Instruction: Generate impression based on findings.

Input: 63 year old man with history of recent heart transplant, with reduced cardiac output on right heart catheterization concerning for occult rejection, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 115 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 51 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). The basal septum measures 11mm in thickness. There is no regional wall motion abnormality. There is a borderline area of patchy late gadolinium enhancement in the basal inferolateral wall, which is improved from before but may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time in the septum is 1048-1062ms, and 1133ms in the basal inferior wall (On previous study, native T1 time was reported as 1063ms in basal septum and 1150ms in basal inferior wall). Extracellular volume fraction is 27%, which is within normal limits. There is no evidence of significant edema on T2 STIR imaging. Due to artifact, T1 black blood imaging was nondiagnostic.Left AtriumThe left atrium is consistent with cardiac transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 91 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 49 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a bovine 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires are present. There is a right lower lobe consolidation versus mass which has increased in size from the previous study and does not enhance with contrast. Also, there may be a mass in the left hilum and a small nodule in the left upper lung. 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 56%, which is improved from before. 2. There is a borderline area of patchy late gadolinium enhancement in the basal inferolateral wall, which is improved from before but may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, which is stable when compared to the previous study.4. See extra-cardiac findings.Findings discussed with Dr. Uriel.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 41 years Male (DOB:4/20/1975)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular and subcortical white matter lesions present which are bright on T2 and FLAIR MRI and low signal on T1-weighted imaging which are perpendicularly oriented to the lateral ventricles. Additional similar appearing lesions are present in the left cerebral peduncle, the right pons, the right medulla as well as the right cerebellar hemisphere. Additional similar-appearing lesion is present along the left posterior lateral aspect of the spinal cord at the C2 vertebral level.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple periventricular and subcortical white matter lesions as well as brainstem lesions and cervical spinal cord lesion are present. These are compatible with patient's clinical history of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Left asymmetrical sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Chiari malformation, yearly follow up: neck pain, gait changes. Brain: The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum and displays mildly pointed morphologies, which is unchanged. There is intact CSF flow across the anterior foramen magnum, but minimally impeded CSF flow across the posterior foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: The spinal cord displays normal signal and morphology. 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: 1. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum and displays mildly pointed morphologies, which is unchanged. 2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Liver lesion. ABDOMEN:LIVER, BILIARY TRACT: At least 4 lesions are demonstrated in the liver. A large left hepatic lobe mildly T2 hyperintense lesion measures approximately 7.7 x 6.9 cm (series 4, image 27). There is suggestion of central scar demonstrating T1 hypointense signal (series 10, image 59) and mild contrast retention on delayed phase images (series 15, image 60). Two more very slightly hyperintense T2 lesions are better seen on diffusion weighted images. The second ill-defined segment 4 lesion abutting the gallbladder measures approximately 2.7 x 1.9 cm (series 100, image 13). Another small medial right hepatic lobe segment 8 lesion is noted (series 100, images 17). A fourth lesion in segment 8 is best seen on early arterial postcontrast sequence (series 11, image 58). All demonstrate arterial enhancement and are relatively isointense on portal venous phase.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesion.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys enhance symmetrically without focal lesion.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Bowel is normal in caliber without evidence of obstruction or ileus. No abnormal enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: At least 4 hepatic lesions are demonstrated in both lobes of the liver, with largest in the left hepatic lobe with suggestion of central scar. These lesions most likely represent focal nodular hyperplasia, though multiple hepatic adenomas are also differential considerations. Repeat imaging with hepatocellular specific contrast agent would be helpful in differentiating these lesions.


Instruction: Generate impression based on findings.

Input: Evaluate for etiology of dizziness, nystagmus. History of diabetes and hypertension. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered foci of cerebral white matter T2 hyperintensity, most of which are attributable to prominent perivascular spaces. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.Brain MRA: There is a fetal right posterior cerebral artery, which is an anatomic variant. There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.Neck MRA: The bilateral internal carotid arteries are tortuous, with redundant looping of the right side. There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive arterial lesions in the head and neck.3. The bilateral internal carotid arteries are tortuous, with redundant looping of the right side, which may be attributable to hypertension.


Instruction: Generate impression based on findings.

Input: Reason: 26 year female, please do MRI of And/pelvic to r/o urachal or cyst, drainage from umbilici and assess for any abnormalties History: leakage ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a cystic lesion extending inferiorly from the umbilicus along the course of the medial umbilical ligament which measures 11 x 6 mm in transverse dimension and 12 mm in craniocaudal dimension, likely representing a urachal sinus. The urachus is otherwise closed.OTHER: Small amount of free fluid in the pelvis, likely physiologic.

Output: Small cystic lesion extending 1.2 cm inferiorly from the umbilicus is consistent with a small urachal sinus.


Instruction: Generate impression based on findings.

Input: Effusion and pain. Evaluate meniscus. MENISCI: There is globular increased internal signal throughout the medial meniscus, with attenuation of the posterior horn compatible with tearing and/or degeneration. The body of the medial meniscus is slightly medially extruded. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is an approximately 10 mm full thickness focal defect in the articular cartilage of the weight bearing portion of the medial femoral condyle. There are mild reactive bone marrow changes in the medial femoral condyle and medial tibial plateau associated with this defect as well as the aforementioned medial meniscus degeneration/tearing. There is mild degenerative-type signal in the articular cartilage of the patellofemoral and lateral tibiofemoral compartments, without fluid-filled defects. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Globular increased internal signal and attenuation of the posterior horn of the medial meniscus compatible with tearing and/or degeneration.2. 10 mm full-thickness focal defect in the articular cartilage of the medial femoral condyle. 3. Mild reactive bone marrow changes in the medial femoral condyle and medial tibial plateau reflecting the aforementioned abnormalities.


Instruction: Generate impression based on findings.

Input: Reason: L shoulder pain, evaluate for labral tear; h/o long head of the biceps tear. ROTATOR CUFF: There is some tendinopathy of the supraspinatus tendon. The subscapularis and infraspinatus tendons are intact.SUPRASPINATUS OUTLET: No significant abnormality present.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and the glenoid labrum are grossly intact.BICEPS TENDON: The long head of the biceps tendon is intact and is located in the bicipital groove.ADDITIONAL

Output: 1.Supraspinatus tendinopathy.2.The glenoid labrum and biceps tendon are intact.


Instruction: Generate impression based on findings.

Input: The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, 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. No opacification of the paranasal sinuses or mastoid air cells.

Output: Normal exam without specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 44-year-old man with history of abdominal pain and elevated bilirubin. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour and there is prominence of the hepatic fissures. The intrahepatic biliary ducts are irregularly dilated up to 9 mm, worse in the left hepatic lobe and with areas of stricturing such as that seen at the confluence of the medial and lateral branches of the left hepatic duct (series 601, image 29). There is no area of restricted diffusion or abnormal signal to suggest a mass.The extrahepatic biliary duct is also irregularly dilated and the common bile duct measures up to 11 mm in maximal diameter. The common bile duct is seen tapering distally without evidence of mass lesion.An apparent filling defect seen in the mid common bile duct (series 601, image 23) is not seen on the other sequences and thus considered less likely to represent choledocholithiasis, appearance is similar to prior outside MRI.SPLEEN: The spleen appears normal. Numerous perisplenic varices are noted.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: An 8 mm right mid pole renal cyst is seen along with additional subcentimeter renal cysts bilaterally.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal. There is no evidence of colonic wall thickening or loss of haustral pattern.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings of PSC and cirrhotic liver without lesion suspicious for cholangiocarcinoma.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a T12 anterior wedge fracture which has been present as far back as 2011 although has progressed without retropulsion of fragments. There is no cauda equina or cord compression.

