Instruction: Generate impression based on findings.

Input: There is no abnormal intracerebral enhancement to suggest metastatic disease. There is an enhancement in the right side of the soft palate extended to the right side of oropharynx due to post surgical changes. No significant interval change since prior Neck CT scan performed on Sep 4 2015.There is chronic infarction of the right middle frontal gyrus and the left superior parietal lobe. There are foci of T2/FLAIR hyperintensities in the subcortical and the periventricular white matter, which are nonspecific, but most likely consistent with chronic small vessel ischemic changes. There is no susceptibility or diffusion abnormalities.There is age related volume loss. The ventricles and the sulci are prominent. There is no midline shift. Basal cisterns are patent.Fluid is seen in the right mastoid air cells.

Output: 1. There is no intracerebral metastatic lesions.2.There is chronic infarction of the right middle frontal gyrus and the left superior parietal lobe. 3. Chronic small vessel ischemic changes. 4. Age-related volume loss.


Instruction: Generate impression based on findings.

Input: There is no abnormal signal within spinal cord. There is multilevel spondylosis in cervical spine with apparent neural foraminal narrowing at several of these levels however, this cannot be completely characterized on this limited study. There is also slight indentation upon the cervical spinal cord at the C3-4 level secondary to a disc-osteophyte complex. There are scattered small disc-osteophyte complexes in the upper thoracic spine with mild eccentric right indentation upon the spinal cord at T5-6. There are small disc bulges at multiple levels in the lumbar spine. In particular, at L5-S1, a disc bulge results in moderate bilateral neural foraminal stenosis. There are subcentimeter hemangiomas or areas of focal fat in the thoracic and lumbar vertebral bodies at T3, L1, and L3. High T2 signal within the inferior aspect of T8 and superior aspect of T9 are likely related to endplate degenerative changes. The vertebral heights and alignment are preserved. The paraspinal soft tissues are unremarkable.

Output: 1.Multilevel degenerative cervical spondylosis with slight indentation upon the spinal cord at the C3-4 level.2. Scattered small disc-osteophyte complexes in the upper thoracic spine with mild eccentric right indentation upon the spinal cord at T5-6. 3. Multilevel spondylosis with moderate bilateral neural foraminal stenosis at L5-S1, but no evidence of cauda equina compression.4. No evidence of spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 81-year-old male status post AAA repair, intubated with decreased responsiveness. There is no evidence of intracranial hemorrhage, mass or edema. Small focal decreased hypointensity within the periventricular white matter may represent small vessel ischemic disease, age indeterminate. No evidence of acute intracranial ischemia/infarction; however, CT is insensitive in the early detection of CVA , if there is clinical suspicion for stroke, MRI may be consideredThe ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base demonstrate multiple small ill-defined lucencies concerning for metastatic/metabolic disease. A partial empty sella is present. The visualized paranasal sinuses and mastoid air cells demonstrate mild mucosal thickening.Postsurgical changes of cataract surgery present bilaterally.

Output: No evidence of acute intracranial ischemia/infarction; however, CT is insensitive in the early detection of CVA , if there is clinical suspicion for stroke, MRI may be considered


Instruction: Generate impression based on findings.

Input: Reason: history of UC and PSC. elevated lipase History: nausea, vomiting, abdominal pain ABDOMEN:LUNG BASES: Left basilar atelectasis.LIVER, BILIARY TRACT: Irregularity of the intrahepatic and extrahepatic biliary ducts compatible with patient's history of PSC. Intrahepatic and extrahepatic biliary ductal dilatation increased compared to prior MRCP. Common bile duct dilatation measures up to 12 mm, previously 8 mm. No focal hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic inflammation. No pancreatic mass. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Biliary ductal irregularity and dilatation has increased slightly compared to prior MRCP compatible with history of PSC. 2.No focal hepatic lesion. 3.No specific evidence of acute pancreatitis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Tension-type headache, unspecified, not intractableClinical question: Eval for structural lesionsSigns and Symptoms: trauma and headaches MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There appears to be a transitional vertebra. Assuming that the L1-2 disc spaces at the level of the left renal vein this transitional vertebra would represent partial lumbarization of S1.At S1-S2 there is no significant compromise to spinal canal or neural foramina.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is heterogeneous signal present along the right sacral alla which is incompletely assessed on this exam. It is bright on T2-weighted imaging and dark on T1. This suggests possible edema

Output: 1.No stigmata of intracranial traumatic brain injury are appreciated. MRI of the brain is within normal limits.2.There is no significant compromise to lumbar spinal canal or exiting nerve roots. There are no stigmata of trauma to the lumbar spine appreciated. There are minimal degenerative changes present in the lumbar spine. Please note that findings suggest a transitional vertebra which was labeled S1 for the purpose of this exam. This may confound enumeration of lumbar vertebrae.3.There is heterogeneous signal present along the right sacral Alla. It is incompletely evaluated on this exam. Additional imaging or comparison with any available imaging such as plain films may be of further benefit in evaluating this if clinically appropriate.


Instruction: Generate impression based on findings.

Input: Pain after injury MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Increased T2 signal is seen within the lateral tibial plateau. A discrete fracture line is not identified however. Mild edema is also noted in the lateral femoral condyle posteriorly.LIGAMENTS: The ACL is absent. The remaining ligaments of the knee are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. ACL rupture.2. Contusions of the lateral tibial plateau and lateral femoral condyle without discrete fracture line identified.3. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: History of retroperitoneal fibrosis, evaluate for disease recurrence PELVIS:UTERUS, ADNEXA: Fibroid uterus, leiomyomas measure up to approximately 1.3 cm, endometrial complex normal in size.BLADDER: No significant abnormality noted.LYMPH NODES: Small subcentimeter bilateral external iliac lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild circumferential mildly enhancing soft tissue signal in region of distal abdominal aorta, beyond level of origin of inferior mesenteric artery and extending to level of common iliac bifurcation, associated restricted diffusion present (image 101 series 9). In distal abdominal aortic area, signal abnormality appears to encircle aorta approximately 180 degrees or less. This area described was not imaged in its entirety on prior 4/10/14 exam but demonstrates significant improvement since earlier 12/28/12 outside MRI, for example, portion of thickening previously measuring up to 6 mm now measures 3 mm.

Output: 1. Circumferential soft tissue signal in aortobiiliac area as described, corresponding to patient's history of retroperitoneal fibrosis.


Instruction: Generate impression based on findings.

Input: There are post-treatment findings, including a defect in the right lateral temporal lobe. There is interval evolution of the signal characteristics of some of the cystic components of the craniopharyngioma, without significant interval change in the overall size of the tumor, which spans the sella, suprasellar cistern, and other adjacent cisterns, and measures up to approximately 45 mm. The basilar artery is tortuous and encased by the tumor and there is persistent mild mass effect upon the surrounding brain and brainstem. There is asymmetric volume loss of the left cerebellar hemisphere associated with increased T2 signal, which may be attributable to crossed cerebellar diaschisis versus chronic ischemic effects. There is a right transfrontal catheter with the tip in the right prepontine cistern. The ventricular system appears to be unchanged in size. The skull and orbits appear unchanged.

Output: Post-treatment findings related to a complex craniopharyngioma, without significant interval change in size of the tumor or the shunted ventricular system.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged ill-defined subtle somewhat linearly configured T2 hyperintensity within left parietal white matter as well as within the white matter adjacent to both occipital horns, greater on the right. There are no additional areas of abnormal parenchymal signal; specifically no juxtacortical or infratentorial white matter lesions.The ventricles and basal cisterns are normal in size and configuration. There is a prominent extra-axial CSF space within the anterior left temporal fossa that likely represents an arachnoid cyst, with mild localized mass effect. There is no diffusion restriction. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1.Stable signal abnormality within the left periatrial and right greater than left occipital periventricular white matter. The appearance is nonspecific with differential diagnosis including primarily gliosis perhaps from prior infection/inflammation or ischemia, and demyelinating disease. Due to multiplicity of findings and stability, neoplastic process is felt to be unlikely.2.Left anterior temporal fossa presumed small arachnoid cyst with mild localized mass effect.


Instruction: Generate impression based on findings.

