Instruction: Generate impression based on findings.

Input: 62-year-old male with history of a hemangioma. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: No significant change in the right hepatic lobe T1 hypointense, T2 hyperintense lesion demonstrating peripheral nodular enhancement most consistent with hemangioma; this lesion measures 9.7 x 8.1 cm (series 701, image 32), unchanged. Additional small hemangiomas are also unchanged.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: No significant interval change in the large right hepatic lobe hemangioma.


Instruction: Generate impression based on findings.

Input: T3N0 poorly differentiated SNUC status post surgical resection, 5-FU, and radiation. There are postoperative findings related to sinonasal tumor resection. There is opacification of the left frontoethmoid recess and anterior ethmoid air cells. There is also persistent complete filling of the left sphenoid sinus with secretions and mucosal thickening and diffuse mucosal thickening within the right maxillary, right sphenoid, left frontal, and right ethmoid sinuses. Otherwise, there is no measurable mass lesion in the sinonasal region. The salivary glands are unremarkable. There is encephalomalacia in the inferior right cerebellar hemisphere. There are bilateral lens implants.

Output: 1. Post-treatment findings in the sinonasal region with persistent scattered mucosal inflammatory changes, but no convincing evidence of recurrent tumor. 2. Chronic right PICA territory infarct.


Instruction: Generate impression based on findings.

Input: S/P OHT - evaluate for constriction Left VentricleThe left ventricle is normal. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 144 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19). No regional wall motion abnormalities. Mild concentric LVH.Left AtriumThe left atrium is c/w post transplant. Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Right AtriumThe right atrium is c/w post transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. 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 (25 mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium. IVC is dilated (3 cm).PericardiumThere is no obvious pericardial effusion. Pericardial fat is noted. Pericardium does not appear thickened. Myocardial tags and real-time imaging do not demonstrate cardiac motion consistent with constriction.Extracardiac FindingsSmall BL pleural effusions R>L. 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. Normal LV systolic function2 Normal RV systolic function3. Nothing on MRI suggestive of pericardial constriction. RHC and/or TTE would provide complementary physiologic evaluation.


Instruction: Generate impression based on findings.

Input: BRAIN: The cerebellar tonsils have a pointed configuration and lie 20 mm below the craniocervical junction, terminating at the C1-C2 level. The posterior fossa is mildly small. There is diminished CSF flow dorsally and mildly diminished as well as simultaneous bi-directional CSF flow ventrally at the craniocervical junction. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at L1. The paravertebral soft tissues are unremarkable.

Output: Chiari I malformation without syringohydromyelia.


Instruction: Generate impression based on findings.

Input: 28 year-old female with headache and syncope. Please evaluate for bleed/mass. Family history of aneurysms. There is no evidence of intracranial hemorrhage, parenchymal, intra-axial mass or edema. Adjacent to the left parietal lobe, there is a small extra axial broad based soft tissue density mass with punctate areas of calcification which has associated hyperostosis of the adjacent skull and measures 8 x 15 mm, (coronal series 80232, image 40). This most likely represents a meningioma. Further evaluation with MRI is recommended as clinically indicated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormalities, specifically no bleed.2. Small left parietal region extra-axial mass with adjacent associated hyperostosis most likely representing a meningioma. Further evaluation with MRI is recommended as clinically indicated.


Instruction: Generate impression based on findings.

Input: 18 year-old male patient with fever and left elbow pain and history of sickle cell. Question of osteomyelitis. LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is patchy low T1 signal and high STIR signal within the distal humeral metadiaphysis and more confluent low T1 and high STIR signal within the proximal radial diaphysis with corresponding enhancement. There is no specific evidence of cortical destruction.  SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: 1. Findings are highly concerning for osteomyelitis of the distal humerus and proximal radius. Acute bone infarction is considered less likely given surrounding abnormalities.2. Large joint effusion with thick rind of enhancement; septic arthritis cannot be excluded.


Instruction: Generate impression based on findings.

Input: 86 year old man with history of dual chamber pacemaker for sick sinus syndrome, recent worsening atrial fibrillation burden, who presents for pre-ablation cardiac MRI. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 111 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 34 g/m2 (normal range 85+/-15), and the LV mass is 55 g (normal range 164+/-36). There is global hypokinesis and dyssynchrony of the interventricular septum. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17). There is a pacemaker lead in the right ventricle.Right AtriumThe right atrium is severely dilated. There is a pacemaker lead which terminates in the right atrial appendage. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflet tips are thickened. The valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta measured 39 x 41mm.Pulmonary VeinsAll five pulmonary veins drain normally into the left atrium.The pulmonary vein dimensions are as follows:RLPV: 14 x 16mmRUPV: 17 x 21mmRMPV: 11 x 10mmLLPV: 18 x 18mmLUPV: 12 x 17mmPulmonary ArteryArtifact from the pacemaker overlies the main pulmonary artery. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Pacemaker leads are visualized in the SVC.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions. There are multiple well circumscribed nonenhancing lesions on the kidneys bilaterally; most likely represent cysts. 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 (37%).2. The right ventricle is normal in size with mild-moderately reduced systolic function (44%). 3. Severe right atrial dilation. 4. Pulmonary vein anatomy and dimensions as noted above. 5. Pacemaker leads visualized in the right atrium and ventricle. 6. At least moderate tricuspid regurgitation. 7. 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: 42-year-old male with history of multiple sclerosis who presents with bilateral leg weakness. There are numerous, greater than 10, patchy T2 hyperintense white matter lesions scattered throughout the subcortical and deep cerebral periventricular white matter in addition to the basal ganglia, midbrain, peripheral pons, and cerebellar peduncles and hemispheres. There is no evidence of enhancing lesions or any areas of restricted diffusion. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. The major intracranial vascular flow voids appear to be intact. There is mild left maxillary sinus mucosal thickening. The mastoid air cells are unremarkable. The orbits are unremarkable.

Output: Findings compatible with multiple sclerosis in the supratentorial and infratentorial regions without evidence of enhancing lesions or restricted diffusion to suggest active demyelination.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49-year-old male patient status post radial head arthroplasty. There is been interval placement of a radial head arthroplasty device in near-anatomic alignment without evidence of hardware complication. There are severe degenerative changes in the remaining elbow with osteophyte formation and several ossifications that may represent loose bodies in the joint, similar to slightly decreased in number compared to prior. Suture anchors are again noted in the olecranon. There is mild diffuse soft tissue swelling.

Output: Postsurgical changes from radial head arthroplasty in near-anatomic alignment as described above.


Instruction: Generate impression based on findings.

Input: Complex febrile seizure. There is no evidence of intracranial heterotopia, hamartomas, hemorrhage, mass, or acute infarct. The brain parenchyma, including the medial temporal lobes, brainstem, cerebellum, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There are left maxillary sinus secretions.

Output: No evidence of gross seizure foci. However, certain cortical dysplasias are not discernible on 1.5T MRI.


Instruction: Generate impression based on findings.

Input: Patient had ultrasound done in China and told she had a mass. No further information available. On exam has fullness in the right anterior neck. No lymphadenopathy. No difficulty breathing, swallowing, eating. No change in voice. No symptoms of thyroid dysfunction. Mother status post thyroidectomy. RIGHT LOBE MEASUREMENTS: 5.7 x 2.1 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.4 x 0.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: 2.6 x 1.4 x 1.8 cm complex solid appearing nodule in the right lobe would be amenable to thyroid FNA if desired clinically. No microcalcifications or other irregularities.LEFT LOBE: No significant abnormality noted.ISTHMUS: 5 mm nodule in the isthmusPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodesOTHER: No significant abnormality noted.