Output: There is no cauda equina or cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes.


Instruction: Generate impression based on findings.

Input: Gait disorder with right upgoing toe and left leg paresthesia. There appears to be patchy T2 hyperintensity and mild volume loss at the T6-7 level. There is also apparent T2 hyperintensity in the spinal cord at the T1-2 and T4 levels. There are small posterior disc-osteophytes in the mid thoracic spine, but the spinal canal is not significantly narrowed. There are subcentimeter neural foraminal perineural cysts at multiple levels. 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 evidence of mass lesions or abnormal enhancement in the thoracic spine. The paravertebral soft tissues are unremarkable.

Output: Apparent myelomalacia at multiple levels of the thoracic spinal cord. These may be secondary to a prior demyelinating or infectious process, for example.


Instruction: Generate impression based on findings.

Input: memory change Motion artifacts prevent precise evaluation.No evidence of acute ischemic or hemorrhagic lesion on this scan.On FLAIR images, there are patchy high signal intensity lesions especially periventricular white matter and bilateral trigone areas. These lesions are most likely non specific, possibly small vessel ischemic lesions.Left frontal lobe superior frontal gyrus shows focal subcortical high signal intensity lesion which does not show diffusion restriction indicating chronic ischemic lesion.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: Patchy periventricular and bilateral trigone areas' high signal intensity lesions on FLAIR images indicating possible non specific small vessel disease.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Ms. Lyons is a 47 year old female presenting for MR-directed ultrasound based on outside hospital MRI findings. Targeted left breast ultrasound was performed for the outside hospital MRI findings, including 8.4 cm of diffuse nonmass enhancement in the left outer breast. No sonographic correlate was identified for the MRI findings.Targeted left axillary ultrasound was performed for the outside hospital MRI findings. In the left axilla, there is an abnormal morphology lymph node identified measuring 2.5 x 1.1 x 2.1 cm.

Output: (1) No sonographic correlate identified for the 8.4 cm diffuse nonmass enhancement in the left outer breast. Therefore, a two-site MR guided biopsy is recommended for further evaluation.(2) Abnormal morphology lymph node in the left axilla. An ultrasound-guided biopsy with clip placement is recommended for further evaluation.All results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Known right breast cancer, MRI #3 on protocol. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.The index lesion in the right breast 3:00 position posteriorly is no longer visible on post-contrast images. The biopsied satellite lesion is not enhancing, either. Other satellite lesions are not seen above the level of background enhancement. The axillary biopsy clip is present. All right axillary nodes are normal in morphology. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in left axillary region.

Output: Complete imaging resolution of known right breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 82-year-old male with monoclonal gammopathy, multiple myeloma not having achieved remission. Evaluate for multiple myeloma versus MGUS. Evaluate for myeloma lesions. BONE MARROW: There is edema type signal in the left ilium and left sacral ala likely related to recent bone marrow biopsy. Diffuse heterogeneous bone marrow signal intensity of the pelvis, specifically the iliac bones and sacrum likely representing normal red marrow however a miliary form of multiple myeloma is not excluded. There are no discrete measurable myelomatous lesions present.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: 1. Diffusely heterogeneous bone marrow signal intensity of the pelvis likely representing normal red marrow however a miliary form of multiple myeloma is not entirely excluded. There are no discrete measurable myelomatous lesions.2. Edema type signal in the left ilium and left sacral ala likely related to recent bone marrow biopsy.


Instruction: Generate impression based on findings.

Input: confusion, left lower extremity weakness No evidence of acute ischemic or hemorrhagic lesion.Minimal to mild non specific small vessel ischemic disease, no change since prior exam.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No change of minimal non specific small vessel ischemic disease since prior exam.


Instruction: Generate impression based on findings.

Input: Visual changes in the left eye. Malignant neoplasm of kidney. Rule out metastases. Brain MRI appears within normal limits for patient's age. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Mild global parenchymal volume loss.Sella and orbits are grossly within normal limits. Minimal mucosal thickening in the paranasal sinuses and mild opacification of the mastoid air cells. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: Brain MRI appears within normal limits for age. No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: S1 left sciatica pain. Right lower thorax pain. History of T5 plasmacytoma status post RT. Unenhanced thoracic MRI:There is normal anatomical alignment the vertebral column however with mild exaggeration of thoracic kyphosis. There is diffuse marrow signal replacement involving vertebral body of T5 and the pedicles as well as the scan 50% compression deformity. The signal changes of T5 vertebrae consists of T1 hypointense, T2 hyperintense and more noticeably T2 stir hyperintensity. The finding is consistent with patient's known history of T5 plasmacytoma. There is no detectable associated epidural or paraspinal soft tissue abnormality with the findings and the alignment remains feeding normal. No spinal stenosis or neural foraminal compromise at this level.Marrow signal changes in a uniform fashion involving vertebral bodies of T2 through T7 which consists of T1 hyperintense and T2 slightly hyperintense and T2 stir hypointense consistent with postradiation changes.There are numerous varying size however very small foci of T2 stir hyperintensity involving the tuber bodies and the posterior elements all thoracic spine most severely at T9 through T12 which are highly suspected of representing additional foci of tumor. There is mild epidural thickening posterior to the vertebral body of T11 resulting in subtle mass effect and posterior displacement of the thecal sac. There is also slight anterior bulge of thecal sac posteriorly secondary to significant ligamentum flavum hypertrophy at T10 -- T11 level. To entirely exclude epidural spread of tumor at this level post enhanced imaging is recommended. There is normal signal intensity and caliber thoracic cord.Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column.There is diffuse patchy foci of T2 stir hyperintensity throughout the lumbosacral spine highly suggestive of metastatic foci. No fracture or malalignment is detected. No detectable epidural or paraspinal associate soft tissue abnormality with the above findings.T12 -- L1 is unremarkable.L1 -- 2 is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 demonstrate mild disk disease, shallow broad based bulging disk and mild bilateral facet and ligamentum flavum hypertrophy. Mild central spinal stenosis and moderate bilateral neural foraminal compromise is present.L4 -- L5 demonstrate mild to moderate disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. There is widening of bilateral facets spaces containing fluid signal intensity which could represent synovitis or possibly fusion. In addition a small synovial cyst projects within the left ligamentum flavum with resultant further mass effect on the thecal sac. This finding measures approximately 6.5 mm in longest axis (axial T2 series 15 image 18). Constellation of above findings results in mild to moderate central spinal stenosis, significant left and moderate right neural foraminal compromise. At L5 -- S1 demonstrate mild disk disease and loss of disk height and mild bilateral facet and ligamentum flavum degenerative changes. Minimal bilateral facet effusion is present. No spinal stenosis or neural terminal compromise.

Output: 1.Nonenhanced MRI of thoracic spine demonstrate mild compression deformity of T5 vertebrae with diffuse marrow signal changes and consistent with patient's known plasmocytoma. Uniform marrow signal changes from T2 through T7 representing prior radiation therapy. Numerous small foci of T2 stir hyperintensity throughout the thoracic spine highly suspected of additional foci of tumor deposit. Subtle epidural thickening along the ventral aspect of the canal at T11 level could represent epidural spread of tumor and follow up with enhanced imaging is recommended.2.Nonenhanced MRI of the lumbar spine demonstrate numerous small varying sized foci of T2stir hyperintensity highly suspected of tumor deposits. No fracture or malalignment. Degenerative changes at L4 -- L5 and including a left-sided ligamentum flavum centered synovial cyst results in mild to moderate central spinal stenosis and neural foraminal compromise as detailed above.