Input: Redemonstrated are at least 5 punctate to small foci of susceptibility hypointensity within the supratentorial brain, as well as a punctate focus in the right pons. The largest of these is present within the anterior left temporal lobe measuring 9 mm AP x 11 mm transverse x 11 mm craniocaudal dimension (as measured on T2 sequences). None demonstrate perilesional edema. There are no associated developmental venous anomalies. There are no new lesions. These findings are stable.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Redemonstrated are at least 5 punctate to small foci of susceptibility hypointensity within the supratentorial brain, as well as a punctate focus in the right pons, consistent with the provided history of familial cerebral cavernous malformations. The largest of these is present within the anterior left temporal lobe measuring 9 mm AP x 11 mm transverse x 11 mm craniocaudal dimension (as measured on T2 sequences). None demonstrate perilesional edema. There are no new lesions. These findings are stable.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for hematoma, either compression of nerve roots, specifically at postoperative T12-L5. Signs and symptoms: L3, L4 and L5 weakness. Pre- and post enhanced lumbar MRI:Moderate dextroscoliosis of lumbar spine centered at L1-L2 level is noted. There is mild right lateral subluxation of L2 on L3 and L3 on L4 levels.T10-T11 demonstrate degenerative changes with mild central spinal stenosis and no significant neural foraminal compromise.T11-T12 demonstrate moderate disc disease without spinal stenosis or significant neural foraminal compromise.T12-L1 demonstrate moderate disc disease and without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate postoperative changes and including a disc space prostheses. No spinal stenosis however mild to moderate left lateral recess and left neural foraminal compromise secondary to scoliosis and asymmetric left-sided hypertrophic changes is noted. There is a tiny left lateral disc protrusion (axial T2 series 501 image 38 and sagittal T2 series 801 image 13) with resultant mild compression effect on the thecal sac is also noted.L2-L3 demonstrate advanced disc disease and significant loss of disc height, no spinal stenosis or neural foraminal compromise. Disc space prosthesis is identified.L3-L4 demonstrate moderate disc disease and loss of disc height, disc space prosthesis is present. There is mild asymmetric right-sided facet hypertrophic changes result in mild to moderate right neural foraminal compromise and no evidence of central spinal stenosis.L4-L5 demonstrate mild disc disease and mild facet and ligamentum flavum hypertrophy. There is a disc space prosthesis at this level. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate mild disc disease and degenerative changes of posterior elements without spinal stenosis or neural foraminal compromise.There is no evidence of epidural hemorrhage as is questioned clinically.There is mild increased T1 hyperintensity of the right psoas muscle suggestive of fatty infiltrate and possible atrophy. No evidence of spinal hemorrhage or mass effect. The visualized abdominal aorta demonstrate normal caliber and signal intensity.Post enhanced images demonstrate subtle expected enhancement of degenerative changes and including mild enhancement along the adjacent endplates to L1-L2 disc level.

Output: 1.Examination demonstrate no findings to account for patient's symptomatology.2.Postoperative changes and including disc space prostheses as detailed above and without evidence of complication.3.No evidence of central spinal stenosis at any level.4.Neural foraminal compromise secondary to degenerative changes and an alternating pattern related to scoliosis as detailed. 5.Expected enhancement of the degenerative changes and unremarkable post contrast images otherwise.


Instruction: Generate impression based on findings.

Input: 44-year-old male patient with newly diagnosed prostate cancer. Staging examination.PSA of 3.7 ng/mL on a routine screening in July 24, 2015 A prostate biopsy was performed and revealed a Gleason 3+3 =6 in six cores. The positive findings were primarily on the right lobe with maximum involvement of 50%. Prostate biopsy parameters:RLB 3+3=6 42%RLM 3+3=6 37%RLA 3+3=6 50%RB 3+3=6 19%RA 3+3=6 37%LA 3+3=6 17% PELVIS:PROSTATE:Prostate Size: 4.5 x 2.9 x 3.4 cm (ML x AP x CC).Peripheral Zone: There is bilateral multifocal cancer. In the left mid gland there is a focus of decreased T2 and ADC signal intensity that measures 3 x 8 mm (series 701 image 17) that extends towards the apex.In the right mid peripheral zone there is a focus of decreased T2 and ADC signal intensity that measures 4 x 6 mm (series 701 image 17).Central Gland: No suspicious lesions.Seminal Vesicles: There is no extension into the seminal vesicles.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Small scattered subcentimeter lymph nodes.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No significant abnormality noted.

Output: 1.Multifocal bilateral cancer foci as described above without evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Low back painIMAGE ACQUISITIONS: Lumbar spine CT without contrast Lumbar spinal alignment is normal. Vertebral body heights are intact. Intravertebral disk spaces are normal.T12-L1: No neuroforamina or central canal stenosis.L1-2: No neuroforamina or central canal stenosis.L2-3: There neuroforamina worse central canal stenosis.L3-4: Diffuse disk bulge without central canal stenosis. No neuroforamina stenosis.L4-5: Diffuse disk bulge without central canal stenosis. Questionable right lateral disk protrusion. Neural foraminal narrowing bilaterally.L5-1: Diffuse disk bulge without central canal or neuroforamina stenosis.In the sacrum, there is a large low attenuation lesion with extension into the retroperitoneum. This is a biopsy-proven schwannoma. We would prefer MRI with contrast to further evaluate this lesion if clinically warranted.

Output: 1. Degenerative disease as described above2. Sacrum schwannoma


Instruction: Generate impression based on findings.

Input: Reason: underlying lesion of SAH History: SAH. There is increased T1 signal in the right cerebellum corresponding to subacute hemorrhage seen on the prior exams. This is associated with mild increased T2 signal. Hemorrhage is seen along the posterior aspect of the right cerebellum extending into the cisterna magna as well as within the right ambient cistern. Fluid in the occipital horns of the lateral ventricles also likely represents subacute hemorrhage and is similar to the prior exam. No abnormal signal is seen within the left frontal lobe to correspond with finding on prior CTs. Susceptibility along the tentorium bilaterally is likely the result of hemorrhage.There is no evidence of mass, however due to the lack of postcontrast sequences, an underlying lesion in the right cerebellum at the site of hemorrhage cannot be excluded. Prominent ventricles and sulci suggest mild atrophy. Scattered punctate subcortical and periventricular T2 hyperintensities without diffusion restriction are nonspecific but likely represent mild small vessel ischemic disease. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Dysplastic maxillary sinuses with mucosal thickening

Output: 1.Limited exam, which was terminated prior to pre and postcontrast T1 and MRA sequences due to patient claustrophobia.2.Overall stable right cerebellar hemorrhagic contusion and subarachnoid hemorrhage. Due to lack of postcontrast and MRA sequences, and underlying mass or vascular anomaly in the right cerebellum cannot be excluded.3.Mild chronic small vessel ischemic disease and atrophy.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness. History of multiple sclerosis, with reportedly previous MRI showing characteristic Dawson's fingers.IMAGE ACQUISITIONS: 5-mm contiguous axial CT sections of the brain without contrast infusion. No acute intracranial hemorrhage, mass effect or shift of midline structures. As on the previous head CT, there is multifocal white matter low attenuation, compatible with history of multiple sclerosis. There has likely been some interval progression compared to the previous CT scan, although the previous scan was somewhat degraded by patient motion and part of the apparent difference could be due to higher diagnostic quality of the current scan. There is no hydrocephalus. There are no subdural fluid collections.Some of the lesions in the left hemisphere are orientated anterior to posterior, which can be found with borderzone infarction, and the lesions are more prominent in the left hemisphere. It is not possible to definitively exclude superimposed ischemic lesions. If there is clinical concern for recent infarction or acute worsening of multiple sclerosis, MRI would be more sensitive.

Output: 1. No acute intracranial hemorrhage.2. slight interval worsening of white matter disease versus greater conspicuity of lesions due to motion artifact on the previous CT scan. Follow-up as indicated clinically.


Instruction: Generate impression based on findings.

Input: Vertigo and coagulation abnormalities, and headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are scattered paranasal sinus secretions and possible retention cyst formation in the left maxillary sinus. There are also polypoid opacities in the nasal cavity.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings suggestive of sinonasal polyposis and sinusitis.


Instruction: Generate impression based on findings.