Output: Dominant solid nodule in the right lobe of the thyroid. This be amenable to FNA if desired clinically.


Instruction: Generate impression based on findings.

Input: There are is failure of fat suppression on the axial sequences related to cervical hardware limiting evaluation. Anterior cervical fusion is noted from C4 to C7. There is no abnormal signal involving the brachial plexus based on the coronal STIR sequence, which is of decent quality. No abnormal enhancement is appreciated on the coronal sequences. No masses within the lung apex or lower neck soft tissues to suggest extrinsic compression.

Output: Technically degraded study due to cervical fusion hardware. Within this limitation, no abnormal edema or enhancement is appreciated based on the coronal sequences to suggest a brachial plexopathy. There are no masses to suggest extrinsic compression.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (9/29/2016), ultrasound images of left breast (9/29/2016), images from ultrasound guided biopsy of left breast with postprocedural left mammographic images (9/30/2016), ultrasound images of left axilla (10/4/2016), breast MRI (10/5/2016) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (9/29/2016):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). A triangular marker is placed at upper inner quadrant of left breast, denoting the area of palpable lump. There is an ill-defined mass at posterior lower inner quadrant in the left breast, posterior to the palpable marker. On the secondary captured tomo images, the mass appears partially circumscribed measuring 17 mm.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (9/29/2016):There is a microlobulated hypoechoic mass measuring 22 x 18 mm at 8:00 position, 6-cm from the nipple, in the left breast. Blood flow of this mass is confirmed with Doppler study.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (9/30/2016):Ultrasound guided biopsy for the left 8:00 mass was performed. Targeting appears good, and a marker clip is placed into the mass. Postprocedural mammograms show that a marker clip is located within the mass at inferior central aspect.The biopsy result was malignant as per outside radiology report.ULTRASOUND IMAGES OF LEFT AXILLA (10/4/2016):There are 2 adjacent hypoechoic masses in the left axilla, consistent with enlarged lymph nodes with effaced hila. The larger lymph node nature is 41 x 28 x 29 mm and the smaller lymph node measures 26 x 18 x 20 mm. Ultrasound guided needle biopsy was performed for the larger lymph node. A biopsy needle appears appropriately placed. A sonographically visible clip was placed into the target lymph node.Pathology results are not available to us.BREAST MRI (10/5/2016):Dynamic contrast enhanced breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are multiple small cysts in both breasts.A large irregularly-shaped enhancing mass, which is a proven malignancy, is present at 5:00 - 7:00 position, measuring 37 x 39 x 30 mm (AP x LR x CC) in the left breast. The mass extends near the skin at the anterior lower portion. In the left axilla, several enlarged lymph nodes are seen; the largest lymph node contains a marker clip measuring 30 x 37 mm (AP x LR) on axial plane. An enlarged internal mammary lymph node, measuring 7 mm, is seen in the left parasternal region.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. A biopsy proven malignant tumor in the left breast with multiple highly suspicious abnormal lymph nodes in the left axilla and a suspicious left internal mammary lymph node. Pathology slides should be reviewed at the University of Chicago. 2. No MRI evidence of malignancy in the right breast or right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient and the patient's mother, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 9 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner, although it was difficult to inject contrast into the joint space, suggesting the possibility of adhesive capsulitis. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 40 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the right hip for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: Procedure: MRI BRAIN WODiagnosis: Other speech disturbancesClinical question: eval for ICH MRI of the brainNo diffusion weighted abnormalities are appreciated.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.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.No evidence for acute ischemic cerebral infarction.2.No evidence for cervical carotid or vertebral occlusive disease.3.MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 50 year-old woman with right hemiparesis. Status post recent aneurysm coiling, remote history of intracranial hemorrhage. Evaluate for ICH / stroke. There is no evidence of acute intracranial hemorrhage, mass or edema. There are midline metallic densities consistent patient's known history of aneurysm coiling. There are periventricular hypodensities which are more pronounced on the left as well as focal regions of hypodensity in the subcortical regions and basal ganglia bilaterally. These findings are consistent with age-indeterminate small vessel ischemic disease and lacunar strokes, respectively. Areas of encephalomalacia are present in the distribution of the bilateral anterior cerebral arteries (series 5 image 24) consistent with prior stroke. There are no definite CT findings of acute stroke. However, if acute stroke remains clinical concern recommend MRI.The left lateral ventricle is larger than the right. There is a shunt which enters through the frontal bone to the right of the midline and terminates in the region of the third ventricle. There is a region of encephalomalacia adjacent to the shunt.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT findings of acute intracranial hemorrhage.2. No definite CT findings of acute stroke. If stroke remains clinical concern, recommend further evaluation with MRI.3. Metallic densities consistent with prior aneurysm coiling and ventricular shunt with adjacent encephalomalacia.4. Age-indeterminate findings of small vessel ischemic disease.5. Midline frontal and parietal regions of encephalomalacia consistent with prior stroke in bilateral ACA distribution.


Instruction: Generate impression based on findings.

Input: 77-year-old female with persistent chronic lumbar radiculopathy and left hip pain/sciatica. ACETABULAR LABRUM: There is heterogeneity and linear increased signal abnormality traversing the anterior superior labrum at the 2 o'clock position, indicating degeneration / degenerative tearing. There is subchondral cyst formation within the superior acetabulum and the surrounding area.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities identified. The femoroacetabular joint alignment is anatomic. Mild to moderate osteoarthritis affects the left hip.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance. ADDITIONAL

Output: 1. Osteoarthritis of the left hip and degeneration/tearing of the acetabular labrum as described above.2. Degenerative disc disease of the lumbar spine. Please refer to the dedicated lumbar spine MRI examination report for additional details.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with metastatic breast cancer now presenting with left groin numbness and subtle left lower extremity weakness. With the exception of T11, all of the visualized vertebral bodies, as well as the sacrum and iliac wings, demonstrate heterogeneous hypointense T1 and T2 signal compatible with sclerotic metastases.Vertebral body height and morphology are otherwise within normal limits. Spinal alignment is anatomic. No evidence of any enhancing paraspinal or epidural soft tissue disease is seen.A 3 mm enhancing nodule is evident within the left aspect of the thecal sac at the L4-5 level, apparently in association with the left S1 or S2 nerve roots (see image 14 series 11). The nerve roots of cauda equina are otherwise unremarkable. No other pathologic intrathecal enhancement is seen.At L5-S1, there is significant loss of disc height and mild disc bulging with osteophytic spurring. No significant spinal canal stenosis is seen. Mild encroachment upon the left neural foramen is noted. No significant disc bulge or disc herniation is seen at the remaining lumbar levels. No other areas of spinal canal or foraminal stenosis are detected. Mild facet arthropathy is seen at lower lumbar levels.

Output: 1.Diffuse sclerotic osseous metastases are seen without evidence of any pathologic epidural or paraspinal soft tissue tumor encroachment.2.A nodule of enhancement is seen within the left aspect of the thecal sac at the L4-5 level, probably in association with either the left S1 or S2 nerve roots. This could represent an incidental nerve sheath tumor. Given the history, however, the possibility of intrathecal tumor spread would need to be considered as well.3.Significant disc degeneration at L5-S1 one which does result in some encroachment on the left neural foramen.