Instruction: Generate impression based on findings.

Input: Evaluate bony lesion in left proximal femur History: Night leg pain, left quadriceps atrophy, weight loss, and increased ESR. Centered within the anterior cortex of the left proximal femoral diaphysis, there is an approximately 8 mm cortically based targetoid lesion with associated surrounding cortical thickening (series 1401, image 16). The cortical thickening extends for a length of approximately 7 cm. The targetoid lesion demonstrates increased T2 signal peripherally with low T1 and T2 signal centrally. The periphery of the targeted lesion demonstrates increased enhancement. At the level of the targetoid lesion, there is an approximately 7 cm segment of bone marrow edema and increased bone marrow enhancement (series 1301, image 12). The remaining portions of the left femur demonstrate normal signal intensity. On the large field-of-view images, the right femur also appears normal.The musculature of left thigh is atrophic compared to the right.

Output: Cortically based left proximal femoral lesion most suggestive of an osteoid osteoma. Correlation with plain radiography is recommended.


Instruction: Generate impression based on findings.

Input: 51-year-old female with multiple sclerosis. Please perform on 3T with Dr. Javed protocol. Redemonstrated are multiple supratentorial multiple sclerosis plaques, without definitive new lesion. None demonstrate contrast enhancement. There is no detectable lesion in the posterior fossa. The cortical sulci and ventricular system as well as the CSF spaces remain within normal normal limits. Unremarkable calvarium, orbits and paranasal sinuses.

Output: Redemonstrated are multiple, nonenhancing, supratentorial multiple sclerosis plaques, without definitive new lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Febrile convulsions (simple), unspecifiedClinical question: r/o acute intracranial processSigns and Symptoms: febrile seizure, h/o Wolf-Hirschhorn 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. Myelination pattern appears appropriate for 12 monthsNormal 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 have not fully developed. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Examination is mildly compromised due to patient motion on some of the pulse sequences.

Output: 1.No intracranial abnormalities are appreciated to explain the patient's convulsions.2.Examination is mildly compromised due to patient motion which may reduce sensitivity


Instruction: Generate impression based on findings.

Input: Contrast remains in radiocarpal joint with no apparent communication with the distal radial ulnar joint. Please refer to the subsequent MRI report for further information.Exposure time: 35 seconds

Output: Fluoroscopic guided injection of dilute gadolinium into the left wrist for subsequent MR arthrogram examination. Please see the MRI examination report for further details.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: 52 yo M with metastatic NSCLC to brain s/p SRS to cerebellar, right occipital, and right superior parietal lesions; eval other lesions History: none The left inferior frontal lobe lesion adjacent to anterior orbital gyrus lesion appears to be slightly smaller than prior scan ( 10 x 6mm to 8.1 x 5mm). The left cerebellar lesion also shows slightly decrease its size (10 x 10mm to 7x 7.6mm) since prior scan.Subtle enhancing lesion on the right occipital cortex and right superior parietal lobule lesion do not show any significant interval change since prior scan in terms of enhancement pattern, maximum diameter and other MR characteristics since prior scan.There is no new lesion on FLAIR/T2 weighted images and no evidence of new enhancing lesion on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Partial opacification of the right mastoid air cells.

Output: 1. Interval decrease in size of non-enhancing lesions including left frontal inferior frontal gyrus and left cerebellar hemisphere since prior scan.2. No change of minimally enhancing lesions on the right occipital lobe and right parietal lobe superior parietal lobule since prior scan.3. No evidence of new lesion. No evidence of new abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Ms. Martin is a 39-year-old female enrolled in a research breast cancer screening study for high risk individuals. She has a family history of breast cancer in her sister (diagnosed at the age of 33) and paternal grandmother. Known BRCA2 mutation carrier. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally (right greater than left), appearing similar in appearance to multiple prior older examinations.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 76 years old, female, with a history of hypertension, possible hypertrophic cardiomyopathy, recent syncope in the setting of sinus bradycardia. She is referred for cardiac MRI to evaluate LV hypertrophy and rule out infiltrative heart disease. Left VentricleThe left ventricle is normal in size and systolic function. The interventricular septum is moderate to severely hypertrophied; where as, the posterior wall is normal thickness. The LV apex is aneurysmal. The IVSd ranges between 15-18mm. The posterior wall dimension is approximately 8mm. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 132 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10), the LV mass index is 107 g/m2 (normal range 67+/-11), and the LV mass is 177 g (normal range 114+/-24). There is a large transmural myocardial infarction involving the entire apical aneurysm. There is additionally diffuse late gadolinium enhancement involving much of the interventricular septum suggest the presence of an underlying myocardial fibrosing, infiltrative, or inflammatory process. These findings are strongly suggestive of the diagnosis of hypertrophic cardiomyopathy.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size and hyperdynamic. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 103 ml (normal range 110+/-24), the RV end systolic volume index is 19 ml/m2 (normal range 22+/-8), and the RVESV is 31 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is evidence of mild systolic anterior motion of the mitral leaflets resulting in mild flow acceleration through the LVOT.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 53%). The interventricular septum is moderate to severely hypertrophied; where as, the posterior wall is normal thickness. The LV apex is aneurysmal. There is a large transmural myocardial infarction involving the entire apical aneurysm. There is additionally extensive fibrosis (>20% of the total myocardial mass) of the interventricular septum. These findings are strongly suggestive of the diagnosis of hypertrophic cardiomyopathy.2. Normal RV size with hyperdynamic systolic function (RVEF 70%).3. Mild systolic anterior motion of the mitral valve is noted.


Instruction: Generate impression based on findings.

Input: Multiple pancreatic cysts, likely IPMNs. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal and morphology. No focal mass lesion. No intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: There is prominent fatty atrophy of the pancreas. There are innumerable cystic foci throughout the pancreas largest of which is in the mid body and measures 16 x 17 mm in axial dimension. There is no appreciable enhancement of any of these lesions on the postcontrast images. The main pancreatic duct remains nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple cysts bilaterally.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.Innumerable cystic lesions in the pancreas measuring up to 1.7 cm in maximum dimension. There is no associated enhancement or dilatation of the main pancreatic duct. The leading differential consideration remains multiple sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: 70 year-old male history of elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate is enlarged measuring 6.4 x 5.7 x 7.7 cm.Peripheral Zone: No suspicious lesions identified. Right greater than left probable apical scarring. Central Gland: BPH with mass effect on the bladder.Seminal Vesicles: No significant abnormality notedExtracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Profound BPH, however no suspicious lesions identified. Right greater than left probable apical scarring. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 40-year-old male patient with known liver mass suspicious for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There is a vaguely T2 hyperintense and DWI hyperintense lesion in the liver adjacent to the falciform ligament in segment 4a that measures 2.3 x 3.5 cm (series 10 image 34). This lesion does not demonstrate arterial enhancement and demonstrates capsular enhancement on late images.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Segment 4 lesion does not meet imaging criteria for HCC. Biopsy is recommended.


Instruction: Generate impression based on findings.