Input: Loss of hand dexterity with worsening balance. Evaluate for spinal stenosis. There is moderate anterolisthesis of C3 on C4, measuring 6 mm. There is mild retrolisthesis of C4 on C5 and C5 on C6. The vertebral body heights are preserved. There is disc dessication with severe loss of disc height at C4-C5 through C6-C7. The vertebral bone marrow signal is benign. There is a 14 mm T2 hyperintense lesion in the subcutaneous fat of the back just right of midline (seen on the sagittal STIR) and a 19 mm T2 hyperintense lesion in the subcutaneous fat of the left posterior neck. The paravertebral soft tissues are otherwise unremarkable.C2-C3: Small posterior disc-osteophyte complex, bilateral facet degenerative changes and thickening of the ligamentum flavum, but no significant spinal canal or foraminal stenosis.C3-C4: Moderate anterolisthesis of C3 on C4 with pseudo disc bulge, bilateral facet degenerative changes and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis, mild right and mild to moderate left foraminal stenosis. There is cord impingement at this level with subtle increased T2 signal.C4-C5: Posterior disc-osteophyte complex with central disc protrusion, bilateral uncinate spurs, bilateral facet degenerative changes and thickening of the ligamentum flavum, contributing to moderate spinal canal stenosis and moderate bilateral foraminal stenosis. There is flattening of the cord ventrally.C5-C6: Posterior disc-osteophyte complex, bilateral uncinate spurs, bilateral facet degenerative changes and thickening of the ligamentum flavum, contributing to mild to moderate spinal canal stenosis, moderate right and mild left foraminal stenosis. C6-C7: Posterior disc-osteophyte complex with central disc protrusion, bilateral uncinate spurs, bilateral facet degenerative changes and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis, moderate right and mild left bilateral foraminal stenosis. C7-T1: No significant disc bulge, herniation, spinal canal or foraminal stenosis.

Output: 1. Advanced degenerative changes of the cervical spine with grade 2 anterolisthesis of C3 on C4, contributing to severe spinal canal stenosis and cord impingement with associated subtle increased T2 cord signal at this level likely representing myelomalacia. 2. Moderate spinal canal stenosis at C4-C5 and C5-C6 and to a lesser degree at C6-7. 3. Variable multilevel foraminal stenoses and facet arthropathy as detailed above.4. 14 mm lesion in the right paramidline subcutaneous fat of the back (seen on sagittal STIR) and a 19 mm lesion in the left posterior neck subcutaneous fat, which may represent sebaceous cysts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 36-year-old female with history of hypertension presents with headache. On Plavix. There is no evidence of intracranial hemorrhage, mass or edema. Questionable periventricular small vessel disease that may be an artifact due to volume averaging. Follow-up MRI may be considered to evaluate for small vessel disease if clinically indicated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Questionable small vessel disease. MRI may be considered for further evaluation if clinically indicated.2.Otherwise normal examination.


Instruction: Generate impression based on findings.

Input: History of prostate cancer (right apex 2008) status post brachytherapy now with rising PSA. Recent positive left-sided biopsy. Preoperative evaluation prior to laser ablation. PELVIS:PROSTATE:Prostate Size: 4.6 x 4.1 x 3.3 cmPeripheral Zone: There is diffusely heterogeneous low T2 signal throughout the peripheral zone, limiting evaluation. There is susceptibility artifact throughout the prostate related to brachial therapy seeds.Within the left base there is confluent low T2 signal which extends into the transitional zone. This is associated with restricted diffusion (series 604 image 484) as well as early contrast enhancement (series 1501 image 2657). The abnormal signal extends cranially and medially to abut the internal urethral sphincter. Appearance is compatible with tumor.There is an additional focus of low T2 signal in the posterior mid gland (series 801 image 20). This however does not have associated abnormality on the diffusion-weighted and contrast images and is therefore equivocal for an additional site of tumor.Central Gland: Cystic changes related to benign prostatic hypertrophy. There is mild dilatation of the prostatic urethra; correlate with prior TURP.Seminal Vesicles: Unremarkable.Extracapsular Extension: Abnormal signal abuts the superior and posterior aspects of the left peripheral zone capsule, however there is no definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Abnormal signal in the left peripheral zone base compatible with tumor. The abnormal signal abuts the internal urethral sphincter and the capsule wall, but there is no definite extracapsular extension or evidence of metastatic disease.2.Additional small focus of T2 signal abnormality in the mid gland without associated restricted diffusion or contrast enhancement is equivocal for another site of tumor involvement.


Instruction: Generate impression based on findings.

Input: Memory problems: forgetfulness, cognitive decline. There appears to be minimal diffuse cerebral volume loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal retention cyst formation within the maxillary sinuses.

Output: Perhaps minimal diffuse cerebral volume loss. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Left upper extremity numbness and weakness. There are postoperative findings related to right transfrontal biopsy of the medullary and upper cervical spinal cord lesion, which has decreased in size and demonstrated considerably less enhancement. There is high T2 signal and enhancement along the biopsy tract in the right frontal lobe, but no additional lesions within the brain, There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The paranasal sinuses and orbits are unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Interval decrease in size and enhancement of the medulla and upper cervical spine cord lesion.


Instruction: Generate impression based on findings.

Input: Reason: progressive vision loss for the past few years History: progressive vision loss for the past few years MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Similar punctate lesions are present in the ponsNo abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Some of the images are degraded by patient motion

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions are present in the pons which are most likely vascular related at this age.3.No abnormal lesions are appreciated within the orbits.4.Some of the images are degraded by patient motion which could obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 29 year old man with Tetralogy of Fallot s/p pulmonic valve replacement. Now with significant pulmonic valve stenosis and regurgitation, biventricular failure, and a possible RA/RV mass noted on echo. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 254 ml (normal range 142+/-34), the LV end systolic volume index is 82 ml/m2 (normal range 25+/-9), the LVESV is 188 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 133 g (normal range 164+/-36). There is systolic flattening of the interventricular septum suggesting increased RV systolic pressure. A ventricular septal defect patch is noted in the membranous septum and there is no evidence of residual VSD. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is severely dilated and hypertrophied with severely reduced systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 202 ml/m2 (normal range 82+/-16), the RVEDV is 462 ml (normal range 142+/-31), the RV end systolic volume index is 160 ml/m2 (normal range 31+/-9), and the RVESV is 368 ml (normal range 54+/-17). No mass or thrombus is noted in the RV, the finding seen on echocardiography likely represents prominent muscular bands.Right AtriumThe right atrium is severely dilated without evidence of thrombus or mass.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe bioprosthetic valve is noted in the pulmonic position. There is significant flow acceleration through the pulmonic valve consistent with at least moderate pulmonic valve stenosis. There is severe pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate to severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. An over-riding aorta is noted. The aortic root is dilated. The maximum dimension of the sinus of Valsalva is 39mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated. The RPA is normal in size. The LPA is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. Mild LV dilation with severely reduced systolic function (LVEF 26%). 2. Severe RV dilation and hypertrophy with severely reduced systolic function (RVEF 20%).3. Mild LA dilation4. Severe RA dilation.5. At least moderate to severe tricuspid regurgitation.6. Severe bioprosthetic pulmonic valve regurgitation with at least moderate pulmonic valve stenosis.7. Moderate dilation of the main pulmonary artery.8. Mild aortic root dilation.9. No right atrial or right ventricular mass or thrombus present. Echocardiographic findings likely represent prominent muscular bands. At the time of interpretation, the MRA and late gadolinium enhancement images were not available for review due to image transfer problems. An addendum will be added after those components are available for interpretation.


Instruction: Generate impression based on findings.

Input: Pineal mass: headaches and vertigo. There is a cystic pineal gland that measures up to 10 mm, without nodular enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus rentention cyst.

Output: A cystic pineal gland that measures up to 10 mm may represent benign cystic degeneration.


Instruction: Generate impression based on findings.

Input: 53-year-old female with idiopathic recurrent acute pancreatitis. EUS was negative for pancreatic mass. MRCP with secretin to assess the pancreatic duct and pancreatic parenchyma. Rule out pancreatic duct stricture. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild decreased signal intensity of the pancreatic parenchyma on precontrast T1 sequence. No pancreatic ductal dilatation or focal stricture. No suspicious parenchymal mass. No surrounding inflammatory change or drainable fluid collection. Appropriate response to secretin including pancreatic ductal distention and duodenal filling. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild decreased signal intensity of the pancreatic parenchyma on precontrast T1 sequence. No pancreatic ductal dilatation, stricture, or parenchymal lesion. Appropriate response to secretin.


Instruction: Generate impression based on findings.

