Instruction: Generate impression based on findings.

Input: Female, 40 years old, with wound drainage. Concern for infection. Redemonstrated are findings related to left parietal craniotomy for tumor resection. On comparison with the prior examination, fluid within the subgaleal space along the craniotomy has increased, as has fluid subjacent to the craniotomy, presumably within the epidural space. The thickness of this region, inclusive of both fluid collections and the craniotomy flap, measures up to 23 mm in the coronal plane (image 39 series 601), and previously measured no more than 18 mm.The margins of the subgaleal fluid collection are enhancing, thickly in some areas, whereas only mild thickening and enhancement of the dura underlying the craniotomy is seen. The bone flap itself does not enhance and shows at most minimal increase of diploic T2 signal.The cerebral gyri underlying craniotomy are mildly displaced by the above process, but no significant parenchymal edema or pathologic parenchymal enhancement is seen. No clear subdural or subarachnoid fluid collections are seen. Diffusion weighted images are within normal limits. The ventricular system is normal in size and morphology.

Output: Fluid surrounding the left parietal craniotomy, largely within the subgaleal space but to a lesser degree within the epidural intracranial space, has increased relative to the prior examination. The tissues surrounding the subgaleal fluid are enhancing, thickly in some areas, with minimal enhancement of the subjacent dura. The possibility of infected fluid should be considered. The bone flap itself, however, shows no definite evidence of osteomyelitis, though mild increased T2 signal within the diploic space could represent early infection. Clinical and radiologic follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Episodic dizziness, recent right ear infection and hearing loss, for which the differential diagnosis includes vestibular neuritis or labyrinthitis versus BPPV, although Dix-Hallpike was negative. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions or abnormal enhancement in the region of the internal auditory canals. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms.Neck MRA: There is mild to moderate stenosis of the proximal right internal carotid artery and perhaps mild stenosis of the proximal left internal carotid artery. The vertebral arteries appear to be intact.

Output: 1. No evidence of retrocochlear lesions.2. Mld to moderate stenosis of the proximal right internal carotid artery and perhaps mild stenosis of the proximal left internal carotid artery, but no evidence of intracranial steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: Partially imaged cervical spine demonstrates disc osteophyte complexes at the C4-C5, C5-C6, and C6-C7 levels. There is moderate degree of neural foraminal stenosis at right C5-C6 and moderate to severe right C6-C7 neural foraminal stenosis. There may be associated impingement of the right C6 and right C7 nerve roots. There are no abnormal masses impinging on the right brachial plexus. No T2 signal abnormality or abnormal enhancement involving the right brachial plexus.

Output: No evidence of brachial plexopathy. There is right-sided neural foraminal stenosis at the C6-C7 and to a lesser degree C5-C6 levels which can be more completely assessed with dedicated cervical spine MRI.


Instruction: Generate impression based on findings.