Input: Female 76 years old Reason: Shoulder pain, evaluate for rotator cuff tear ROTATOR CUFF: Marked atrophy of the supraspinatus muscle is noted. There is diffuse T2 signal throughout the supraspinous tendon indicating tendinopathy. T2 hyperintense fluid signal at the insertion of the supraspinatus tendon consistent with full thickness tear, with no evidence of retraction. Intramuscular lipoma is noted within the infraspinatus muscle, with homogeneous fat signal on all sequences.SUPRASPINATUS OUTLET: T2 hyperintense fluid signal and degenerative changes is noted at the AC joint. Small amount of fluid is present in the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Anterior inferior labrum is torn with underlying osseous destruction consistent with osseous anterior labral tear. Edema type signal is noted in the subglenoid.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Full-thickness insertional tear of the supraspinatus tendon with no evidence of retraction.2.Marked atrophy of the supraspinatous muscle.3.Osseous anterior labral tear.4.Findings suggestive of adhesive capsulitis.5.Intramuscular lipoma of the infraspinatus


Instruction: Generate impression based on findings.

Input: Persistent N/V. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small areas of apparent encephalomalacia and gliosis in the white matter adjacent to the frontal horn of the left lateral ventricle. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is streaky high T2 signal material in the bilateral cheek subcutaneous tissues. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: 1. Small areas of periventricular leukomalacia adjacent to the frontal horn of the left lateral ventricle.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Probable cosmetic filler material in the bilateral cheeks.


Instruction: Generate impression based on findings.

Input: Reason: 45 y/o with pmh L4/L5 fusion, s/p MVA presenting with acute lumbar pain, decreased strength and ROM. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease aside from desiccation. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: Postsurgical changes with evidence of laminectomy and interspinous fusion. There is solid interspinous fusion. Degenerative changes anteriorly including severe loss of disc height, vacuum phenomena, and subchondral cyst are not significantly changed. There is a disc osteophyte complex with partial effacement of the left lateral recess which was also present on prior 2012 MRI. No significant central canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis. Facet arthropathy, left greater than right.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.There is a 2.1 cm left adnexal cyst, which is of doubtful clinical significance in a woman of reproductive age

Output: 1. No findings to suggest traumatic injury including compression fracture or hematoma within the spinal canal.2. Evidence of interspinous fusion at L4-L5 is again seen. 3. Degenerative changes involving the L4-L5 disc space are similar to prior from 2012. Partial effacement of the left lateral recess as well as mild to moderate left and mild right neural foraminal stenosis are also similar to prior from 2012.


Instruction: Generate impression based on findings.

Input: 65 year old male with CAD and complex past revascularizationMEDICATIONS: amlodipine, carvedilol, lasix, ibesartan, isosorbide, pravastatin, ranolazine, warfarin, nitro patch Viability/ Myocardial ScarThere is late gadolinium enhancement noted in the basal inferolateral wall suggesting prior myocardial infarction; approximately 70% wall thickness. Otherwise, the entire myocardium is viable. First Pass PerfusionDuring hyperemia, there is fixed perfusion defect in the mid and basal inferolateral wall. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVEDV is 131 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 39 ml (normal range 47+/-19), the LV mass index is 81 g/m2, and the LV mass is 172 g. There is a sigmoid shape to the ventricular septum. There is hypokinesis in the infero and inferolateral wall of the ventricular myocardium. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 88 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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. During hyperemia, there is fixed perfusion defect in the mid and basal inferolateral wall. 2. There is presence of late gadolinium enhancement in the basal inferolateral wall suggesting prior myocardial infarction approximately 70% of the myocardial wall. There is hypokinesis in the infero and inferolateral wall of the ventricular myocardium.3. Normal LV size and systolic function (LVEF 70%). 4. Normal RV size and systolic function (RVEF 52%).


Instruction: Generate impression based on findings.

Input: Reason: leukemia. HA. New binocular History: diplopia. The CSF spaces are appropriate for the patient's stated age with no midline shift. Multiple punctate foci of susceptibility are scattered in the genu, body and splenium of the corpus callosum as well as the periventricular white matter.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Susceptibility artifact partially obscures the eyes.In general the marrow signal is relatively low, however, this is not too unusual in a younger age.

Output: 1.Multiple microhemorrhages are present in the genu, body and splenium of the corpus callosum as well as the periventricular white matter. This pattern is rather unusual but has been seen with a prior history of high altitude cerebral edema. Please correlate with clinical history2.No brain stem lesions are appreciated specifically to explain the patient's diplopia.3.Low marrow signal the calvarium is a nonspecific finding and can be seen at younger age but also with myeloproliferative disorders.


Instruction: Generate impression based on findings.

Input: History of acute pancreatitis in September 2015. ABDOMEN:LIVER, BILIARY TRACT: Marked hepatic steatosis. Hepatomegaly measuring 26 cm in the craniocaudal dimension. In the posterior segment of the right hepatic dome there is a 2.5 x 1.9 cm arterial enhancing wedge-shaped lesion which remains isointense on portal venous and delayed phase imaging. It is associated with T2-weighted hyperintensity and restricted diffusion. No signal loss of out-of-phase imaging. Otherwise, no focal suspicious liver lesion or biliary ductal dilatation. Normally distended gallbladder without gallstones.SPLEEN: Upper limits of normal splenic size measuring 13 cm in length without a focal lesion. It is normal in signal intensity.PANCREAS: The pancreas is normal in morphology. It is mildly decreased in intrinsic T1-weighted signal intensity with mild restricted diffusion but no significant peripancreatic inflammatory changes. The pancreas enhances homogeneously without evidence of parenchymal necrosis or other stigmata of acute pancreatitis. The main pancreatic duct is poorly seen at the level of the pancreatic head but there is no significant upstream dilatation. There appears to be adequate excretory response to secretin administration. 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.Diffuse fatty infiltration of the liver puts the patient at risk for steatohepatitis. A focal hepatic dome lesion is likely benign, likely representing focal sparing.2. There is mild edema, restricted diffusion and loss of intrinsic T1-weighted signal intensity of the pancreas compatible with residua of acute pancreatitis. The main pancreatic duct is not well visualized at the level of the pancreatic head but without significant upstream dilatation which may reflect a subtle stricture, likely related to patient's pancreatitis. No significant peripancreatic inflammation, fluid collection, or arterial/venous complication.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with seizure disorder, occipital seizures, follow-up abnormal MRI from 11/2011. Diffusion restriction and T2 hyperintensity seen on the prior examination within the splenium of the corpus callosum have resolved.No new restricted diffusion is seen. There remain scattered T2 hyperintense lesions in the white matter which are stable in size and number relative to the prior examination.No evidence of parenchymal edema or mass effect is seen. No abnormal extra axial fluid collections are detected. The ventricles are stable and normal in size and morphology.Sequences tailored to the temporal lobes were performed and these show no areas of signal asymmetry or morphologic abnormality. No specific abnormalities are demonstrated in the occipital lobes.

Output: 1. Restricted diffusion and T2 hyperintensity seen on the prior examination within the splenium of corpus callosum have resolved without sequelae. These findings may therefore have represented a transient phenomenon related to seizure activity or perhaps medication.2. Scattered T2 hyperintense lesions are demonstrated within the cerebral white matter without significant interval change in size or number. These remain nonspecific and may reflect the sequela of an ischemic, inflammatory or demyelinating process among others.3. No specific abnormalities are detected within the temporal or occipital lobes.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There is a focus of decreased diffusion and T2 hyperintensity centered within the right hemi-pons. There are scattered additional foci of T2 hyperintensity throughout the supratentorial white matter. There is a fluid signal intensity well-defined lesion within the pineal cistern that measures up to 18 mm. There is no midline shift or herniation. The vertebrobasilar flow voids are relatively inconcpicuous. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is a left lens implant.