Instruction: Generate impression based on findings.

Input: Vertigo, pregnant. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

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


Instruction: Generate impression based on findings.

Input: Ms. Phillips is a 57-year-old female with a family history of breast cancer in her mother (diagnosed at the age of 60) and sister (diagnosed at the age of 37). She presents today for a high-risk MRI-study 13073B. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Several enhancing foci are identified in both breasts, stable when compared back to multiple prior examinations. High T1 signal fluid in retroareolar ducts is unchanged. 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: 73-year-old male with prostate cancer, status post radiation therapy. Now with biochemical recurrence. Please evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Punctate calcified granulomata are present at the lung bases.MEDIASTINUM AND HILA: There are coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There are centimeter sized hepatic parenchymal hypodensities at axial images 68 and 73/212 which may represent simple cysts.SPLEEN: The native spleen appears absent and partially regenerated including a 5-cm left infra-diaphragmatic remnant and axial image 67/212. This contains a solitary 6-mm diameter calcification. Anterior to the tail of the spleen and axial image 77/212 is a 4.2 x 4.7 cm mass which may represents regenerated spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are bilateral renal lesions including a hypodense left upper pole lesion which measures approximately 4 cm in diameter with attenuation of less than 3 Hounsfield units compatible with a benign simple cyst. An exophytic right mid pole lesion measures 5 cm in diameter at axial image 92/212 and has attenuation of approximately 15 Hounsfield units. This may be an atypical cyst, but a solid renal mass cannot be excluded. Ultrasound or MRI examination may be helpful for further evaluation, if comparison studies are not available.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Atrophic prostate and seminal vesicles compatible with history of radiation therapy.BLADDER: Diffuse bladder wall thickening compatible with history of pelvic radiotherapy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes in the pelvis and spine.OTHER: No significant abnormality noted

Output: Probable regenerated spleen in the left upper quadrant. Left renal cyst. Right renal mass versus atypical cyst, recommend ultrasound or MRI, if CT comparison studies are not available. Hepatic hypodensities are probably cysts.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with CCM and intractable epilepsy, fMRI for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical stimulation maps as expected along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the verb generation, sentence completion and rhyming paradigms. Language is left dominant. Broca's area activity is seen within the left inferior frontal gyrus, primarily pars opercularis and pars triangularis. Foci of activity favored to reflect Wernicke's are seen along the posterior aspect of the left superior temporal sulcus, and just cranially at the posterior margin of the sylvian fissure. These foci are lateral and posterior to the patient's left temporal lesion. Although not in the most typical location for Wernicke's area, they are consistently seen on each language paradigm, and no other likely candidates for Wernicke's area are identified. Please note that as the left temporal lesion induces a large area of susceptibility artifact and signal void, the immediate surrounding parenchyma cannot be accurately assessed with functional MRI. As such, the presence of some functional activity immediately adjacent to the lesion cannot be excluded.

Output: Technically successful functional MRI for sensorimotor and language mapping. The sensorimotor and visual cortices are well delineated. Language is left dominant. Broca's area is seen in its customary location. Wernicke's area is also likely visualized with foci of activation located lateral and posterior to the patient's left temporal lesion.


Instruction: Generate impression based on findings.

Input: Foot pain There is abnormal marrow edema of the first metatarsal extending from the proximal diaphysis into the head. A discrete fracture line is not visualized although there is a small full-thickness articular cartilage defect of the head of the metatarsal best appreciated on series 901 image 11/48.The marrow signal of the visualized tarsals, metatarsals and phalanges is normal.There is soft tissue edema surrounding the head of the first metatarsal with a trace amount of fluid in the first metatarsophalangeal joint felt to be reactive in nature. The remaining soft tissues and muscles are normal. The visualized extensor and flexor tendons are also normal.

Output: Small full-thickness cartilage defect of the head of the first metatarsal with associated marrow edema throughout the diaphysis. No discrete fracture line is identified.


Instruction: Generate impression based on findings.

Input: History of pancreatic neuroendocrine tumor with known liver metastases. ABDOMEN:LIVER, BILIARY TRACT: There are multiple T2 bright lesions within the liver having early arterial enhancement and a predominantly peripheral distribution with washout compatible with metastases. The largest lesion is in segment 7 and measures 2.4 x 2.3 cm (series 17 image 8). There are additional lesions in segments 6 and 5. The second largest lesion is in segment 6 and measures 2.2 x 2.1 cm (series 17 image 18).The background liver parenchyma demonstrates loss of signal on out of phase images compatible with hepatic steatosis. Cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: In the head of the pancreas there is a heterogeneously enhancing 2.2 x 1.5 cm mass (series 9 image 60). The enhancement has a predominantly peripheral distribution. There is marked atrophy of the pancreatic body and tail. There is mild prominence of the main pancreatic ducts distal to the mass measuring 4 mm in diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Horseshoe kidney with fusion of the inferior poles. No focal lesion. No hydronephrosis. Note is made of multiple peripelvic cysts.RETROPERITONEUM, LYMPH NODES: No upper abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Dependent soft tissue edema in the posterior soft tissues. Focus of increased T2 and T1 signal in the T12 vertebral body without enhancement compatible with an intraosseous hemangioma.OTHER: No significant abnormality noted.

Output: Pancreatic head mass with multiple metastases in the right lobe of the liver as described compatible with patient's known metastatic tumor as above.


Instruction: Generate impression based on findings.

Input: 69-year-old female with shoulder pain. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus from its insertion on the greater tuberosity, with 1 cm or less of proximal retraction. This appears to be a complete or near-complete tear, possibly with a few intact articular surface fibers posteriorly. There is a 7 mm ossicle within the retracted end of the torn tendon corresponding to a small ossicle seen on prior radiographs from October 2014. There is slight loss of volume of the supraspinatus muscle with relatively minimal fatty infiltration. There is intermediate signal intensity within the anterior fibers of the infraspinatus tendon at its insertion suggesting tendinosis but we see no fluid-filled filled tear. There is mild volume loss of the infraspinatus muscle with minimal fatty infiltration. There is mild intermediate signal abnormality within the subscapularis tendon suggesting mild tendinosis. The subscapularis muscle and tendon appear intact. The teres minor muscle and tendon appear intact. There is spurring at the greater tuberosity representing chronic enthesopathic changes as seen on prior radiographs.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint and there is a small os acromiale. Additional small ossicles lateral to the acromion process likely represent chronic enthesopathic changes at the deltoid origin. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is perhaps mild fraying of the superior labrum, but we see no fluid-filled tear within the limitations of a non arthrogram study. The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint but no large effusion is evident.BICEPS TENDON: The tendon of the long head of biceps appears intact.