Input: 58 years Male (DOB:2/14/1958)Reason: MS, follow up progression History: diplopiaPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple periventricular and subcortical white matter T2 and FLAIR signal hyperintense foci present which were also present on the prior exam. There does not appear to be any new lesions on the present exam when compared to the previous. There are total of approximately 10 or 12 the lesions identified. The majority are supratentorial. However, there is a larger one is located along the posterior aspect of the pons which extends to the medulla.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: There are multiple periventricular and subcortical white matter lesions as well as a larger lesion in the brainstem which are compatible with patient's diagnosis of demyelinating disorder. They appear to be stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Reason: Treatment planning MRI for SRS- metastatic NSCLC History: Treatment planning MRI for SRS- metastatic NSCLC The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small focus of enhancement present measuring 5 mm in diameter along the medial aspect of the left frontal lobe at the cingulate gyrus at the level of the genu of the corpus callosum. This previously measured 4mm. Another small focus of enhancement is present along the left inferior temporal gyrus posteriorly measuring 3 mm in diameter. This was the same on the prior exam.There is gyral enhancement present along the medial aspect of the right frontal lobe inferiorly and mediallyNo 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.Redemonstration of small nodules in the left cingulate gyrus and left temporal lobe are compatible with the clinical history of metastases. These appear slightly larger than on the prior exam.2.Gyral enhancement in the right medial frontal lobe is present. This could represent unusual distribution of metastases with some leptomeningeal involvement which has mildly progressed.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with low back pain on minimal exertion. Evaluate for cord compression. History of newly diagnosed metastatic esophageal adenocarcinoma. Diffuse marrow heterogeneity is seen compatible with widespread osseous metastatic disease. Superimposed degenerative endplate signal abnormality is also seen at L4-5. There is a very slight anterior wedging of the T11 vertebral body. Otherwise, vertebral body heights are preserved in the lumbar spine. A trace retrolisthesis of L4 relative to L5 is seen. Otherwise, alignment is anatomic.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Disc bulging. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. L3-4: Facet arthropathy. Bulging disc. Mild spinal canal narrowing. Moderate bilateral foraminal narrowing. L4-5: Facet arthropathy. Bulging disc. Mild spinal canal narrowing. Moderate left and mild right foraminal narrowing. L5-S1: Facet arthropathy. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: 1.Diffuse marrow heterogeneity is seen compatible with widespread osseous metastases. No significant compression deformities are seen.2.No evidence of cord compression or any epidural or intrathecal tumor is seen. 3.Multilevel degenerative findings are seen as discussed above.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with radicular pain and known myelopathy. Straightening of the cervical lordosis is again seen along with a trace retrolisthesis of C4 relative to C5. Vertebral body heights are preserved. Degenerative endplate signal change is evident at C5, C6 and C7, similar to prior. No concerning marrow replacement or marrow edema is detected.Within the limitation of motion degradation, there may be mild persistent T2 hyperintensity within the spinal cord at C6-7, though this is less conspicuous than on the prior examination. Elsewhere, cord signal is within normal limits. No epidural abnormality is suspected.C2-3: Minimal facet hypertrophy. No significant spinal canal or foraminal stenosis. No interval changes. C3-4: Facet hypertrophy, left greater than right. No significant spinal canal stenosis. Minimal left foraminal narrowing. No interval changes.C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation which effaces the ventral thecal sac and slightly impinges the ventral spinal cord. Mild to moderate spinal canal stenosis. Moderate right and mild left foraminal narrowing. No interval changes. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. No interval changes. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation with a right paracentral superimposed protrusion which is perhaps slightly smaller than on the prior examination. This continues to impinge the right aspect of the spinal cord causing a moderate generalized spinal canal stenosis which is unchanged. Severe left and moderate right foraminal narrowing, unchanged. C7-T1: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes.

Output: Significant disc degeneration is again seen at C4-5, C5-6 and C6-7 where there is spinal canal narrowing and cord impingement.At C6-7, a right paracentral disc osteophyte complex may be slightly smaller than on the prior examination but cord impingement persists. Spinal cord signal abnormally seen on the prior examination at C6-7 is not as apparent on the present study which could represent improved edema or simply differences in technique.


Instruction: Generate impression based on findings.

Input: 45-year-old female patient with known pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Again seen is a 1.9 x 1.2 cm lesion in the pancreatic body (series 3 image 69), unchanged. The cystic lesion contains thin enhancing central septations without nodular components. There appears to be a connection with the pancreatic duct. Small subcentimeter cystic lesions are again noted and unchanged. No pancreatic ductal dilatation.ADRENAL GLANDS: Nodularity of the left adrenal gland appears similar to prior.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable 1.9 cm cystic lesion within the pancreatic neck/body with thin enhancing septations, suggestive of an IPMN.2.Additional subcentimeter cystic lesions throughout the pancreas are also stable and suggestive of small sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: Breast density study, exam for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not to be used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not to be used for clinical purposes.


Instruction: Generate impression based on findings.