Output: 1. Acute right brainstem infarct without evidence of hemorrhagic transformation, but the vertebrobasilar flow voids are relatively inconspicuous. Dedicated vascular imaging ir recommended.2. Mild chronic small vessel ischemic disease. 3. Pineal cyst.


Instruction: Generate impression based on findings.

Input: 74 year old male patient with right kidney mass and concern for invasion into liver. ABDOMEN:LIVER, BILIARY TRACT: Mass effect on the right hepatic lobe secondary to a large right renal mass as described below. A 1.5 cm T2 hyperintense lesion within the left hepatic lobe without enhancement is compatible with a cyst. Additional subcentimeter T2 hyperintensities are too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The right adrenal gland is not discernible from the right renal mass.KIDNEYS, URETERS: There is a large T2 heterogeneous, enhancing mass arising off the upper pole of the right kidney measuring approximately 8.3 x 6.6 x 11.2 cm (transverse by AP by craniocaudal) with central low intensity compatible with necrotic tumor. Internal foci of increased T1 signal likely represent foci of hemorrhage. The mass extends superiorly and abuts the liver over at least a 7 cm distance. No discrete fat plane is identified on in and out of phase imaging. There is neovascularization of the tumor through recruitment from right intercostal arteries. There is a single right renal artery and vein. No definite right renal vein thrombus. There is a simple left renal cyst.RETROPERITONEUM, LYMPH NODES: There are small retroperitoneal lymph nodes; an aortocaval lymph node measures 1.4 x 0.5 cm (image 66, series 13). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large necrotic right renal mass compatible with renal cell carcinoma. Extension, abutment, and mass effect of the tumor with the right hepatic lobe without a discrete fat plane is worrisome for invasion.


Instruction: Generate impression based on findings.

Input: Syrinx, follow-up thoracic disk disease Again seen is a thoracic syrinx extending from the T3-T4 to the T7-T8 levels. Syrinx measures up to 5x5 mm in the axial plane at the T4-T5 level Atrophy of the mid thoracic cord is again noted with cystic myelomalacia at T7-8 involving nearly the full dimension of the thoracic cord . The spinal cord is anteriorly displaced which is at least in part related to exaggerated thoracic kyphosis. There is however focal kinking of the cord at the T6-T7 level where the thoracic cord abuts the ventral thecal sac. Degenerative changes are seen at multiple levels similar to prior with small disk bulges and a relatively more prominent disk protrusion at the left T6-T7 level which indents the left thoracic cord. Smaller disk bulges and small protrusions are seen at the T4-T5, T5-T6, T7-T8, and T8-T9 levels. levels. Posterior thecal sac is widely patent.Vertebral body heights are preserved. Small perineural cysts are again seen in the lower thoracic spine. There is loss of intravertebral disk space at the L1-L2 level with suggestion of ankylosis and mild retrolisthesis. Degenerative changes are also seen in the partially visualized cervical spine including mild anterolisthesis of C4 on C5.

Output: 1. Unchanged thoracic syrinx which extends from the T3-T4 to the T7-T8 levels. There is atrophy involving the mid thoracic cord. There is extensive bilateral cord signal abnormality at the T7-T8 level where there is suggestion of cystic myelomalacia. These findings may be related to remote ischemia, inflammation, or other injury.2. Unchanged kinking of the thoracic cord at the T6-T7 level where it abuts the anterior dural surface. Findings may be related to scar tissue however transdural cord herniation cannot be excluded. 3. Degenerative changes including left paracentral disk protrusion at the T6-T7 level which indents the thoracic cord again noted. Posterior thecal sac is widely patent. Exaggerated thoracic kyphosis again seen.


Instruction: Generate impression based on findings.

Input: 56-year-old male with metastatic small cell lung carcinoma status post radiation therapy. Neck mass. Headache. There is a 1.7 x 1.5 cm ring enhancing mass within the right high parietal convexity, with surrounding hypodensity consistent with a metastatic lesion with surrounding vasogenic edema. There are also questionable punctate enhancing lesions within the left frontal lobe and the left high parietal convexity. Brain MRI with contrast is recommended for more sensitive evaluation of these lesions. No midline shift or intra-cranial hemorrhage is seen. 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.The neck demonstrates a 2.8 x 2.7 x 3.1 cm enhancing mass within the right neck, with mass effect and compression of the right internal jugular vein. This likely represents a deep cervical nodal metastasis. In addition, there are multiple sclerotic lesions within the C3, T1, T3, T5, and T6 vertebral bodies, as well as the right posterior elements of C5. Within the visualized lung, there is bilateral pleural thickening and left-sided fibrosis and focal calcification. Please refer to dedicated chest CT for further discussion.

Output: Multiple intracranial, osseous, and deep cervical metastatic lesions as described above. Brain MRI with contrast is recommended for more sensitive characterization of intracranial lesions.


Instruction: Generate impression based on findings.

Input: 54-year-old female with strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 52-year-old female with family history of breast cancer. Mother, maternal aunt and cousin diagnosed with breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Stable enhancing foci in the left breast 9:00 and right central breast 6:00 posteriorly. Right retroareolar skin enhancing lesion seen on prior studies is not seen today.No abnormal lymph nodes are identified in either axillary region.High T2 hepatic lesions likely represent cysts and/or hemangiomata.

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


Instruction: Generate impression based on findings.

Input: History of P53 - Li-Fraumeni syndrome. Evaluate for malignancy. Scattered very small lymph nodes are noted in the thorax abdomen and pelvis. In the aortopulmonary window there is a 1.7 x 1.6 cm well-circumscribed nodule (series 901/8). No pathologically enlarged lymphadenopathy. Bilateral probable adnexal follicles and cysts. The right ovary is enlarged measuring 5.2 x 4.0 cm with a 3.4 cm probable hemorrhagic cyst. Otherwise, no focal suspicious mass lesion is identified of the visceral organs.In the distal right femur involving the metaphyseal lateral cortex is a well-defined lobular lesion with a peripheral hypointense rim suggesting a peripherally sclerotic bone lesion, likely a benign fibrous cortical defect, however further confirmation with dedicated radiographs of the right femur is recommended. No additional focal lesion of the imaged osseous or soft tissue structures.

Output: 1. 1.7 cm nodule in the aortopulmonary window warrants further characterization with a dedicated chest CT. Differential diagnosis includes metastatic adenopathy, para ganglioma, or thymic origin neoplasm.2. Well-circumscribed lesion involving the lateral cortex of the distal right femoral metaphysis, likely a benign fibrous cortical defect, however confirmation with dedicated radiographs of the right femur is recommended. 3. Probable right adnexal hemorrhagic cyst. Follow-up pelvic ultrasound in 3 months to confirm resolution is recommended.4. Small scattered lymph nodes.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of brain metastasis. Evaluate for progression. There is a new intraparenchymal lesion measuring 2.0 x 1.5 cm within the peripheral aspect of the left cerebellar hemisphere demonstrating heterogeneous enhancement as well as components of diffusion restriction and hemosiderin staining with surrounding vasogenic edema most compatible with metastasis. There are additional smaller enhancing lesions located at the grey-white junction along the right cingulate sulcus, and within right occipital lobe, measuring 5 mm and 8 mm respectively with increased adjacent T2/FLAIR signal abnormality. These lesions are most compatible additional metastatic deposits.There are postoperative findings related to right parietal craniotomy with a right parietal lobe resection cavity containing chronic blood products with additional mild surrounding non-masslike and ill-defined enhancement. Adjacent vasogenic edema has significantly decreased when compared to the prior exam. These findings are favored to represent granulation tissue/post surgical changes, though continued follow up is required to ensure stability or continued regression.Additionally, scattered areas of T2/FLAIR hyperintensity within the periventricular white matter are thought to represent stable chronic small vessel ischemic disease.The basal cisterns are intact. Flow-voids are present within the major cerebral vessels. There is no evidence of abnormal leptomeningeal enhancement. The soft tissues of the scalp are unremarkable. The orbits, paranasal sinuses, and mastoid are cells are clear.