Output: Rotator cuff tear, acromioclavicular joint osteoarthritis, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Patient with history of schizophrenia; 4 day hx of "comatose state" without recovery back to baseline and subsequent cognitive impairment+parkinsonism and impaired vertical gaze; subacute onset; look for cortical ribboning, midbrain atrophy. Symmetrical hyperreflexia. Brain: There appears to be mild disproportionate volume loss involving the midbrain, better appreciated on the post gadolinium T1 sequence with thinner slices. There also appears to be mild concavity of the lateral midbrain tegmentum. Pontine and cerebellar volumes are maintained without signal abnormality. No appreciable abnormal mineralization involving the basal ganglia or midbrain. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. These are relatively more conspicuous in the left corona radiata. There is suggestion of small chronic lacunar infarcts involving the bilateral thalami. There is a punctate focus of susceptibility involving the right frontal subcortical white matter consistent with chronic microhemorrhage. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is diffuse opacification of the bilateral mastoid air cells. Minimal scattered opacification of the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. 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: Small disc osteophyte complex with effacement of the ventral thecal sac and overall mild narrowing of the spinal canal. Minimal narrowing of the neural foramina. C4-5: Disc osteophyte complex which effaces the ventral thecal sac and mildly indents the ventral cord. Overall mild spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.C5-6: No significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowing related to uncovertebral hypertrophy.C6-7: Minimal disc osteophyte complex. 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: 1. There appears to be mild disproportionate volume loss involving the midbrain which may represent progressive supranuclear palsy in the appropriate clinical setting.2. Mild chronic small vessel ischemic disease. Foci of volume loss involving the bilateral thalami compatible with lacunar infarcts related to prior ischemia or other injury.3. Mild degenerative changes in the cervical spine, relatively worse at the C4-C5 level, but without high-grade spinal canal stenosis or cord signal abnormality at any level. Additional details as above.4. Opacification of the bilateral mastoid air cells which is nonspecific.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disturbance of skin sensation Pain in joint, pelvic region and thigh. Pain in limbClinical question: please r/o stenosis, disc disease, other pathologySigns and Symptoms: pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is an 11mm T1 hyperintense lesion at the superior and right aspect of the T11 vertebral body present.At L5-S1 there is mild disk dessication present. There is a disk bulge at this level associated with ligamentum flavum hypertrophy and partial effacement of the fat at the lateral recesses. There is mild encroachment of the exiting nerve roots within the neural foramina at this level.At L4-5 there is loss of disk space height disk dessication and a large right paramedian disk extrusion associated with encroachment of the nerve roots at the right lateral recess. There is bilateral facet and ligamentum flavum hypertrophy at this level. There is a right far lateral broad based disk protrusion at this level. There is moderate encroachment of the left exiting nerve roots within the neural foramen at this level. There is mild encroachment of the left exiting nerve roots at this level due to disk material and facet hypertrophy. There is mild to moderate encroachment of the nerve roots at the right lateral recess at this level due to facet and ligamentum hypertrophy and disk disease. There is slight anterior subluxation of L4 on L5 at this level.At L3-4 there is a diffuse disk bulge associated with mild facet and ligamentum hypertrophy. There is mild to moderate encroachment of the left exiting nerve roots at this level due to disk material and facet hypertrophy. Overall there is mild spinal stenosis at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disk bulge and disk dessication associated with mild facet and ligamentum hypertrophy. At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disk bulge and disk dessication associated with mild facet and ligamentum hypertrophy. The right adrenal gland appears to be fairly large but is not entirely included on this exam.

Output: 1.There are multilevel degenerative changes present in the form of disk disease and facet disease throughout the lumbar spine which are worse at L4-5 where there is mild subluxation, a disk extrusion and a right far lateral protrusion resulting in mild to moderate spinal stenosis and encroachment of right exiting nerve roots and encroachment of the nerve roots at the right lateral recess.2.There is encroachment of the left exiting nerve roots at L3-4.3.The right adrenal gland appears large, however, it is not entirely included on this exam and not adequately evaluated. If there is clinical concern for adrenal gland disease additional imaging may be helpful. This is an incidental finding.4.An email with the above findings was sent to Dr Kanani and Dr Tao Xie.


Instruction: Generate impression based on findings.

Input: Clinical question: Newly diagnosed GBM status post biopsy only; please evaluate extent of brain tumor. Signs and symptoms: Difficulty speaking. Pre- and post enhanced brain MRI:Examination demonstrates a large focus of vasogenic edema in the left mid and posterior temporal lobe surrounding a large necrotic enhancing tumor. On postenhanced images the tumor measures approximately 51 x 30 mm in transaxial dimensions. Compared to prior study there is interval increased size of tumor which measure that 30 x 24 mm in transaxial dimensions. This is also noticeable interval increased surrounding mesenteric edema and mass effect. The tumor is inseparable from the temporal horn and the trigone of the left lateral ventricle. On coronal images there is significant bulge of tumor into the left lateral ventricle.There is evidence of a small craniotomy in the left posterior temporal-occipital region with underlying subtle parenchymal edema believed to represent site of previous surgical approach for biopsy. There is expected minimal superficial parenchymal enhancement at the site and with linear enhancement extending to the posterior-lateral aspect of tumor along the surgical path.Mildly prominent lateral ventricles without interval change since prior exam or deviation of the midline. Few nonspecific foci of FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres although nonspecific considering patient's stated age of 72 likely representing mild chronic nonhemorrhagic small vessel ischemic strokes.

Output: 1.Interval increased size of a necrotic rim enhancing tumor in the left mid to posterior temporal lobe and its surrounding vasogenic edema since prior exam. The enhancing tumor measures at 51 x 30 mm compared to prior study measurement of 30 x 24.2.Expected postoperative changes of prior tumor biopsy as detailed.3.Unremarkable exam otherwise and evidence of only minimal chronic nonhemorrhagic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: Intra-articular contrast remains within the midcarpal joint. No contrast is identified within the radiocarpal joint to suggest scapholunate or lunotriquetral ligament disruption. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 41 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the right wrist for subsequent MRI arthrogram.


Instruction: Generate impression based on findings.

Input: 20 year-old male with history of neurofibromatosis type II status post resection 5 years ago complaining of headache and right leg weakness x 3 weeks. History of prior tumor in brain stem and cervical spinal cord. No mass effect, midline shift, edema, or areas of abnormal contrast enhancement are seen. Presence of contrast reduces sensitivity for intracranial hemorrhage. No gross intracranial hemorrhage is seen. The brainstem is poorly visualized -- if tumor recurrence is a clinical concern, recommend contrast-enhanced MRI.The ventricles and basal cisterns are normal in size and configuration.Within the limits of CT precision, the diameters of the internal auditory canals are unchanged from the study dated 7/9/2006. The known bilateral acoustic neuromas are not visible on the current study.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.No bony lesions of the skull base are seen. A poorly defined sclerotic lesion is present in the frontal bone -- this finding appears stable from the scan dated 7/9/2006. Patient is status post occipital craniotomy.

Output: 1. No acute intracranial process. 2. Multiple abnormalities as detailed above.


Instruction: Generate impression based on findings.

Input: There are foci of hypodensity in subcortical and periventricular white matter locations without mass effect or enhancement which match T2 abnormality identified by previous brain MRI. The ventricles and sulci are normal in size without evidence of obstruction or hydrocephalus. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain or evidence of metastatic disease.