Input: Left basal ganglia hemorrhage. Intraventricular hemorrhage. Likely cocaine vasculopathy. Evaluate for MISTIE trial. The study is mildly limited by motion.The large intraparenchymal hemorrhage involving the left basal ganglia region with superior and inferior extensions into the left frontal and temporal lobes, respectively, has not significantly changed since the CT done earlier on the same day. Given the different angulation for the axial planes between CT and MR, the size of the hemorrhage is better assessed on the coronal and sagittal planes. On the coronal T2 weighted sequence, the hemorrhage measures 5.0 cm x 2.5 cm compared to 5.1 cm x 2.5 cm previously. Anteroposteriorly on the sagittal T1 sequence, the hemorrhage measures 5.9 cm compared to 5.8 cm previously. The hematoma is heterogeneously T1-hyperintense, T2-hypointense but is T1-hypointense at the periphery, reflecting its early subacute nature. It is associated with relatively mild and unchanged surrounding T2-hyperintensity/vasogenic edema. The associated mass-effect is unchanged compared to the previous CT scan, with midline shift of 4 mm as measured at the lower aspect of the septum pellucidum and mild mass-effect on the left lateral and third ventricles. The hematoma still abuts the frontal and temporal horns of the left lateral ventricle. Susceptibility effect related to the intraventricular component of the hemorrhage is similar to the previous CT scan in distribution. Lack of signal suppression on FLAIR sequences involving the occipital and posterior parietal sulci probably reflects mild redistribution of hemorrhage into the subarachnoid space. Following contrast injection, there is suggestion of vague ill-defined enhancement along the posterolateral margin of the hemorrhage (best seen on image #188 of series #1401). Otherwise, there is no significant contrast enhancement in the intraparenchymal hemorrhage or elsewhere in the brain.There is an additional, small focus of parenchymal blood product manifested by susceptibility effect in the medial aspect of the left frontal lobe, image #152 of series #901, which correlates with a tiny focus of hyperattenuation on the CT scan.There is no brain parenchymal diffusion restriction to suggest acute infarct.Accounting for mass-effect on the left lateral and third ventricles, there is no significant ventricular dilatation. The sulci are mildly enlarged in a global fashion reflecting underlying brain volume loss. The basal cisterns remain open though the ambient cisterns are mildly asymmetric.

Output: 1.The large intraparenchymal hematoma in the left basal ganglia region has not significantly changed since the CT scan done earlier on the same day. Associated surrounding edema and mass-effect remain mild. The hemorrhage is associated with a small focus of questionable mild parenchymal contrast enhancement along the posterolateral margin, which is nonspecific and could very likely be reactive to the hemorrhage. No definite evidence of an underlying lesion is seen.2.The intraventricular component of the hemorrhage is also not significantly changed and is not associated with progressive ventricular enlargement. The hemorrhage has redistributed into the subarachnoid space posteriorly.


Instruction: Generate impression based on findings.

Input: Myelopathy There are postsurgical changes of anterior cervical discectomy and fusion from C4 to C5. Vertebral body heights are grossly maintained with minimal anterior superior endplate deformities at C7 and T1 with associated fatty endplate changes. No suspicious osseous lesions are seen. No findings to suggest a recent compression fracture.There is T2 hyperintensity in the bilateral cervical cord at the upper C5 level with volume loss consistent with myomalacia, which may be related to prior compression. There is minimal retrolisthesis of C3 on C4. Alignment of the cervical spine is otherwise grossly maintained.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Left greater than right facet arthropathy.C3-4: There is a disc osteophyte complex including uncovertebral hypertrophy as well as ligamentum flavum thickening contributing to mild to moderate spinal canal stenosis. There is also moderate left and mild right neural foraminal stenosis.C4-5: Myelomalacia and postoperative changes as described above. No significant spinal canal stenosis. Mild right neural foraminal stenosis. Left neural foramen is patent.C5-6: Small disc osteophyte complex and uncovertebral hypertrophy. There is mild mild narrowing of the spinal canal. Mild to moderate bilateral neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postsurgical changes related to anterior cervical fusion at C4-C5.2. Bilateral cord signal abnormality and volume loss consistent with myomalacia at the upper C5 level, which may be related to prior stenosis and can be compare with prior studies if available.3. Mild to moderate spinal canal stenosis at the C3-C4 level above the fusion. Otherwise no significant spinal canal stenosis is seen in the cervical spine. Neural foraminal stenoses as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for pituitary mass. History: Head CT finding. There is an enhancing pituitary mass that measures approximately 15 AP x 20 SI x 25 RL mm. There is associated mass effect upon the optic apparatus and extension into the cavernous sinuses with partial encasement of the right internal carotid artery. There is no evidence of intracranial hemorrhage or infarction. There is mild patchy cerebral white matter T2 hyperintensity, which likely represents chronic small vessel ischemic disease. The ventricles and sulci are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses, mastoid air cells, and scalp soft tissues are unremarkable. There is a right lens implant.