Output: 1.New lesion within the left cerebellar hemisphere compatible with metastatic disease. Additional smaller lesions are located along the right cingulate sulcus and right occipital lobe also likely represent additional metastatic foci.2.Postsurgical changes of right craniotomy as above with ill-defined enhancement and decreased surrounding vasogenic edema which is thought to represent granulation tissue/post-surgical changes, although continued followup is recommended.3.Stable-appearing chronic ischemic small vessel disease.


Instruction: Generate impression based on findings.

Input: 66-year-old male with urethral cancer at the meatus. PELVIS:PROSTATE/SEMINAL VESICLES: Prostatomegaly measuring 5.6 x 4.6 cm in transaxial dimension. T1 hyperintense focus in the region of the epididymis likely representing a epididymal cyst. Small hydroceles bilaterally.There is no gross abnormal focal or nodular enhancement of the urethra. The known cancer of the distal urethral meatus is not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant inguinal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No inguinal lymphadenopathy. 2.The known cancer of the distal urethral meatus is not well visualized.


Instruction: Generate impression based on findings.

Input: A 67 year old male with history of coronary artery disease, s/p PCI X3 to LCx (2005), hyperlipidemia, left ventricular dysfunction, cardiomyopathy suspected to be secondary to frequent PVC's, s/p attempted ablation (endo and epicardial). A recent echocardiography showed LVEF of 44.7%. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 176 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 122 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). Due to frequent PVC's, volumetric quantification is limited. On late gadolinium enhancement images, there is transmural hypoperfusion of the basal to mid anterior wall (i.e. along the left ventricular summit) with a thin rim of hyperenhancement consistent with microvascular obstruction from the patient's recent ablation procedure. There is no myocardial iron overload. No intracavitary thrombus was noted.Left AtriumThe left atrium is moderately dilated (126ml). Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 54 ml/m2 (normal range 82+/-16), the RVEDV is 105 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mitral annulus calcification and thickening of the leaflets.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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 a trace pericardial effusion, mainly around the RV and RA. Extracardiac FindingsBilateral small pleural effusions were noted. 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 moderately reduced systolic function, the LVEF is 31%. However, quantification is limited by frequent PVC's. 2. On late gadolinium enhancement images, there is transmural hypoperfusion of the basal to mid anterior wall (i.e. along the left ventricular summit) with a thin rim of hyperenhancement consistent with microvascular obstruction from the patient's recent ablation procedure. 3. There is biatrial dilation. 4. The right ventricle is normal in size with moderately reduced systolic function, the RVEF is 37%. 5. There is mitral annulus calcification and thickening of the leaflets. No significant MR was seen.6. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 16 years old with left knee pain and swelling. Evaluate meniscus tear and chronic PCL tear. MENISCI: There is deformity of the posterior horn of the medial meniscus near its root representing a root avulsion as seen on the prior study. Intermediate signal intensity at the expected site of attachment presumably represents scarring. There is mild medial extrusion of the medial meniscus. The body and anterior horn of the medial meniscus are unremarkable. There is a prominent transverse meniscal ligament but we see no definite lateral meniscus tear.ARTICULAR CARTILAGE AND BONE: There is partial thickness degeneration of the articular cartilage of the medial femoral condyle which has progressed compared to the prior study.LIGAMENTS: The anterior cruciate ligament is intact. There is deformity of the posterior cruciate ligament proximally with low signal intensity strands connecting the distal ligamentous fibers to the femur likely reflecting scarring from prior PCL rupture. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Chronic tear of the root of the posterior horn of the medial meniscus.2.Chronic tear of the posterior cruciate ligament with low signal intensity fibers extending from the ligament to the femur likely representing scarring.3.Partial-thickness degeneration of the articular cartilage of the medial femoral condyle which has progressed compared to the prior study.4.Joint effusion and Baker's cyst.5.Popliteal artery bypass incompletely imaged on this study.


Instruction: Generate impression based on findings.

Input: 35 year-old female with new diagnosis of malignancy of unknown origin presenting with dyspnea and tachycardia. Abdominal mass on palpation. Evaluate for PE and neoplasm. PULMONARY ARTERIES: Technically adequate pulmonary embolus examination without evidence of filling defect to indicate pulmonary embolus.LUNGS AND PLEURA: Left-sided pleural effusion with adjacent compressive atelectasis. Scattered bilateral micronodules too numerous to count.MEDIASTINUM AND HILA: Left upper lobe round soft tissue density mass measures 2.1 x 2.1 cm (image 59/159) series 9, within the left perihilar region region demonstrates mass effect on the left mainstem bronchus and left segmental pulmonary artery.CHEST WALL: Scattered, nonspecific axillary lymph nodes. Destructive lesions of third and fifth anterior ribs. Destructive lesions involve the scapula bilaterally. Multiple lytic lesions throughout the thoraco- lumbar spine consistent with metastatic disease. Expansile lytic lesion within the vertebral body T7 demonstrates posterior expansion into the central canal and may be further evaluated with MRI as clinically warranted.UPPER ABDOMEN: Ill-defined hypodense lesion within the left lobe of the liver with correlated with abdomen and pelvis CT performed same day consistent with metastatic lesion. Multiple retroperitoneal lymph nodes.For further evaluation of the abdomen and pelvis please see dedicated abdomen and pelvis CT report performed same day.

Output: 1. No evidence of pulmonary embolus as clinically questioned.2. Left-sided large pleural effusion.3. Multiple scattered micronodules likely represent lymphangitic spread.4. Left parahilar mass causes mild adjacent compression of the left segmental pulmonary artery and left bronchus.5. Multiple bony and hepatic metastases as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cervical stenosis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Again seen is a disc extrusion at the C4-C5 level which appears minimally larger than prior and is associated with deformity of the ventral cord. Subtle T2 hyperintensity is suspected in the cord at this level. The remainder of the cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Right central disc extrusion which appears minimally larger than prior study. No significant right neural foraminal narrowing. There is mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. C5-6: Small disc osteophyte complex and ligamentum flavum thickening contributing to mild spinal canal narrowing. There is mild right-sided neural foraminal narrowing related to uncovertebral hypertrophy. No significant left neural foraminal narrowing. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Compared to 4/22/2014 there is minimal interval increase in size of disc extrusion at the C4-C5 level which deforms the ventral cord at this level. Subtle T2 hyperintensity in the cord is suspected at this level. Mild degenerative changes at additional levels as detailed above.


Instruction: Generate impression based on findings.

Input: Elevated prolactin, rule out prolactinoma. Pituitary: There appears to be a focus of hypoenhancement in the posterior left adenohypophysis that measures up to 2 mm. Otherwise, the pituitary gland is not enlarged. The posterior pituitary bright spot is intact. The infundibulum is intact and situated in the midline. The optic apparatus and cavernous sinuses are intact. Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma 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 mucosal thickening in the sphenoid sinuses.