Input: 67 year old man with history of AL amyloid, referred for evaluation of cardiac amyloidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 126 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 38 ml (normal range 47+/-19), the LV mass index is 41 g/m2 (normal range 85+/-15), and the LV mass is 78 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The native myocardial T1 time in the interventricular septum is 1093 ms. Values between >1100 may indicate possible cardiac amyloid. There is a possible area of late gadolinium enhancement in the mid-myocardial lateral wall in a pattern that is not typical of myocardial infarction. This pattern is also not typical of amyloidosis. It could suggest an suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is free of late gadolinium enhancement and is viable.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 133 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 46 ml (normal range 54+/-17).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 mild 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 FindingsThere are multiple lesions in the liver the largest measuring 7.9 x 8cm. Recommend clinical correlation and consideration of further dedicated abdominal imaging (ultrasound or CT) This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 70%2. There is a possible small area of late gadolinium enhancement in the mid-myocardial lateral wall in a pattern that is not typical of myocardial infarction or cardiac amyloidosis.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%4. Multiple well-circumscribed lesions noted in the liver. If clinically indicated, a separate dedicated evaluation should be considered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Assess for changes in hepatic adenomas. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size, measuring 19.2 cm in craniocaudal dimension. There is diffuse fatty infiltration of the liver.No intra or extrahepatic biliary ductal dilatation.Status post cholecystectomy.The right hepatic lobe lesions demonstrate homogeneous T2-weighted hyperintensity with the largest measuring 1.2 x 0.9 cm in segment 8 (series 3/32), compared to 1.2 x 1.1 cm previously and 1.2 x 0.8 in segment 7 (series 3/32) compared to 2.2 x 2.0 cm previously. Additional more posterior segment 7 subcentimeter lesion is present, not significantly changed. The lesion at the hepatic dome measures approximately 5 mm (series 3/13), compared to 1.1 x 0.9 cm previously. The lesions demonstrate homogeneous arterial enhancement with no retention of contrast on the hepatobiliary phase compatible with small adenomas.The partially exophytic segment 2 lesion measures 4.5 x 4.0 cm (series 9/28), compared to 5.4 x 4.6 cm previously, and demonstrates heterogeneous T2 mild hyperintensity, is isointense to the liver on T1-weighted imaging, contains no intralesional fat and demonstrates homogeneous arterial enhancement which persists in the portal venous phase and delayed/equilibrium phase. In the hepatobiliary phase the lesion demonstrates heterogeneous retention of contrast, compatible with focal nodular hyperplasia. The previously described segment 7 lesion characterized as FNH is not well seen on today's study.SPLEEN: The spleen is normal in size, signal intensity and enhancement without a focal lesion. A small splenule is noted adjacent to the inferior tip of the spleen.PANCREAS: The pancreas is normal in morphology and signal intensity. The main pancreatic duct is normal in caliber. Normal variant ductal anatomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific increased number of lymph nodes in the right small bowel mesentery, likely reactive.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Interval decrease in the size of the hepatic lesions compatible with adenomas and focal nodular hyperplasia. Resolution of the segment 7 focal nodular hyperplasia.2. Fatty infiltration of the liver.


Instruction: Generate impression based on findings.

Input: Any recurrence of enhancing brain lesions? Focal seizures (abated). There is no evidence of intracranial hemorrhage or acute infarct. There is no residual or recurrent abnormal intracranial enhancement. There are a few residual scattered foci of cerebral white matter T2 hyperintensity, particularly in the left frontal and temporal lobes. 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. There are bilateral lens implants.

Output: 1. No residual or recurrent abnormal leptomeningeal enhancement. 2. A few residual scattered cerebral white matter lesions are non-specific.


Instruction: Generate impression based on findings.

Input: CERVICAL: The patient is status post C2 -- T4 posterior fusion with bilateral pedicle screws and laminectomies at C3 -- T1 with susceptibility artifact from hardware limiting evaluation. There are immediate postoperative findings including edema and small fluid collection in the surgical bed. There are scattered foci of soft tissue gas consistent with immediate postsurgical change. There is improved anterolisthesis at C7-T1 which now measures up to 4 mm as compared 6 mm previously. There is persistent severe loss of intravertebral disk space, with endplate sclerosis and mild anterior wedging of T1 vertebral body. Again seen is moderate loss of height of the anterior T1 vertebral body and minimal loss of height involving the C7 vertebral body. There is significant improvement in the previously seen marked cervical spinal canal stenosis with the spinal canal now well decompressed from C3 to T1. There is abnormally increased T2 signal with mild expansion of the cord at the C7-T1 level which was present on preoperative study. THORACIC: There is susceptibility artifact from surgical hardware limiting evaluation of the levels to and including T4. There is no significant disk herniation, spinal canal or neural foraminal stenosis in the thoracic spine otherwise. The osseous marrow signal shows scattered foci of high T1 consistent with focal fatty deposition or hemangiomas. There is an isolated stable focus of low T1 signal and associated high T2 signal in the L1 vertebral body measuring up to 10 mm on series 14 image 4 which is nonspecific and may represent atypical hemangioma or other lesion.

Output: 1.Immediate postoperative findings related to laminectomies from C3 through T1 and C2 to T4 posterior fusion. Spinal canal is well decompressed. Hardware can be better evaluated with CT. Again seen is T2 cord signal abnormality at the C7-T1 level which was present preoperatively. 2.Improved 4-mm anterolisthesis at C7-T1 level compared 6 mm previously. Degenerative/destructive endplate changes at C7-T1 and compression fracture of T1 with differential considerations similar to prior exam.3.No epidural collection in the cervical or thoracic spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Bilateral arm and neck pain (right arm also extremely tender with tingling pain). Also, hyperreflexia in the legs. Clinical suspicion for compressive or demyelinating c-spine disease versus brain process. Brain:There is a moderate burden of scattered/patchy T2 hyperintensity in the frontoparietal white matter. The temporal white matter is very mildly involved. This is not associated with diffusion restriction, or susceptibility effect or abnormal contrast enhancement. There is no involvement of the juxtacortical white-matter or of the corpus callosum, which shows preserved morphology, volume and signal characteristics. The brainstem and cerebellum are also spared. The lesions are not associated with brain volume loss. The CSF-containing spaces are normal in size. There is no mass affect, midline shift or herniation. There is no intracranial hemorrhage. The major intracranial vessels are patent.The orbits are normal. The right maxillary sinus is small and shows osseous wall thickening and minimal mucosal thickening which may reflect chronic sinusitis. The paranasal sinuses and the mastoid air cells are clear.Cervical Spine:Cervical alignment is notable for minimal reversal of the normal lordosis, which may relate to patient position. Vertebral body heights are preserved. Marrow show no suspicious focality, accounting for degenerative change adjacent to the endplates, most pronounced at C6-C7. The cervical spinal canal is diffusely, congenitally small. In addition, degenerative disease at multiple levels contribute to the narrowing which is most pronounced at C5-C6 as described below. There is no abnormal signal is the spinal cord.C2-C3: There is mild canal narrowing by disc-osteophyte complex which is slightly more pronounced on the left. There is moderate right and mild left foraminal narrowing by uncovertebral/facet arthropathy.C3-C4: There is moderate spinal canal narrowing by disc-osteophyte complex. There is mild right and left neural foraminal narrowing by uncovertebral/facet arthropathy. Dorsal annular fissure.C4-C5: There is moderate spinal canal narrowing by disc-osteophyte complex. There is mild-to-moderate left and minimal right neural foraminal narrowing by uncovertebral/facet arthropathy.C5-C6: The disc-osteophyte complex has a central disc protrusion component moderately narrowing the spinal canal and mildly deforming the spinal cord. This is associated with moderate right neural foraminal narrowing caused by uncovertebral and facet arthropathy. The left neural foramen is not narrowed.C6-C7: Disc-osteophyte complex moderately narrows the spinal canal while uncovertebral/facet arthropathy cause moderate right worse than left neural foraminal narrowing.C7-T1: Disc-osteophyte complex cause no significant spinal canal narrowing. There is right worse than left moderate bilateral neural foraminal narrowing by facet/uncovertebral arthropathy.

Output: 1.Moderate patchy cerebral white matter abnormality is nonspecific and most likely related to moderate chronic small vessel ischemic disease. There are no specific features to suggest demyelination.2.Degenerative changes in the cervical spine with moderate spinal canal stenosis at C3-C4, C4-C5, C5-C6 (worst at C5-C6) with mild cord deformity. No cord signal abnormality. In addition, there is variable neural foraminal narrowing (moderate-to-severe). There are no findings to suggest demyelination.