Output: 1.Mild to moderate small vessel ischemic disease, which given differences in technique is unchanged compared to previous MRI.2.There is no abnormal enhancement within the brain or evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 64 year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.0 x 4.0 cm (TR x AP x CC)Peripheral Zone: Note is made of multiple foci of decreased T2 signal abnormality in the right and left paramedian base of the peripheral zone of the prostate gland with associated restricted diffusion. While no postcontrast images are available for further evaluation, these findings are suspicious for prostate carcinoma. The largest focus measures 8 x 4 mm (17; series 801).Seminal Vesicles: There is no evidence of seminal vesicle involvement.Extracapsular Extension: No convincing evidence of extracapsular extension.BLADDER: Concentric bladder wall thickening is nonspecific, but suggestive of chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: Focus of decreased T1 and T2 signal abnormality in the right superior pubic ramus likely represents a benign bone island. Nonspecific diffusely heterogenous bone marrow signal abnormality is incompletely characterized due to lack of contrast administration, but may represent islands of red marrow. OTHER: No significant abnormality noted.

Output: Multiple foci of signal abnormality in the base of the peripheral zone of the prostate gland. While no post contrast images were obtained, these findings are suspicious for prostate carcinoma.


Instruction: Generate impression based on findings.

Input: Ms. Jargella is a 62 year old female with a personal history of right breast mastectomy in 2008 for multifocal IDC/DCIS treated with radiation, chemotherapy, and hormonal therapy. Personal history of benign left breast biopsy in 2011 for atrophic breast parenchyma and left breast reduction mammoplasty in 2013. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Postsurgical changes consistent with right breast mastectomy and implant-based reconstruction are re-identified. There is no abnormal enhancement seen in the right chest wall.There is no abnormal enhancement seen in the left breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: 38 year old male with non-ischemic cardiomyopathy referred for further evaluation with cardiac MRI. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The LV is hyper-trabeculated. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 283 ml (normal range 142+/-34), the LV end systolic volume index is 114 ml/m2 (normal range 25+/-9), the LVESV is 230 ml (normal range 47+/-19), the LV mass index is 35 g/m2 (normal range 85+/-15), and the LV mass is 71 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload. No LV thrombus is noted. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 67 ml/m2 (normal range 82+/-16), the RVEDV is 135 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 68 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (LVEF 19%). The LV is hyper-trabeculated. There is no evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size and systolic function (RVEF 50%).3. Severe left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 37 year old female with morbid obesity who had recently an episode of wide complex tachycardia while felling palpitations. The echocardiography showed normal left ventricular function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 76 ml (normal range 31+/-10), the LV mass index is 33 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of underlying focal replacement fibrosis or an infiltrative, or inflammatory process. Native myocardial T1 relaxation times are mildly elevated at the basal septum and within normal range throughout the remainder of the left ventricle. Increased T1 relaxation times can be seen with the presence mild interstitial fibrosis. Left AtriumThe left atrium is normal in size. The LA volume is 93 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). No fatty infiltration, focal aneurysm or regional wall motion abnormality are noted.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC 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 with normal systolic function, the LVEF is 54%. 2. There is no late gadolinium enhancement to suggest the presence of underlying myocardial scar or infiltrative/ inflammatory process. There is, however, a mild increase in native myocardial T1 relaxation time in the basal septum, which is likely due to the presence of mild interstitial myocardial fibrosis. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. No fatty infiltration, focal aneurysm or regional wall motion abnormality was see. No MRI findings to support the diagnosis of arrhythmogenic right ventricular dysplasia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of pancreatic cysts. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again are multiple cystic structures connecting with the peripheral biliary tree most notable in the segment II. These are nonspecific and may be postinflammatory or postinfectious peribiliary cysts. No focal liver lesion. No extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: Several splenules adjacent to the inferior anterior margin of the spleen.PANCREAS: Interval increase in size of the reference exophytic cystic lesion arising off of the anterior body measuring 2.4 x 2.1 cm (series 4/22), compared to 1.1 x 1.0 cm previously.Reference multilobulated cystic lesion arising off of the mid pancreas body measures approximately 2.1 x 1.2 cm (series 4/24), not significantly changed when using similar measurement technique.No suspicious mural nodularity or enhancement. Numerous additional subcentimeter cystic lesions in the pancreas are not significantly changed in size or number. The main pancreatic duct is mildly prominent up to 5 mm, unchanged.No solid pancreatic lesion is identified.ADRENAL GLANDS: Stable right adrenal nodule measuring 2.2 x 2.0 cm (series 4/19) compatible with a lipid rich adenoma.KIDNEYS, URETERS: Bilateral simple renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Incompletely characterized right lower lobe nodular focus may represent a vessel or nodule; attention to this on subsequent surveillance imaging is recommended. Cardiomegaly. Poststernotomy changes.

Output: 1.Interval increase in the size of one of the reference pancreatic cystic lesions without suspicious imaging characteristics.2.Stable right adrenal adenoma.3.Incompletely characterized right pulmonary lower lobe nodular focus may represent a vessel or nodule; attention to this on subsequent surveillance imaging is recommended.


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 display mildly pointed morphologies. 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 display mildly pointed morphologies. 2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: 16-year-old female with left knee pain after suddenly changing directions while playing basketball 1 month ago. Knee pain acutely worsened 1 week ago while jumping and patient has been unable to ambulate since that time. MENISCI: There is a longitudinal tear of the medial meniscus, which extends from its posterior horn to its body. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a partial thickness defect within the cartilage of the lateral femoral condyle and an underlying bone contusion is present. The osseous structures are otherwise normal in appearance.LIGAMENTS: The ACL demonstrates a wavy contour with a heterogeneous appearance. Its fibers are frayed near its insertion on the lateral femoral condyle, however, there are some fibers that reach the surface of the lateral femoral condyle without disruption. The PCL and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Partial-thickness tear of the ACL.2. Longitudinal tear of the medial meniscus.3. Cartilage defect of lateral femoral condyle.


Instruction: Generate impression based on findings.

Input: Right hand tingling and numbness Note that the exam is limited secondary to the patient's inability to complete all sequences. Note that T1 weighted images of the proximal forearm and postcontrast images were not obtained.Although the median and ulnar nerves are not fully identified on all axial images, we see no masses along the course of either nerve. The signal intensity of the musculature and the marrow of the radius and ulna appear normal. There is a small focus of near fluid signal intensity along the volar lip of the distal radius which may represent a small ganglion however this is equivocal. Additional small foci of signal abnormality in the carpal bones may represent degenerative cysts.

Output: Limited examination; however within these limits, we see no findings to account for the patient's neuropathy.


Instruction: Generate impression based on findings.

Input: 8-year-old male with macrocephaly and a left arachnoid cyst. Evaluate progression of the cyst. Left middle intracranial fossa cyst without significant change in size given the differences in technique. No evidence of hydrocephalus or midline shift. No evidence of intracranial hemorrhage, edema or solid mass. The ventricles and basal cisterns are unremarkable in size and configuration.Intracranial mild scalloping and thinning of the calvarial bone is nonspecific and may be secondary to a history of chronic increased intracranial pressure or a normal variant. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Grossly stable left middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Clinical question:CVA. Signs and symptoms : CVA Nonenhanced head CT :There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.If concern for acute ischemic stroke persist recommend an MRI.