Output: An apparent punctate focus of hypoenhancement in the posterior left adenohypophysis may represent a microadenoma.


Instruction: Generate impression based on findings.

Input: 42-year-old female with multifocal left breast cancer and left nipple discharge. Patient reports left breast lumps have decreased in size and nipple discharge has resolved. LEFT BREAST:There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Previously seen biopsy proven posterior left axillary tail mass with clip susceptibility artifact has significant decreased in size, measuring 6 x 4 x 5 mm (AP x TR x CC), previously 10 x 8 x 9 mm. Area of non-mass enhancement immediately anterior and slightly superior has also decreased in size, measuring 11 x 3 x 3 mm, previously 16 x 7 x 10 mm (AP x TR x CC).No new enhancement. Previously noted left nipple enhancement has resolved. No abnormal lymph nodes are identified in the left axilla.RIGHT BREAST:No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in the right axilla.

Output: 1.Interval decrease in size of left axillary tail mass with clip compatible with patient's biopsy proven malignancy. 2.Interval decrease in size of non-mass enhancement immediately anterior to this mass. 3.Resolution of left nipple enhancement.4.No new enhancing lesion.5.No abnormal lymph nodes bilaterally.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: New diagnosis lupus, on steroids, with hallucinations and change in mental status. MRI: There is cortical and subcortical swelling and T2 hyperintensity in the bilateral frontal, parietal, and occipital lobes along watershed zones without restricted diffusion. There is prominence of leptomeningeal vessels in the affected regions. There is also mild periventricular white matter T2 hyperintense surrounding the posterior portions of the bilateral lateral ventricles. The infratentorial contents are unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is nonspecific patchy enhancement within the oral tongue.MRA: There is no evidence of large vessel significant steno-occlusive arterial lesions or aneurysms.MRV: There is no evidence of venous sinus thrombosis.

Output: 1. Cortical and subcortical swelling and T2 hyperintensity in the bilateral frontal, parietal, and occipital lobes along watershed zones is most suggestive of posterior reversible encephalopathy syndrome, without associated hemorrhage or acute infarction.2. No evidence of large vessel significant steno-occlusive arterial lesions.3. No evidence of venous sinus thrombosis.REFERENCES: 1. Kur JK, Esdaile JM. Posterior reversible encephalopathy syndrome--an underrecognized manifestation of systemic lupus erythematosus. J Rheumatol. 2006 Nov;33(11):2178-83. 2. Leroux G, Sellam J, Costedoat-Chalumeau N, Le Thi Huong D, Combes A, Tieulié N, Haroche J, Amoura Z, Nieszkowska A, Chastre J, Dormont D, Piette JC. Posterior reversible encephalopathy syndrome during systemic lupus erythematosus: four new cases and review of the literature. Lupus. 2008 Feb;17(2):139-47.


Instruction: Generate impression based on findings.

Input: 53 year-old female with known left breast cancer, status post neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, the known cancer is again visualized at central - 3 o'clock position, measuring 29 x 32 x 21 mm (AP x LR x CC, previous measurement: 29 x 39 x 34 mm). There is susceptibility artifact from two biopsy marker clips superior to the mass. The medially located clip is approximately 10 mm superior to the anterior portion of the mass.No other abnormal enhancement in present in the left breast.In the left axilla, no abnormally enlarged lymph nodes are identified (previously, there were two abnormally enlarged lymph nodes). A susceptibility artifact from a marker clip is present in the left axilla.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.A Port-A-Cath is present within the medial superior right chest wall.

Output: 1. Mild reduction in size of the known left breast carcinoma 2. Marked reduction in size of left abnormally enlarged lymph nodes.3. No MR evidence for malignancy in right breast or right axillaBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Vomiting with a medullary lesion. There is an expansile, infiltrative, high T2 signal lesion with patchy enhancement involving the medulla and upper cervical spinal cord, which measures up to 48 mm in length and 18 mm in width. There is no evidence of other spinal cord lesions. 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. There is a small amount of fluid in the pelvis, which is likely physiological.

Output: An infiltrative lesion involving the medulla and upper cervical spinal cord may represent a neoplasm, such as an astrocytoma, rather than an atypical demyelinating or inflammatory lesion.


Instruction: Generate impression based on findings.

Input: Check ligaments, direct blow laterally MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Bone marrow signal intact and cartilage well visualized without focal defects.LIGAMENTS: Complete tear of the ACL with minimal retraction questionable adherence of the distal component to the PCL . The PCL, collateral ligaments and extensor complex are otherwise intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: ACL tear without associated meniscal abnormalities.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is horizontal intrasubstance tearing of the posterior horn of the medial meniscus which extends into the body where there is truncation of the free edge. There is mild extrusion of the meniscus into the medial gutter although the meniscal root appears intact.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss involving both the medial femoral condyle and medial tibial plateau with associated degenerative marrow signal in the underlying bone. There is diffuse thinning of the articular cartilage of the lateral compartment, particularly anteriorly. The patellofemoral articulation demonstrates scattered areas of partial and full-thickness cartilage loss most notably involving the lateral patellar facet and trochlea. LIGAMENTS: Mildly increased signal surrounding the MCL. Otherwise no significant abnormality noted. EXTENSOR MECHANISM: Extensor mechanism is intact. A mild amount of subcutaneous fluid is seen overlying the anterior tibial tuberosity.ADDITIONAL

Output: 1. Predominantly horizontal tear of the posterior horn and body of the medial meniscus. The lateral meniscus is intact.2. Severe cartilage loss of the medial compartment with more moderate changes noted in the lateral and patellofemoral compartments.3. Mild MCL sprain.


Instruction: Generate impression based on findings.

Input: 50 year old with BRCA mutation and personal history of ovarian cancer. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Annual screening MRI and mammogram are recommended given her BRCA mutation. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: BRCA1 mutation carrier. History of breast carcinoma in mother diagnosed at age 65 and a maternal aunt diagnosed in her 60s. A second maternal aunt diagnosed with breast cancer and non-Hodgkin's lymphoma, and a maternal great aunt with breast cancer. History of colon cancer in mother diagnosed at the age of 69 and maternal grandmother. History of bladder cancer in maternal grandfather. Patient has no current breast related complaints. Breasts and axilla:There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Extra mammary findings:The 19 mm high T2 lesion in the right hepatic lobe has gradually increased in size from 11 mm in 2009. Posterior to this lesion is another 7 mm high T2 lesion in the right hepatic lobe, which is stable since 2010. The third lesion in the left hepatic lobe on the prior studies is not well seen on today's exam likely due to the technique differences.

Output: No MRI evidence for malignancy in either breast. 19 mm high T2 lesion in the right hepatic lobe has gradually increased in size since 2009, which is incompletely characterized. The imaging characteristics are suggestive of benign lesions such as a hepatic cyst or hemangioma. However, given it's increase in size, MRI liver protocol is recommended for confirmation. Recommendations were discussed with Dr. Iris Romero at approximately 12:11 PM on 10/29/2015BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Localized swelling, mass and lump, head [R22.0], Reason for Study: ^Reason: eval sellar lesion History: lesion on Head CT Pituitary MRIThere is relatively well circumscribed, homogeneously enhancing, expansile sellar mass with a couple of daughter nodules. The mass is sized about 35.7mm (RL) x 33.6mm (CC: not including daughter nodule) x 33.4mm (AP). The epicenter of the lesion is located slightly on the right side of sellar. The lesion encases right distal ICA from the foramen lacerum segment to paraclinoid segment. Enhancing portion of the tumor involves right cavernous sinus, upper part of clivus, right side of sphenoid sinus and anterior aspect petrous apex.Brain MRI with stealth protocolSellar mass with suprasellar extension was demonstrated. The ventricles, sulci and cisterns are symmetric and unremarkable. The mastoid air cells are clear. Mucosal thickenings are seen on bilateral ethmoid sinuses.