Instruction: Generate impression based on findings.

Input: Left submandibular gland swelling. There is mild diffuse prominence and hyperenhancement of the left submandibular gland, without evidence of focal mass lesions. The right submandibular gland appears unremarkable. There is herniation of the left sublingual gland through a mylohyoid defect. There are punctate cysts in the bilateral superficial parotid glands. There is no significant cervical lymphadenopathy. The thyroid gland is unremarkable. There is a small amount of fluid within the left maxillary sinus. There is torus mandibularis. There is a right upper lung subcentimeter nodule.

Output: 1. Mild diffuse prominence and hyperenhancement of the left submandibular gland, without evidence of focal mass lesions, may represent sialadenitis.2. Fluid within the left maxillary sinus is suggestive of acute sinusitis.3. Nonspecific right upper lung subcentimeter nodule. A dedicated chest CT may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 38-year-old male with pancreatitis and pseudocysts in the past, here with pain ABDOMEN:LIVER, BILIARY TRACT: Foci suspicious liver lesions. Hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: There is minimal interstitial edema surrounding the pancreatic head, uncinate process, and second and third portion of the duodenum. Interval resolution of previously described fluid collections. There is a multiseptated cystic lesion noted in the uncinate process, appearing similar to that seen on the prior exam, favored to be a sidebranch IPMN. Significantly motion limited postcontrast sequences.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Cystogastrostomy tube is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Splenic vein appears patent.

Output: 1.Minimal interstitial edema type signal involving pancreatic head and uncinate process and adjacent edema, in relation to duodenum as well, compatible with resolving or recurrent edema in the setting of acute pancreatitis. Correlation with patient's clinical history and lab values recommended.2.Interval resolution of previously described peripancreatic fluid collections.


Instruction: Generate impression based on findings.

Input: Reason: 1 yr s/p sarcoma removal History: previous thigh surgery There is a scar traversing the anterior subcutaneous fat of the thigh. There is mild edema type signal and enhancement of the remaining vastus lateralis musculature which extends superiorly along the anterior margin of the proximal femur that we suspect reflects post therapeutic changes rather than tumor recurrence. We see no focal nodular masslike enhancement to confirm tumor recurrence. There is similar edema and enhancement noted affecting the short head of the biceps femoris as well as the adductor musculature of the hip. There is a small amount of fluid within the right hip as well as a mild synovitis. There is mild edema of the subcutaneous fat of the thigh as well. There is a small knee joint effusion.

Output: Edema and enhancement of the thigh musculature as described above which likely reflects post therapy changes. We see no focal nodules or masses to confirm tumor recurrence.


Instruction: Generate impression based on findings.

Input: Weakness with possible recent TIA. Evaluate for acute abnormalities. Two foci of restricted diffusion are visualized in the right thalamus and left parietal lobe parenchymal compatible with acute ischemic infarcts. There is associated surrounding increased T2 signal in these regions. There is additional moderate to severe periventricular and subcortical T2/FLAIR signal hyperintensity compatible with moderate small vessel ischemic disease. Evidence of old infarcts are seen in the PICA distribution bilaterally. Diffuse volume loss is also noted. A small right anterior maxillary sinus polyp/mucous retention cyst is visualized.There is no evidence of intracranial hemorrhage or mass. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, remaining paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage.2.Small acute ischemic infarcts within the right thalamus and left parietal lobe white matter. No significant mass effect, midline shift or herniation.3.Moderate small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Male, 29 years old. Pain, weakness The patient was not able to fit into the chimney coil and hence knee and CTL coils were used instead. TENDONS: There is a full-thickness tear of the Achilles tendon 4 to 5 cm above its calcaneal insertion. The proximal tendon is retracted resulting in a gap of approximately 4 to 5 cm. Increased signal intensity within the remaining Achilles tendon likely represents a combination of degeneration and edema. There is mild edema within the distal gastrocnemius muscle. The distal fibers of the plantaris tendon are identified, but the fibers become indistinct approximately 3 cm above the tibiotalar joint, and this tendon may be torn as well. There is mild intermediate signal intensity within the distal fibers of the posterior tibialis tendon which may represent tendinosis, but we see no fluid-filled tear. The peroneus brevis tendon appears flattened posterior to the distal fibula, but we see no tear.LIGAMENTS: The ligamentous structures appear intact.ARTICULAR SURFACES AND BONE: There is a small focus of mild edema in the tibial plafond anteriorly which is nonspecific and could represent a small bone contusion. We see no frank osteochondral defect.

Output: Achilles tendon rupture and other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Villa is a 67 year-old female with left breast ILC/LCIS status post lumpectomy with positive margins. MRI demonstrated abnormal enhancement separate from the lumpectomy bed. Patient subsequently underwent left breast simple mastectomy and hormonal therapy. No family history of breast cancer. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. Stable well circumscribed oval isodense masses within the right upper outer quadrant, with imaging features suggestive of benign intramammary lymph nodes on prior MRI study of 12/22/2015.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Spastic diplegic cerebral palsy. Syringomyelia and syringobulbia. There is transitional lumbosacral anatomy, with partial lumbarization of S1 vertebra. For purposes of this exam, the last fully formed disc is at L5-S1 with a rudimentary disc at S1-S2. The last rib-bearing vertebra is designated as T11.There is abnormal mildly expansile CSF signal intensity within the center of the cord extending from C4-C5 down to C7-T1 has not changed and is not associated with abnormal contrast enhancement. This measures up to 7 x 7 mm in greatest axial dimensions at the C6-7 level. The additional area of expansile central cord CSF intensity extending from T3-T4 down to T7-T8 is also unchanged and without abnormal contrast enhancement. It measures transaxially up to 7 x 8 mm at the mid T5 level. There is an unchanged single septation within the lower intramedullary abnormality at the approximate T5-T6 level. The urinary bladder is not as distended as on the previous examination. There is resolution of the right and significant improvement of the left urinary pelvic and calyceal dilatation.

Output: 1.Syringohydromyelia throughout the majority of the cervical and thoracic cord, most conspicuous at the lower cervical and mid thoracic levels, measuring up to 7 x 8 mm, remains unchanged. There is no associated abnormal contrast enhancement.2.Improved but not completely resolved left hydronephrosis.


Instruction: Generate impression based on findings.

Input: Clinical question: 7 year old ex 26 week gestation with PMH febrile seizures who presents with 2 seizures in the past 24 hours. R/o mass vs brain malformationSigns and Symptoms: seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some of the imaging is degraded due to patient motion

Output: 1.MRI of the brain is within normal limits. There is no intracranial lesion appreciated which would explain the patient's seizures.2.Some of the imaging is degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Metastatic head and neck cancer with suspicious mass and neck CT. There is redemonstration of a 5 mm enhancing nodule involving the left frontal pericallosal white matter, which is unchanged in size compared to prior CT head from 4/26/2015. No other enhancing mass or evidence of intracranial mass effect. There is no evidence of large acute intracranial hemorrhage or acute infarct. There are minimal scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Incidental note is made of a right frontal lobe developmental venous anomaly. There is a 7 mm focus of enhancement within the right parietal bone, a 11 mm enhancing lesion within the right aspect of the clivus as well as 11 mm enhancing lesion in the left occipital condyle. The left parotid gland is atrophic, unchanged.

Output: 1.A 5 mm enhancing nodule involving the left frontal lobe pericallosal white matter is unchanged in size compared to CT head from 4/26/2015 and is suspicious for intracranial metastasis. Mild associated edema without significant mass effect. No other enhancing parenchymal lesion is identified.Enhancing lesions within the right parietal bone, right clivus and left occipital condyle as described above, suspicious for osseous metastases. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 79-year-old female. Lung cancer, possible proximal humeral progression based on recent PET/CT. Right shoulder pain. Corresponding to the hypermetabolic area in the right proximal humerus on prior PET/CT, there is extensive confluent signal abnormality (intermediate T1 and hyperintense T2/STIR) from the humeral head into the proximal diaphysis with associated areas of cortical destruction consistent with a large metastasis. There are intersecting T1 hypointense lines through this lesion, likely a pathologic nondisplaced comminuted fracture (series 4, images 7 and 8). Additional smaller separate metastases are noted in the humeral head and more distally in the humeral diaphysis (series 5, image 10). There is significant residual red marrow in the humerus.Two small degenerative cysts in the glenoid, unchanged. Examination is not tailored for evaluation of the rotator cuff and glenoid labrum.