Output: Negative head CT.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with neck pain. Assess spondylosis for progression. Reversal of the cervical lordosis is unchanged. Trace anterolisthesis of C3 on C4 and C4 on C5 is unchanged. Alignment is otherwise unremarkable. Vertebral body morphology is within normal limits. No concerning marrow signal abnormality is detected.The visualized spinal cord demonstrates normal signal intensity and morphology throughout.C2-3: Left greater than right facet hypertrophy with moderate left neural foraminal stenosis, unchanged .C3-4: Left greater than right facet hypertrophy, unchanged. No significant spinal canal or neuroforaminal stenosis.C4-5: Right greater than left facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal or neuroforaminal stenosis. No interval changes.C5-6: Right facet hypertrophy. No spinal canal stenosis or neuroforaminal narrowing. No interval changes.C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. C7-T1: Facet hypertrophy. Mild posterior disc-osteophyte complex formation with a slightly larger central disc component containing a new annular fissure. There remains no significant spinal canal or neuroforaminal stenosis.

Output: 1.C2-3: Moderate left neural foraminal stenosis, unchanged .2.C6-7: Mild bilateral foraminal narrowing. No interval changes. 3.C7-T1: Mild posterior disc-osteophyte complex formation with a slightly larger central disc component containing a new annular fissure. There remains no significant spinal canal or neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, preoperative planning for tumor resection presenting with loss of hearing. A predominantly solid but slightly heterogeneously enhancing mass is evident at the left CP angle measuring 19 x 18 mm (image 47 series 301). The lesion projects minimally into the left IAC. The lesion does indent the adjacent medulla and middle cerebellar peduncle. Since the prior examination, lesion appears to increased in size by two or three millimeters. No additional enhancing lesions are seen. Brain parenchymal morphology is otherwise unremarkable. The ventricles are normal in size. Small mucous retention cysts are seen in the maxillary sinuses.

Output: Redemonstration of a left CP angle mass with mild interval increase in size likely representing a schwannoma.


Instruction: Generate impression based on findings.

Input: 23-day-old male with concern for anatomic abnormalities, particularly brainstem History: Desaturations requiring stimulation, 3 week old infant, 37 week gestation. Examination is moderately motion degraded. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There appears to myelination of the posterior limb of the internal capsule which is appropriate for patient's age. There is mild asymmetric enlargement of the right lateral ventricle and mild focal narrowing in the region of the right occipital horn, which can be a normal variant. The sulcation and myelination patterns are grossly within normal limits. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Examination is grossly within normal limits within the limits of motion degraded study.


Instruction: Generate impression based on findings.

Input: Cellulitis Osseous structures: There is partial visualization of bilateral total knee arthroplasties. The marrow signal of the bilateral tibia and fibula are normal. No osseous lesions or erosions are identified.Soft tissues: A minimal amount of subcutaneous edema is noted within the posterior aspect of the right lower extremity distally. Varicosities are noted within the right lower extremity. There is no abnormal enhancement following gadolinium administration.

Output: No evidence of osteomyelitis or focal fluid collection. Minimal amount of subcutaneous edema within the posterior aspect of the right lower extremity.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddinessClinical question: exclude any possibility of vestibular nerve lesionSigns and Symptoms: vertigo BRAINThe 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 demonstrate some small mucous retention cyst in the mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of a small arachnoid cyst behind the cerebellar vermis measuring 20 x 20 mm coronal dimensions. The cerebellar tonsils are low lying. Extend approximately 1 or 2 mm below the level of foramen magnum.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

Output: 1.There is no evidence for abnormal lesion in the vestibular nerves.2.No abnormal lesions are appreciated intracranially which can explain the patient's vertigo symptoms.3.There is a small arachnoid cyst present in the posterior fossa. This is an incidental finding. Usually these are of little clinical significance


Instruction: Generate impression based on findings.

Input: 39-year-old male with history of sinus cavity tumor. There is complete opacification of the right maxillary sinus. There is no definite osseous destruction. These findings are nonspecific and may represent a benign process such as sinusitis or mucocele, however, recurrent tumor cannot be entirely excluded. Further evaluation by contrast-enhanced MRI may be considered if clinically indicated. Extensive post-surgical osseous changes are evident. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Complete right maxillary sinus opacification may represent a benign process such as sinusitis or mucocele. However, recurrent tumor cannot be entirely excluded. Correlation with prior examinations recommended. Recommend continued follow up as clinically indicated.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of brain Preoperative examination, unspecified Unspecified epilepsy without mention of intractable epilepsy. Brain tumor to left temporal parietal area, MRI brain STEALTH for preop planning for tumor resection The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a 12 x 7 mm axial dimension ring-enhancing type lesion along the left precentral gyrus associated with a T2 hyperintense component measuring 19 x 14 mm axial dimensions. It is stable compared to the previous exam from 4/29/2015.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partially opacified paranasal sinuses which were not opacified on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination is performed for the purpose of stereotactic guidance.2.There is redemonstration of a left frontal lobe lesion which is stable since April.3.Since the prior exam paranasal sinus opacification has progressed. This is a nonspecific finding. Please correlate with clinical symptoms for possible acute sinusitis.4.An alphanumeric page was sent to the referring physician.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: 75 yo F with hx of metastatic breast cancer s/p SRS, eval for new metsSigns and Symptoms: none The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an irregularly-shaped enhancing focus located in the right precentral gyrus measuring 14 x 9 mm axial dimensions which previously measured approximately the same dimensions. It is associated with some susceptibility effect, loss of volume and surrounding FLAIR and T2 signal hyperintensity. The T2 and FLAIR signal hyperintensity remains stable. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. A couple small enhancing foci present along the inferior aspect of the left cerebellar hemisphere one measuring 4 x 6 mm and the other one measuring 6 x 4 mm. On the prior exam these were not readily visible.There is a 3 mm enhancing focus present along the right cuneus which was not readily visualized on the prior exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam the patient has developed a new lesions in the right cuneus and the left cerebellar hemisphere inferiorly. These are compatible with metastatic disease.2.A lesion in the right precentral gyrus remains stable and compared to the prior exam and is status post treatment3.Periventricular and subcortical white matter changes of a mild degree and the signal changes within the brain stem are nonspecific. At this age they are most likely vascular related. This is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: History of laryngeal cancer. Receiving chemotherapy. CT of the soft tissues of the neck:Images through the skull base and including cavernous sinuses remain within normal limits.Images through the larynx reidentifies post therapy changes and with no definitive evidence of residual tumor. It has not changed in appearance since 2/25/07. The thyroid cartilage shadow remains splayed. The glottis is not distorted. The epiglottis is not identified No evidence of pathologic adenopathy in the neck. There is a left jugular chain lymph node present at the level of the hyoid bone measuring about 8 mm short axis dimension which can be identified on previous exams dating back to 22507 when it measured 6 mm short axis dimension. Limited images through the apices of the lungs and mediastinum are negative for metastatic lesions. Large quantities of air within the esophagus may reflect reflux. This finding was noted on prior study and no change. There are atherosclerotic calcifications of the carotid bifurcations on the left side the there is concern for significant narrowing of the left internal carotid artery at its origin.There are degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at multiple levels and associated narrowing of the spinal canal and the neural foramina in the upper cervical spine there is some right-sided facet hypertrophy.The patient is status post median sternotomy.The esophagus appears to have diverticulum at the level of the thoracic inlet which is directed anteriorlyCT of brain with infusion.There is a focus of encephalomalacia in the left cerebellar hemisphere unchanged since prior exams which likely represents a prior infarct. Periventricular and subcortical white matter hypodensities are present which are nonspecific but likely vascular related at this age.. A hypodense focus is redemonstrated at the genu of the right internal capsule probably lacunar infarct. There is associated atrophy of the right caudate nucleus.Along the left parietal lobe adjacent to the left intraparietal sulcus there is a small focus of enhancement measuring approximately 6 mm in size. This was not present on prior exams and is suspicious for metastatic disease. If clinically appropriate an MRI of the brain may help confirm this and to help identify additional foci that may be present. It is best seen on image number 22 and 21 of the axial CTs of the head

Output: 1.Stable CT of soft tissues of the neck and with no evidence of tumor or pathologic adenopathy.2.Suspicion for left parietal lobe metastasis as described above. This is new since the prior exam. An MRI of the brain may help confirm this and identify any other lesions. referring clinician was paged.3.Findings raise the question of a left carotid stenosis please correlate with clinical evaluation and at any other evaluation of the carotids.4.Findings suggest an esophageal diverticulum unchanged since prior exams.5.Findings suggest old infarctions previously demonstrated as described above.