Output: 1. Large expansile sellar mass with suprasellar extension. MR evidence of local extension of the mass in particular toward right cavernous sinus with encasing distal right ICA, sphenoid sinus right side, superior aspect of the clivus and right side petrous apex. The size of the mass is measured about 35.7mm (RL) x 33.6mm (CC: not including daughter nodule) x 33.4mm (AP).2. Ventricular system appears to be normal. No other mass is seen.


Instruction: Generate impression based on findings.

Input: MRI brain: There is no diffusion abnormality. Punctate focus of T2 FLAIR hyperintensity in the periventricular right frontal white matter, nonspecific. There are no areas of abnormal signal or pathological enhancement. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the right maxillary sinus.MRI pituitary: Dedicated images through the sella demonstrate a normal height of the pituitary gland. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.

Output: No MR findings to indicate an intracranial mass or convincing evidence of demyelinating disease. No evidence of sellar/parasellar mass seen on dedicated pituitary MRI.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, history of GBM, presumably IDH wild type, MGMT unmethylated, prior to resection and TMT/RT; PD two cycles of IDO pathway immunotherapy, D56 on anti-angiogenic agent plus Avastin. Postop findings are again seen compatible with bilateral frontal craniotomy. A cystic space occupying the left frontal lobe has not significantly changed.A large area of signal abnormality and mass effect is again seen involving the entire right frontal lobe, corpus callosum, insula, basal ganglia, and thalamus. The core of the lesion demonstrates a scarlike area of intense enhancement with more feathery subtle enhancement elsewhere. The intensity of enhancement has decreased when compared to the prior examination. However, the overall size of the abnormal has progressed. In particular, tumor-like bulkiness expanding many of the frontal gyri has progressed in areas which previously appeared simply edematous.Mass effect is again seen in the right cerebral hemisphere including inferior displacement and partial effacement of the right lateral ventricle, and a midline shift to the left of at least 5 mm. The left lateral ventricle is not dilated.Progressive enhancement has also occurred within the left cerebellum. The prior single enhancing nodule has become larger, and there is now a new rim-enhancing nodule which projects into the fourth ventricle, and perhaps an additional new satellite nodule just lateral to the original lesion. The fourth ventricle is partially effaced and signal abnormality extends from these lesions into the midbrain.

Output: Findings are again seen concerning for progressive disease. Although the intensity of enhancement of the right frontal lobe lesion has diminished, the overall size of the abnormality, and in particular the tumor-like bulkiness of many of the frontal gyri, have progressed. Furthermore, new and larger enhancing nodules are also demonstrated adjacent to the fourth ventricle.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: neck pain, tingling in the UE with h/o spinal stenosis, evaluate for nerve impingement The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. Exam is degraded by motion artifact.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal . There are left sided uncovertebral osteophytes present associated with disk material and encroachment of the left exiting nerve roots. This is stable compared to the prior exam.At C5-6 there are endplate and uncovertebral osteophytes present associated with posterior ligamentous hypertrophy and left worse than right neural foraminal encroachment of exiting nerve roots. There is moderate left sided encroachment of exiting nerve roots and mild to moderate right sided encroachment of exiting nerve roots. There is loss of disk space height and disk dessication present at this level. This is stable compared to the prior exam. There is mild spinal stenosis.At C6-7 there are endplate and uncovertebral osteophytes present and left worse than right neural foraminal encroachment of exiting nerve roots. There is moderate left sided encroachment of exiting nerve roots and mild to moderate right sided encroachment of exiting nerve roots. There is loss of disk space height and disk dessication present at this level. This is stable compared to the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge and disk dessication present at this level.The vertebral artery flow voids appear to be intact.

Output: There are degenerative changes present in the cervical spine present worse at C5-6 and C6-7 where there is moderate left sided encroachment of exiting nerve roots and mild to moderate right sided encroachment of exiting nerve roots. There is mild spinal stenosis at C5-6 and mild to moderate encroachment of the left exiting nerve roots at C4-5. These findings are stable compared to the prior exam from 3/3/14.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: infective cause of seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A small fatty sessile lesion is present adjacent to the right frontal bone probably a small lipoma measuring 5 mm x 20 mm coronal dimensionsMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The left posterior communicating artery is small the right posterior communicating artery is tiny.. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: 70-year-old male with prostate cancer status post prostatectomy with rising PSA PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically absent. T2 hypointense lesion demonstrating diffusion restriction in the region of the right seminal vesicles surrounding a surgical clip with extension across midline to the left. This lesion measures 2.3 x 1.7 cm and demonstrates early enhancement.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter 5 mm lymph nodes along bilateral external iliac chains. No lymphadenopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the region of the region of the right seminal vesicle measuring 2.3 x 1.7 cm extending across midline to the left highly suspicious for local recurrence.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L4 and L5 and some straightening involving the lumbar lordotic curvature. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.There is developmental narrowing of the mid to lower lumbar spinal canal with superimposed degenerative changes as described below: L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation with minimal disc bulge. Mild facet arthropathy with distention of the facet joints. There is no significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis. L4-L5: There is disc desiccation with mild disc bulge and dorsal annular fissure. There is also mild facet arthropathy with distention of the facet joints. Mild narrowing of the spinal canal which is predominantly on a developmental basis and in part related to minimal retrolisthesis and disc bulge. Minimal narrowing of the bilateral neural foramina.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy with mild distention of the facet joints.Paraspinous soft tissues are within normal limits. Left renal cysts incidentally noted.

Output: Mild developmental narrowing of the lumbar spinal canal with superimposed mild degenerative changes including small disc bulges at the L3-L4 and L4-L5 levels. There is mild bilateral L3-L4 and minimal L4-L5 neural foraminal stenosis. There is also mild facet arthropathy with distention of the facet joints from L3-L4 to L5-S1 which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with metastatic breast cancer and back pain. Heterogeneous enhancing lesions within the left aspect of the T12 vertebral body in the right aspect of the L1 vertebral body have not significantly changed in size or morphology. Minimal associated concavity of the superior L1 endplate, and minimal posterior expansion of the L1 vertebral body, are unchanged.Small marrow replacing lesions within the left aspect of the L4 vertebral body and the left aspect of the L5 vertebral body are also redemonstrated without significant interval change. These lesions produce no significant osseous expansion. The L4 lesion enhances while the L5 lesion does not. A heterogeneous enhancing lesion within the left iliac bone is unchanged.Spinal alignment is anatomic. Vertebral body heights are preserved. Minimal disc bulging is evident at L3-4 with slight facet degeneration. Minimal disc bulging with a tiny left paracentral protrusion is evident at L4-5 along with mild facet degeneration. No significant spinal canal or foraminal compromise is demonstrated at any level. The visualized distal spinal cord and cauda equina are within normal limits. No pathologic intrathecal enhancement is seen.

Output: Multiple metastatic lesions are redemonstrated including within the T12, L1, L4 and L5 vertebral bodies as well as the left iliac bone. There has been no significant interval change in size of these lesions. No new lesions are detected.