Output: Multiple metastases in the right proximal humerus, the largest in the head/proximal diaphysis with a likely pathologic fracture.


Instruction: Generate impression based on findings.

Input: Memory loss and pituitary adenoma. Brain: There is no evidence of intracranial hemorrhage or acute infarct. There are minimal scattered punctate foci of nonspecific 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 scalp soft tissues are grossly unremarkable. There is extensive bilateral maxillary and ethmoid sinusitis with sections.Pituitary: There is a T2 hyperintense lesion with delayed enhancement in the right anterior pituitary that measures up to 2 mm. The pituitary gland is otherwise not enlarged or atrophic. The pituitary stalk is intact. There is no mass effect upon the cavernous sinuses or optic apparatus.

Output: 1. A lesion in the ight anterior pituitary that measures up to 2 mm may represent a microadenoma. 2. Minimal scattered punctate foci of nonspecific T2 hyperintensity. 3. Findings suggestive of acute sinuitis.


Instruction: Generate impression based on findings.

Input: Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: 64 yo patient with gastroesophageal adenocarcinoma. Please rule out brain mets prior to starting study. History: as above No evidence of acute ischemic or hemorrhagic lesion on this scan.Scattered T2/FLAIR high signal intensity lesions on bilateral periventricular white matter is non specific but likely represent non specific small vessel ischemic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.A small retention cyst on the left maxillary sinus.

Output: Minimal non specific small vessel ischemic disease as described above.No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 56-year-old male patient with prostate cancer with pathology demonstrating tumor in the right and left gland. PELVIS:PROSTATE:Prostate Size: 4.5 x 4.1 x 4.0 cm.Peripheral Zone: There are multifocal areas of T2 hypointensity and ADC hypointensity extending from the apex to the base of the peripheral zone. For example, a region of signal abnormality compatible with carcinoma in the left mid gland measures 1 x 0.3 cm (image 13, series 901). Additionally, the peripheral zone is not well seen in the base which is likely replaced by tumor with possible extension into the extraprostatic tissue and seminal vesicles particularly on the left. Central Gland: There is hyperplasia of the transitional zone secondary to BPH nodules. Seminal Vesicles: See above.Extracapsular Extension: See above.BLADDER: No significant abnormality noted.LYMPH NODES: There are non-specific inguinal lymph nodes. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat-containing umbilical hernia and fat-containing bilateral inguinal hernias.

Output: Multifocal areas of signal abnormality in the right and left gland compatible with tumor with possible extraprostatic extension of tumor in the region of the base which may be diffusely involved with tumor, further described above.


Instruction: Generate impression based on findings.

Input: Ganglioneurocytoma status post resection and radiation, completed in 3/2011. There are stable post-surgical findings related to left frontal craniotomy and partial resection of the left frontal lobe. There is no significant interval change in the degree of confluent T2 hyperintensity surrounding the resection cavity. There is no abnormal enhancement, mass, or mass effect in the region of the surgical cavity, or elsewhere in the brain parenchyma. There is unchanged susceptibility effect along the periphery of the surgical cavity. The ventricles are unchanged in size and configuration, including ex vacuo dilatation of the left frontal horn, which is continuous with the surgical cavity. There is no evidence of hydrocephalus. There is an unchanged focus of nonspecific susceptibility effect in the right frontal lobe. There is no evidence of acute infract. The major cerebral flow voids are intact. The extracranial structures are unchanged.

Output: Unchanged signal abnormality surrounding the left frontal lobe resection cavity.


Instruction: Generate impression based on findings.

Input: 31-year-old female complains of aphasia for two hours yesterday. Patient is postpartum two weeks. Rule out dissection. CT of brain without infusion.No definitive evidence of any area of edema, mass effect, midline shift, hydrocephalus or hemorrhage is detected. Follow-up with an MRI is recommended.The cortical sulci, ventricular system and all CSF cisterns are essentially normal for patient stated age.The bony density of calvarium, pneumatization of paranasal sinuses and mastoid air cells are also unremarkable.CTA of the cervical region:Right carotid system.The origin of right common carotid artery is normal. The entire course of right common carotid artery, right carotid bifurcation, right internal carotid artery and right external carotid artery remain within normal limits.Left carotid system:The origin of left common carotid artery and entire course of the left common carotid artery remains normal.There is an abrupt sharp reduction in the caliber of the internal carotid artery from its origin distally which is believed to represent a dissection. There is a very narrow string of flow in an interrupted pattern is noted through the cervical region. This extends from the origin of left internal carotid artery to the skull base. The left internal carotid artery across the skull base has a small lumen however remains patent. The small lumen of the left internal carotid artery across the skull base may be due to diminished flow and not dissection.CTA of vertebral basilar system.A dominant normal appearing right vertebral artery in the cervical and across the skull base is noted.A smaller left vertebral artery which appears normal from its origin through the skull base.CTA of intracranial circulation:The supraclinoid portion of both internal carotid arteries are patent. There is also normal visualization of bilateral middle and anterior cerebral arteries. The left internal carotid artery immediately below the left anterior clinoid demonstrates reduction in its caliber.CTA of vertebral basilar system demonstrate patent bilateral vertebral arteries across the skull base with no pathology. There is also normal visualization of basilar artery and all of its branches with no pathology.On source images there is evidence of a patent anterior communicating artery and a small patent left posterior imaging artery.

Output: 1.No definitive evidence of pathology on CT examination of brain. Please follow-up with an MRI.2.Dissection of the left internal carotid artery at its origin which appears to extend superiorly to the skull base. A string of lumen of left internal carotid artery is noted in the cervical region which appears to have a interrupted segment immediately below the skull base.3.Unremarkable CTA of the cervical region of other vasculature.4.Essentially unremarkable CTA of intracranial circulation.5.Reduced caliber of left internal carotid artery across the skull base.


Instruction: Generate impression based on findings.

Input: 37-year-old male. Pain. Evaluate for stress fracture of the medial tibial metaphysis. MENISCI: The medial lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Diffuse mild thinning of the medial patellar facet and median eminence articular cartilage consistent with chondromalacia without a full-thickness defect. Marked diffuse thinning of the lateral tibiofemoral compartment articular cartilage with areas of near full thickness cartilage loss. Moderate diffuse thinning of the medial tibiofemoral compartment articular cartilage.T1 hypointense ill-defined line in the medial tibial plateau, corresponding to the area of sclerosis seen on recent radiograph, most likely represents a stress fracture. Lack of associated edema indicates it is likely healed.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1. No evidence of a meniscal or ligamentous injury.2. T1 hypointense line without associated edema in the medial tibial plateau likely represents a healed stress fracture.3. Tricompartmental cartilage degeneration, most severe in the lateral tibiofemoral compartment.


Instruction: Generate impression based on findings.

Input: 72-year-old female with pancreatic tail cyst. Evaluate for growth or changes. ABDOMEN:LIVER, BILIARY TRACT: Segment 2 hepatic cyst measuring 1.2 cm is stable. Multiple other nonspecific subcentimeter T2 hyperintense lesions, likely cysts are again noted. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Stable multilobulated cystic nonenhancing lesion of the pancreatic tail measuring 2.9 x 2.0 cm (series 6, image 20). Atrophy of the pancreatic tail is additionally noted. Pancreatic duct measures approximately 0.2 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral saline breast implants are noted.

Output: Stable multiloculated nonenhancing cystic lesion in the pancreatic tail may represent a mucinous cystic neoplasm.


Instruction: Generate impression based on findings.