Instruction: Generate impression based on findings.

Input: New focal left upper extremity weakness and hyperesthesia; started cyclosporin yesterday for severe ulcerative colitis, also on high dose steroids, but no recorded hypertension episodes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are apparent faint areas of heterogeneity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Apparent faint areas of heterogeneity in the cerebral white matter may be artifactual or less likely represents early toxic encephalopathy. Otherwise, no evidence of intracranial hemorrhage, or posterior reversible encephalopathy syndrome.


Instruction: Generate impression based on findings.

Input: NSCLC with brain metastasis. Interval MRI for evaluation. There are new enhancing lesions at the grey-white matter junctions in the superior right precentral gyrus and left superior frontal gyrus that measure up to 4 mm with minimal associated vasogenic edema. There are persistent foci of enhancement in the right precentral gyrus and left parietal lobe. There is unchanged confluent white matter T2 hyperintensity in the bilateral cerebral hemispheres, which is likely treatment-related. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening and fluid signal within the bilateral mastoid air cells, left greater than right.

Output: 1. New punctate metastases in the superior right precentral gyrus and left superior frontal gyrus. 2. Persistent punctate metastases in the right precentral gyrus and left parietal lobe.3. Findings suggestive of sinusitis and mastoiditis.


Instruction: Generate impression based on findings.

Input: Clinical question: Demyelination? Signs and symptoms: Lower extremity weakness. Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Images through the posterior fossa demonstrate a tiny linear right median pontine foci of FLAIR hyperintensity similar to prior exam and unremarkable images otherwise.Images through the supratentorial space demonstrate stable few scattered foci of FLAIR and T2 hyperintensity in the periventricular and to a lesser degree subcortical white matter of cerebral hemispheres as was noted on prior study. These findings are nonspecific, nonhemorrhagic and demonstrate no abnormal enhancement. This is a similar observation is prior exam. Although nonspecific considering patient's stated age of 81 the above findings likely representing chronic changes of microvascular ischemic disease. Possibility of demyelinating disease is considered significantly less likely and cannot be entirely excluded.The cerebral cortex, cortical sulci, ventricular system and CSF spaces are unremarkable for stated age.Signal voids of major intracranial arterial branches are identified. No abnormal parenchymal, leptomeningeal, calvarial or retroperitoneal abnormal enhancement.Pre- and post enhanced cervical MRI:The signal intensity and caliber of the cervical and upper most visualized thoracic cord is within normal and without intravenous or abnormal enhancement.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes with resultant moderate right neural foraminal compromise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate moderate disc disease and loss of disc height, mild facet and ligamentum flavum hypertrophy with resultant significant right and moderate left neural foraminal compromise and mild central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, mild broad-based bulging disc, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Moderate to severe left and moderate right neural foraminal compromise and mild central spinal stenosis.C7-T1 demonstrate moderate disc disease and loss of disc height, mild bilateral facet (left greater than right) and ligamentum flavum hypertrophy. No spinal stenosis however mild left neural foraminal compromise is detected.

Output: 1.Pre and post enhanced brain MRI demonstrate no acute intracranial process and no evidence of any new findings since prior study. Stable scattered nonspecific FLAIR hyperintensity in the periventricular anterolisthesis in the subcortical cerebral hemispheres and punctate focus in the right paramedian pons remained identical to prior exam and without evidence of hemorrhagic change or enhancement. Findings are more suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.2.Pre and post enhanced MRI of cervical spine demonstrate normal signal intensity and caliber of the cervical and upper most visualized thoracic cord without abnormal enhancement. Multilevel degenerative changes with resultant mild central spinal stenosis at C5-C6 and C6-C7 levels as detailed. Multilevel neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with lumbosacral pain, elevated white blood cell count, history of HIV. Assess for epidural abscess. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. The marrow signal characteristics are heterogeneous, similar to prior, but without definite focal lesions and with no evidence to suggest edema.The visualized spinal cord, conus and cauda equina are within normal limits. No epidural or paraspinal fluid collections are seen. No abnormal soft tissue processes are noted.The intervertebral discs are preserved with no evidence of spinal canal or neuroforaminal stenosis.A cystic lesion of the left kidney is noted incidentally.

Output: 1.No evidence of any epidural or paraspinal fluid collection is seen. No findings to suggest bony infection are demonstrated.2.The alignment and morphology of the spine are within normal limits. No evidence of spinal canal or neuroforaminal stenosis is seen.


Instruction: Generate impression based on findings.

Input: BRCA 1 positive There is extreme amount of fibroglandular tissue in both breasts.Moderate to marked parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Small thoracic spinal cord syrinx is noted.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 6-year-old female with multiple cerebral cavernous malformations brain , + CCM1 gene, history left sided weakness, yearly evaluation please do on 3T with ccm protocol. Signs and Symptoms: yearly surveillance The CSF spaces are appropriate for the patient's stated age with no midline shift. Redemonstrated is a heterogeneous pontine mass measuring 19 x 22 mm (previously 19 x 22 mm) as measured on the axial T2 sequence. There has been evolution of internal hemorrhagic components. The surrounding hypointense rim is unchanged in appearance and there is no new perilesional edema.Previously identified lesions within the anterior left temporal lobe, the more posterior left temporal lobe, along the medial right periatrial white matter, and involving the right occipital lobe are unchanged in appearance. There are no new susceptibility foci.Incidental note is made of a small developmental venous anomaly within the medial right frontal lobe without associated susceptibility abnormality focus. 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 and demonstrate some mucosal thickening with new fluid levels in the maxillary sinuses. Mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Stable pontine cavernous malformation. The surrounding hypointense rim is unchanged in appearance and there is no new perilesional edema.2.Stable cavernous malformations elsewhere.3.The visualized portions of the paranasal sinuses and demonstrate some mucosal thickening with new fluid levels in the maxillary sinuses.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is restricted diffusion involving the right cerebellar hemisphere and vermis in the right superior cerebellar artery territory compatible with acute infarct. There is corresponding T2/Flair signal abnormality indicating edema. Susceptibility weighted abnormalities are also noted in the right lateral cerebellar hemisphere compatible with a small amount of hemorrhage. A focus of T2/FLAIR hyperintensity is seen involving the the posterior limb of the left interna capsule with some susceptibility effect likely represent a chronic hemorrhagic infarct. Associated T2/Flair signal abnormality seen along the left corticospinal tracts compatible with Wallerian degeneration. in the subcortical white matter is nonspecific but compatible with small vessel ischemic disease.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. There is mild right maxillary mucosal thickening. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Small right posterior communicating artery. Left PCOM not definitively seen. There is common origin of the right posterior cerebral and superior cerebellar arteries which appear patent. Bilateral PICA are also patent.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.

