white matter and punctate left thalamocapsular junction T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and mastoid air cells are grossly unremarkable. However, there is an ovoid T2 hyperintense and T1 hypointense lesion in the posterior neck subcutaneous tissues, which measures up to 25 mm and likely represents a sebaceous cyst. Likewise, a subcentimeter T1 and T2 hypointense nodule in the left frontal scalp may represent an inclusion cyst. There is also a partially-imaged left parotid tail mass that measures at least up to 21 mm. There is a punctate right maxillary sinus retention cyst.

Output: 1. Mild periventricular white matter and punctate left thalamocapsular junction T2 hyperintensity may represent chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A partially-imaged left parotid tail mass may represent a Warthin tumor, but is incompletely characterized. Dedicated imaging of this region may be useful.


Instruction: Generate impression based on findings.

Input: 26 year old man s/p heart transplant referred to evaluate for rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%. The LVEDV is 142 ml (normal range 142+/-34), the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVESV is 48 ml (normal range 47+/-19) and the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9). The LV mass is 168 g (normal range 164+/-36) and the LV mass index is 74 g/m2 (normal range 85+/-15). 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.The native T1 myocardial relaxation time is 1096ms in the basal interventricular septum, which is upper limits of normal. There is no LV thrombus. Left AtriumThe left atrium shows changes consistent with cardiac transplant.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%. The RVEDV is 140 (normal range 142+/-31), RV end diastolic volume index is 61ml/m2 (normal range 82+/-16), the RVESV is 56ml (normal range 54+/-17), and the RV end systolic volume index is 24ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Normal left ventricular size and systolic function (LVEF 66%).2.Normal right ventricular size and systolic function (RVEF 60%).3.No late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.


Instruction: Generate impression based on findings.

Input: Patient with a T12 bone lesion and left paraspinous lesion previous confined by an and the aspiration. Differential is infection and tumor. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion and the paraspinous soft tissue collection.

Output: T12 vertebral bone biopsy under CT guidance. A total of three samples were delivered to pathology for analysis and 5 bone samples and a 2mL aspirate from a paraspinous collection were sent to microbiology for analysis.


Instruction: Generate impression based on findings.

Input: 45-year-old female with severe pain and history of avascular necrosis. Evaluate for avascular necrosis. There is a curvilinear band of abnormal signal within the right femoral head indicating avascular necrosis. The band extends from the medial aspect of the femoral head just above the fovea to the lateral aspect of the femoral head indicating involvement of the majority of the weight-bearing surface. Mild edema of the adjacent bone on T2 weighted images is noted; the majority of the necrotic segment maintains fat signal on the T1-weighted images. There is a tiny step off along the anterior/superior aspect of the femoral head suggestive of minimal articular surface collapse that we suspect is chronic. Otherwise the shape of the femoral head is maintained. Small right hip joint effusion, which is not uncommon in patients with avascular necrosis. Mild degeneration of the articular cartilage along the anterior/superior aspect of the acetabulum. The anterior labrum is partially separated from the underlying acetabulum from the 3 to 4 o'clock position just superior to the transverse acetabular ligament. We suspect this represents normal variant recess rather than a tear.On the large field of view images, evaluation of the left hip is limited due to metallic susceptibility artifact from the total hip arthroplasty. Note is made of residual red marrow but no focal abnormalities are seen. The musculature is within normal limits.

Output: Avascular necrosis and other findings as above.


Instruction: Generate impression based on findings.

Input: Metastatic lung caner the to brain: followup scan. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged patchy cerebral white matter T2 hyperintensity bilaterally. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is an unchanged nonspecific subcentimeter focus of enhancement in the left occipital bone.

Output: Post-treatment effects in the brain, without evidence of active intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: MRI brain: There is no diffusion abnormality. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, but also in the anterior temporal lobes in the high frontal vertex. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are several punctate foci of susceptibility predominantly in the bilateral basal ganglia indicating chronic microhemorrhage. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA brain: Motion degraded exam. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. Bilateral small P-comm arteries are present. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. No evidence of acute ischemia.2. Numerous white matter lesions are seen, predominantly in the periventricular regions but also in areas less typical for routine small vessel ischemic disease. Atypical vasculopathy or arteriopathy such as CADASIL would be in the differential in addition to other non-vascular inflammatory processes.3. Motion degraded MRA. No significant intracranial vaso-occlusive disease.