Input: 11-year-old female with history of Crohn's disease, evaluate for small bowel disease.EXAMINATION: MR enterography without and with IV contrast 5/27/2015 ABDOMEN:LIVER, BILIARY TRACT: The liver is within normal limits.SPLEEN: The spleen appears normal.PANCREAS: No significant pancreatic abnormality.ADRENAL GLANDS: The adrenal glands are normal in appearance.KIDNEYS, URETERS: No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy or hemorrhage.BOWEL, MESENTERY:There is an approximately 12 cm segment of distal ileum, adjacent to the terminal ileum, which demonstrates wall thickening, abnormal increased enhancement, increased T2 signal intensity and mild adjacent edema. No small bowel obstruction or free air.The appendix is within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The bladder is mildly distended, and appears normal.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Segmental bowel wall thickening/edema affects the distal ileum and TI, consistent with patient's given history of Crohn's disease. Additional mild wall thickening and increased enhancement suggesting sigmoid inflammation.BONES, SOFT TISSUES: There is a small linear area of enhancement within the left perineum likely to represent a perianal fistula.OTHER: No significant abnormality noted

Output: 1. Distal ileum and sigmoid colon bowel wall thickening consistent with given history of Crohn's disease. 2. Likely left perianal fistula as described above.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, ageusia and hyperreflexia There is no evidence of acute infarct or intracranial hemorrhage. No abnormal extra-axial fluid collections are identified. There is no significant intracranial mass effect. The ventricles are within normal limits for size and configuration. A few scattered foci of increased T2/FLAIR signal in the supratentorial white matter are within normal limits for patient age. Scattered prominent perivascular spaces are noted.Note is made of a partially empty sella, which is likely an incidental finding. Midline structures are otherwise unremarkable. There is mild mucosal thickening in the maxillary sinuses and scattered ethmoid air cells. Small amount of fluid signal is present in the bilateral mastoid air cells.

Output: No acute infarct or intracranial mass. MRI appearance of the brain within normal limits for patient age.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma follow up. There are postoperative findings related to transsphenoidal pituitary surgery. There is interval decrease in size of the hypoenhancing lesion in the pituitary, which now measures 2 AP x 7 RL x 2 SI mm. There is no mass effect upon the optic apparatus or extension into the cavernous sinuses. There is no thickening of the infundibulum. The posterior pituitary bright spot is intact. There is mucosal thickening in the right sphenoid sinus.

Output: Interval decrease in size of the pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: 69-year-old male with smoldering multiple myeloma and new lesion seen on skeletal survey There is no evidence of osseous lesion corresponding to the previously questioned small lucencies in the femoral necks. Mild marrow edema edema in the left greater than right greater trochanters, with adjacent inflammatory changes and enhancement is suggestive of insertional tendinosis. No myelomatous lesions are not within the pelvis or proximal femurs. The prostate is enlarged. Small hydroceles.

Output: No evidence of myelomatous lesions and additional findings as described above.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:  There is no diffusion abnormality to indicate an acute infarct or susceptibility abnormality to indicate hemorrhage. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. There is no abnormal pathologic enhancement.MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. Just beyond the anterior communicating artery there is a 2 mm outpouching from the A2 segment of the right ACA which projects inferiorly and medially. This does not give rise to a visualized vessel. The differential includes infundibulum versus small aneurysm. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. The right vertebral artery is smaller than the left, likely congenital.

Output: 1.No acute intracranial abnormality.2.2 mm outpouching from the A2 segment of the right ACA may represent either an infundibulum or small aneurysm. 3.No flow-limiting stenosis of the vasculature of the brain or neck.


Instruction: Generate impression based on findings.

Input: Metastatic papular thyroid cancer with single met to L3 vertebral body. Status post RT. Please assess for progression of disease. Unenhanced CT of thoracic spine:Axial immediate CT images of the entire thoracic spine were obtained. Sagittal and coronal 2-D reformatted images were acquired as well.The bony density in the alignment of the vertebral column is within normal limits. There is no evidence of a sclerotic or lytic changes of vertebral column. No minimal degenerative changes of the thoracic spine are noted. There is no evidence of any perispinal soft tissue abnormality. This examination remains stable since prior study.Unenhanced CT of the lumbar spine:Examination again demonstrates a stable findings of the L3 vertebrae. Subtle sclerotic changes of the L3 vertebrae are similar to prior exam. The exact etiology of this finding is not clear. Possibility of a hemangioma or a metastatic disease should be considered. CT exam is not the appropriate test for definitive diagnosis of metastatic bony lesions. MRI examination is recommended. There is however as mentioned above no change in the size, distribution and pattern of this not a specific L3 vertebrae. This lesion however can be further evaluated with biopsy if patient is unable to obtain an MRI examination.

Output: 1.Unremarkable CT of breath.2.Stable nonspecific sclerotic changes of L3 vertebrae since prior exam.


Instruction: Generate impression based on findings.

Input: 82-year-old male with cholangiocarcinoma per outside hospital abutting the hepatic artery. Evaluate for extent of disease and vascular involvement. ABDOMEN:LIVER, BILIARY TRACT: There is infiltrative enhancing tumor involving the proximal common bile duct, Klatskin point, and extending into the left bile duct. This results in moderate intrahepatic ductal dilatation and moderate dilatation of the common bile duct which measures up to 1.0 cm. Approximately 2 cm of the proximal common bile duct is severely attenuated. The tumor invades the right hepatic artery (series 1903, image 56; series 21, image 55).Two subcentimeter diffusion restricting foci with peripheral enhancement in hepatic segment 7 and 4A/B (series 1902, image 78). Reference segment 7 focus measures 0.9 x 0.7 cm (series 1902, image 49). SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in intrinsic T1 hyperintensity. Multiple T2 hyperintense lesions within the pancreas with the largest measuring approximately 0.9 x 0.7 cm in the pancreatic body most consistent with side branch type IPMNs. No evidence of pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense foci within the kidneys most compatible with cysts; the largest is on the left measuring approximately 1.2 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with cholangiocarcinoma involving the proximal common bile duct, Klatskin point, and extending into the left bile duct. There is invasion of the right hepatic artery.2.Two subcentimeter hepatic lesions most concerning for metastatic disease.3.Multiple side branch IPMNs.


Instruction: Generate impression based on findings.

Input: History of recurrent retroperitoneal sarcoma of the right adrenal gland status post resection and radiation therapy. According to pathology reports the patient had a right adrenal cortical neoplasm with myxoid features 1/23/2014 and recurrence excised 1/7/2016. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Right hepatic lobe calcifications. No significant intra or extrahepatic biliary ductal dilatation. No focal lesion or vascular abnormality. Mildly T2-hyperintense region in the medial inferior aspect of the right hepatic lobe has no additional signal abnormality, likely post-treatment and/or artifactual. SPLEEN: Normal splenic size without a focal lesion.PANCREAS: Mildly atrophic pancreas without pancreatic ductal dilatation or suspicious lesion.ADRENAL GLANDS: Postsurgical changes from right adrenalectomy without findings of recurrent or residual disease. The left adrenal gland is unremarkable.KIDNEYS, URETERS: Left renal upper pole minimally complex appearing septated cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace locule of fluid along the right lateral aspect of the heart is seen on recent CT, likely pericardial fluid.

Output: No evidence of recurrent or residual disease in the right adrenalectomy bed. No additional sites of disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke, Rule out acute ischemia. Signs and symptoms: Speech difficulty. Nonenhanced brain MRI:There is no detectable acute intracranial process in particular no evidence of acute stroke is seen.Examination however demonstrate patchy and confluent foci of FLAIR/T2 hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres and minimally in the basal ganglia without associated susceptibility signal changes likely representing chronic small vessel ischemic strokes of mild to moderate degree.Slight prominence of supratentorial ventricular system suggestive of underlying parenchymal volume loss likely secondary to small vessel ischemic strokes.No detectable cortical signal abnormality, unremarkable cerebral cortical sulci and CSF spaces.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Calvarium and soft tissues of the scalp are unremarkable.Extensive opacification of right mastoid air cells without signal abnormality of the right middle ear cavity is noted of questionable clinical significance.

Output: 1.No acute intracranial process.2.Mild to moderate chronic nonhemorrhagic small vessel ischemic strokes in the supratentorial brain parenchyma as detailed.


Instruction: Generate impression based on findings.

Input: Male 74 years old with prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.3 x 3.5 x 4.4 cmPeripheral Zone: Post ablation changes are seen in the left apex and left mid zone. There is a subcentimeter focus of T2 signal abnormality in the right mid gland without associated ADC abnormality or enhancement. Central Gland: Mild benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post ablation changes in the left apex and left mid gland.2.Subcentimeter focus of signal abnormality in right mid gland is of low suspicion for cancer. PIRADS 2.3.No target lesion is identified.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: 47 year-old Female.INDICATIONS: Reason: pituitary macroadenoma treated previous transsphenoidal surgery and srs treatment; yearly follow up for changes or growth History: surveillance. Brain: There is no mass, mass effect, or midline shift. There is no abnormal enhancement within the brain.The ventricles and sulci are normal in size. No diffusion-weighted abnormalities are identified. There is no evidence of acute intracranial hemorrhage. There are no extra-axial fluid collections or subdural hematomas. Focus of encephalomalacia in the right centrum semiovale is unchanged. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.Pituitary: Again noted is distortion of the pituitary fossa, related to prior adenoma and surgery. Rightward deviation of the optic chiasm/pituitary infundibulum and surrounding mild linear enhancement are unchanged. No new or enlarging lesion. The suprasellar cistern, cavernous sinuses, and orbital contents are otherwise unremarkable.