Output: 1. Acute right cerebellar infarct in the right superior cerebellar artery territory. Small focus of susceptibility is seen within the infarct consistent with hemorrhage. 2. No significant mass effect or hydrocephalus. 3. Chronic lacunar infarct with hemorrhage involving the posterior limb of the left internal capsule with associated findings of Wallerian degeneration along the left corticospinal tract.4. No significant steno-occlusive disease of the major arteries of the brain and neck. Specifically no findings to suggest vertebrobasilar stenosis or dissection.


Instruction: Generate impression based on findings.

Input: Female, 2 years old, with vertigo. Assess for inner ear disturbance or vestibulitis. Mild patchy periatrial T2 hyperintensity is seen, somewhat more than expected for normal variation. No evidence of significant volume loss, mass effect, edema or pathologic parenchymal enhancement is seen. No diffusion restriction is noted.No evidence of any heterotopia or migrational anomaly is seen. The pattern of white matter myelination is appropriate for age. The corpus callosum is well formed and intact. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable. The pituitary gland is also within normal limits.The visualized cranial nerves, including the 7th and 8th nerve complexes, are within normal limits. No IAC or CP angle masses are detected. The fluid-filled structures of the inner ear demonstrate normal morphology. No gross pathologic IAC or inner ear enhancement is suspected, though please note that imaging technique is not adequate to detect subtle or small enhancing lesions.Paranasal sinus mucosal inflammation is noted incidentally.

Output: 1.Mild periatrial white matter lesions are suspected with no associated mass effect, volume loss or pathologic enhancement. These are nonspecific and may represent the sequelae of some remote insult.2.The overall morphology of the brain, and the pattern of white matter myelination, are appropriate for age.3.No definite evidence of any IAC lesion is suspected on the basis of this examination. If clinical concern persists, a dedicated IAC examination with thin section postcontrast images may be considered.


Instruction: Generate impression based on findings.

Input: Left-sided neglect and intracranial hemorrhage on recent CT. Evaluate for abnormalities. MRI Brain:Redemonstrated is a right occipital lobe intraparenchymal hematoma with extension into the right temporal and inferior parietal lobule. The size of the hemorrhage measures approximately 34 x 35 mm which appears similar in size compared to the recent previous head CT. The susceptibility weighted sequences demonstrate motion artifact but there is extensive susceptibility artifact in the right occipital region in the area of known hemorrhage as well as a punctate focus in the left parietal lobe. There is surrounding T2/FLAIR signal abnormality surrounding the right-sided hematoma indicating vasogenic edema which causes minimal mass effect on the trigone of the right lateral ventricle. The small amount of subarachnoid and subdural hemorrhage is also unchanged. There is minimal 2 mm midline shift to the left but this too is unchanged. No uncal herniation. The ventricles and basilar cisterns are unchanged. Redemonstrated are mild patchy areas of subcortical and periventricular T2/flair hyperintensity within the white matter. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Minimal mucosal thickening is visualized in the sphenoid sinus. MRA Brain:The intracranial internal carotid arteries demonstrate no significant stenosis. There is minimal ectasia of the left cavernous segment of the ICA without a definite aneurysm. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. Minimal asymmetric prominence is noted of the vasculature in the right parieto-occipital region which is nonspecific and may be related to congestion. There is no nidus appreciated in the region of hemorrhage in the right occipital lobe that may represent a vascular malformation. The prior MRI in 2010 demonstrates no abnormal flow voids in this region either.

Output: 1.No significant change in intraparenchymal hematoma centered in the right occipital lobe with surrounding edema and adjacent small volume subarachnoid and subdural hemorrhage. 2.There is mild asymmetric prominence of the vasculature in the right parieto-occipital region which is nonspecific but may be related to congestion. There is no nidus appreciated that may represent an AVM and the previous MRI from 2010 shows no abnormal flow voids in this region. No underlying mass within the limits of noncontrast study.3.Given a second focus of microhemorrhage within the left parietal lobe (which is chronic) also in a peripheral lobar distribution and patient age, findings suggest amyloid angiopathy as the etiology. Follow-up imaging with contrast can be considered as clinically appropriate.4.No flow limiting steno-occlusive disease or aneurysm within the intracranial vasculature.


Instruction: Generate impression based on findings.

Input: 73-year-old male with right knee pain for 3 years. Evaluate for medial meniscus tear. MENISCI: There is linear branching signal abnormality traversing the posterior horn of the medial meniscus extending to the tibial and femoral articular surfaces consistent with a complex tear. There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There is increased signal abnormality along the undersurface of the body and anterior horn which extends to the tibial articular surface and is associated with deformity of the meniscus, consistent with fraying/degenerative tearing. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing portion of the medial femoral condyle and medial tibial plateau with underlying subchondral signal abnormality. There is also near full-thickness articular cartilage degeneration along the lateral femoral condyle above the anterior horn of the meniscus. There is thinning of the articular cartilage along the medial facet of the patella. There is a focal full-thickness articular cartilage defect along the median eminence of the patella with underlying subchondral signal abnormality and focal articular cartilage delamination. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is nonspecific subcutaneous edema along the anterior aspect of the patella and patellar tendon as well as medially about the knee.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above. Full-thickness articular cartilage degeneration as described above.2. Large joint effusion.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Pain and numbness. Evidence of radiculopathy any injury. Examination is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild 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: Small left paracentral and foraminal disc protrusion which effaces the left ventral thecal sac and mildly narrows the proximal left neural foramen. No significant right neural foraminal narrowing.C5-6: Loss of disc height with associated endplate marrow signal changes. Small disc osteophyte complex which effaces the ventral thecal sac and causes mild spinal canal stenosis. No significant compromise to the right neural foramen. Minimal left neural foraminal narrowing related to uncovertebral hypertrophy.C6-7: Mild disc bulge with partial effacement of the ventral thecal sac. No significant compromise to the 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: Mild degenerative changes in the cervical spine at the C4-C5, C5-C6, and C6-C7 levels as detailed above. There is mild spinal canal narrowing at these levels.. There is mild narrowing of the proximal left C4-C5 neural foramen and minimal left C5-C6 neural foramen.


Instruction: Generate impression based on findings.

Input: The ventricles and other CSF spaces are diffusely prominent, in keeping with mild generalized cerebral volume loss. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for acute cerebral, brainstem or cerebellar infarction. A small amount of susceptibility artifact is present along the lateral wall of the left lateral ventricle, compatible with intraventricular hemorrhage. No diffusion-weighted abnormalities are identified. There are no abnormal extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. There is mild soft tissue swelling in the posterior superior scalp.High-resolution images of the sella demonstrate the pituitary gland to be normal in size measuring 4.4 mm in height. There is no discrete mass to confirm the presence of a pituitary microadenoma. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no sellar, suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally.

Output: 1.Small amounts of intraventricular hemorrhage in the left lateral ventricle.2.Mild generalized cerebral volume loss. 3.Unremarkable pituitary MRI.