Output: 1.Unchanged posttreatment changes in the sella. No new or enlarging lesion.2. Unchanged focus of encephalomalacia in the right centrum semiovale.


Instruction: Generate impression based on findings.

Input: Diagnosis: Transient alteration of awarenessClinical question: acute altered mental status in setting of hypotensionSigns and Symptoms: as above MRI of the brainSmall foci of diffusion restriction are present along the medial left cerebellar hemisphere, deep white matter of the left cerebellar hemisphere, the left occipital lobe, the left splenium of the corpus callosum the right occipital lobe adjacent to the occipital horn of the right lateral ventricle in the right thalamus. A couple more foci of diffusion restriction are present along the posterior aspect of the right centrum semiovale.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are 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 stenosis present at the proximal intracranial portion of the vertebral arteries bilaterally as well as the distal portion of the right vertebral artery. There is also stenosis present at the proximal basilar artery just above the vertebrobasilar junction and narrowing of the mid basilar artery. There is mild narrowing of the distal left P1 segment.There is a high-grade stenosis present along the distal right internal carotid artery at the level of the communicating segment.There is no evidence for intracranial aneurysm.The anterior communicating artery is identified. The right A1 segment is hypoplastic. The left posterior communicating artery is medium-sized. The right posterior communicating artery is not readily identified.

Output: 1.There are multiple microinfarcts present mainly in the posterior circulation involving the left cerebellum, the left side of the splenium of the corpus callosum, right thalamus and right occipital lobe as well as a left occipital lobe. Additionally there are a couple microinfarcts present in the anterior circulation one of which is adjacent to the central sulcus. This would imply two separate territories are involved.2.There is vertebrobasilar stenoses present with stenosis at the intracranial vertebral arteries and the basilar artery.3.There is a high-grade stenosis present along the distal right internal carotid artery at the level of the communicating segment.


Instruction: Generate impression based on findings.

Input: Originating within the left supraclavicular region there is a lobulated, minimally septated fatty mass with a thin fibrous capsule. There is mild enhancement in some regions of the capsule, but no nodularity or focal enhancement within the mass is evident. This mass measures approximately 13 cm in AP dimension by 15 cm in ML dimension x 7.5 cm in CC dimension, and while it originates within the left supraclavicular region, it is seen to extend anteriorly beneath the left clavicle. The mass does not approach or invade the spinal canal. The mass elevates the trapezius and mildly displaces the deltoid and contacts the supraspinatus muscle posteriorly and anterior/medial scalenes medially, however there is no fatty atrophy of the musculature adjacent to the mass. There is mass effect upon the entire brachial plexus, which appears to be inferiorly displaced, however the nerves are not encased.MRA NECK

Output: There is a fatty, minimally septated mass with a thin fibrous capsule within the left supraclavicular region which has an appearance most consistent with a benign lipoma. There is mass effect upon the entire brachial plexus, which appears to be inferiorly displaced, however no encasement of nerves or arteries is evident.


Instruction: Generate impression based on findings.

Input: 61 year old female with a personal history of left breast lumpectomy for breast cancer in 1997 followed by chemoradiation therapy. BRCA1 positive. Family history of breast cancer in sister and niece. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is a new enhancing mass measuring 16 x 10 x 12 mm at posterior 3:00 position in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: A new suspicious mass at posterior 3:00 position in the left breast. MR directed ultrasound study is recommended. If no sonographic correlation is detected, MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 50-year-old woman with history of visual symptoms and abnormal finding on PET CT. No restricted diffusion to suggest acute ischemia. There are no abnormalities on susceptibility weighted images to suggest intracranial hemorrhage. There is a small area of encephalomalacia in the posterior left lingual gyrus (series 701, image 15) with gyriform increased T2 signal and volume loss extending to the left parahippocampal gyrus (series 401, image 15). The brain parenchyma is otherwise unremarkable for age. There is no intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement is identified. The major flow voids are noted.The 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.

Output: 1.Chronic-appearing infarct in the left PCA territory corresponding to abnormality seen on PET/CT.2.MRI otherwise within normal limits for age without evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 38 year old female with a history of multiple meningiomas. No symptoms. Evaluate for interval change. The patient is status post resection of a right frontal meningioma on 3/17/2015. Compared to previous Brain MRI dated 3/5/2016 the FLAIR hyperintensity/gliosis has decreased and the mild enhancement surrounding the right frontal resection cavity is unchanged. Mild postsurgical dural thickening is also unchanged at the craniotomy site.An enhancing meningioma along the left anterior falx abutting the crista galli measures 0.9 x 0.9 x 1.3 cm (axial series 1001, image 14 and sagittal series 12-3, image 84) and is unchanged compared to the previous exam. There been no interval change in the minimal adjacent edema.There is stable enhancement filling the left Meckel's cave and the right cavernous sinus with extension inferiorly through bilateral foramina ovale with third trigeminal nerves appearing more prominent than expected. These findings are stable.A small enhancing meningioma along the superior aspect of the right tentorium has slightly increased in size, now measuring 0.7 cm (previously 0.6 cm). There is no associated vasogenic edema.There are prominent calcifications of the cord plexus with mild surrounding enhancement which are unchanged. There is grossly symmetric enhancement of the facial nerves, slightly more prominent in the left geniculate ganglion region which is nonspecific. There is also suggestion of enhancement within the distal IACs bilaterally.There is no evidence of intracranial hemorrhage, mass effect, midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Stable postsurgical changes in the right frontal region status post resection of a meningioma. FLAIR hyperintensity/gliosis has decreased and the mild enhancement surrounding the right frontal resection cavity is unchanged.2.Stable small left inferior frontal falx meningioma with mild edema.3.A small enhancing meningioma along the superior aspect of the right tentorium has slightly increased in size4.Stable enhancement filling the left Meckel's cave and the right cavernous sinus with extension inferiorly through bilateral foramina ovale with third trigeminal nerves appearing more prominent than expected. This constellation of imaging features is more suggestive of schwannoma rather than meningioma.5.Stable appearance of the calcified right larger than left choroid plexus with mild surrounding enhancement. Findings are nonspecific, and meningiomas in these regions not excluded.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: Extensive stage SCLC, evaluation for intracranial metastases History: None There is no evidence of acute ischemic lesion.There is a focal susceptibility lesion on the right temporal lobe posterior aspect of middle temporal gyrus (series 42, image 13) which likely represent parenchymal mineralization, unchanged, otherwise no evidence of hemorrhagic lesion on the scan.A couple of scattered T2/flair high signal intensity on white matter is nonspecific but could represent nonspecific small vessel ischemic lesions.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of metastatic lesion.2. No evidence of acute ischemic or hemorrhagic lesion.3. Unchanged right posterior aspect of the temporal lobe susceptibility lesion, left frontal lobe developmental venous anomaly and few nonspecific T2/FLAIR high signal intensity lesions since prior scan.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, right-handed with left frontal lobe cortical lesion. Memory and speech problems. Motor paradigms elicited activation in the expected motor and sensory cortex of the pre- and post-central gyri. All tested language paradigms produced reliable language related activity. Language is left dominant, but with moderate contributions from the right hemisphere.Language paradigms elicit putative Broca's area activity in the left frontal pars triangularis. These foci of activity are medial and anterior to the patient's left opercular lesion. Notably, there is also a small focus of activation seen on two out of four language paragidms within the lesion itself. Language paradigms elicit putative Wernicke's area activity in the left superior temporal sulcus region. Secondary language activity is seen in the left greater than right middle frontal gyri. Language related SMA activity is also seen.

Output: 1.Functional MRI with motor and language paradigms showing activation of the usual expected areas as described above. Language is left dominant but with moderate contributions from the right hemisphere.2.Robust putative Broca's area activation is seen in the left pars triangularis. This activity is anterior and medial to the patient's opercular lesion. Note is made, however, of a small focus of activity within the lesion itself elicited by two different language paradigms. This activation is of uncertain etiology, and may represent a minor contribution to Broca's area processing, or perhaps just secondary language activation.