Output: A pituitary tumor that measures up to approximately 25 mm and exerts mass effect upon the optic apparatus likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: 54 year old female with history of ALH status post excisional biopsy in 2013. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Three metallic artifacts are redemonstrated within the left breast; these are in the upper inner quadrant, 3 o'clock position, and lower outer quadrant. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 50-year-old female with new visual field defect, evaluate for stroke.. There is restricted diffusion involving the right posterior frontal corona radiata consistent with acute infarct. There is mild enhancement. There is a larger area of T2 hyperintensity and mild volume loss involving the right occipital lobe extending into the right medial temporal lobe consistent with late subacute to chronic right PCA infarct. There is T1 hyperintensity involving the occipital cortex consistent with laminar necrosis. There is also enhancement associated with this PCA infarct. Additionally, there is an area of gliosis without restricted diffusion or enhancement involving the right paracentral lobule including the post central gyrus. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. 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. The right internal carotid artery flow void is severely diminutive compatible with occlusion or high-grade stenosis.Sella and orbits are grossly within normal limits. Paranasal sinuses are clear. There is mild opacification of the left mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Acute infarct in the right posterior frontal corona radiata.2. Large late subacute to chronic infarct in the right posterior cerebral artery territory involving the right occipital and medial temporal lobes.3. Chronic infarct in the right parietal lobe involving the medial aspect of the right post central gyrus.4. Severely diminished flow-void of the right internal carotid artery which may be due occlusion or high grade stenosis. Suggest MRA or CTA for further evaluation.Dr. Ali discussed findings with on-call opthalmology resident Dr. Gupta on 5/2/2015 at 1700 hrs.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is disk desiccation and L2-3 and L5-S1 with mild loss of disk height. The conus terminates in L2, within normal limits. The vertebral body heights and alignment is preserved. There is no osseous marrow edema.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: Minimal disk bulge, facet arthropathy and ligament flava thickening causing minimal bilateral neural foraminal narrowing. No significant spinal stenosis.L3-4: Mild disk bulge, left foraminal protrusion and annular fissure, ligamenta flava thickening and facet hypertrophy causing severe left and mild right neural foraminal stenosis. No spinal canal stenosis.L4-5: Mild disk bulge asymmetric to the left, facet arthrosis and ligamenta flava thickening causing moderate to severe left neural foraminal stenosis and mild right neural foraminal stenosis. No spinal canal stenosis.L5-S1: Disk bulge with small central disk protrusion and annular fissure, and mild bilateral facet arthrosis causing moderate left neural foraminal stenosis. No spinal canal stenosis.There is mild increased T2 signal in the left posterior paraspinal musculature best seen on series 7 image 3, and series 8 images 45 -- 50. There may be minimal volume loss of the effect of musculature as well.

Output: 1.Multilevel lumbar spondylosis as described above with areas of mild to marked neural foraminal stenoses. No spinal canal stenosis.2.Mild increased T2 signal and atrophy of the left posterior paraspinal musculature at the level of L5 and sacrum, nonspecific. This maybe secondary to muscle strain/spasm, less likely a denervation effect.


Instruction: Generate impression based on findings.

Input: ACL avulsion, check repair. The previously seen ACL avulsion fracture has been reduced to near-anatomic alignment. Flattening of the lateral femoral condyle represents an impaction fracture likely sustained at the time of trauma as seen on recent MRI. A small joint effusion is noted.

Output: Reduction of ACL avulsion fracture and other findings as above.


Instruction: Generate impression based on findings.

Input: 37-year-old male with new onset seizure. Evaluate for etiology of the seizure. There is scattered mild nonspecific periventricular and subcortical white matter T2/FLAIR signal abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears within normal limits. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus mucous retention cyst and mild right maxillary sinus mucosal thickening.

Output: 1.No evidence of acute intracranial hemorrhage, mass or acute infarct.2.No findings to suggest seizure focus are appreciated.3.There is scattered mild periventricular and subcortical white matter T2/FLAIR signal abnormality which is nonspecific and may represent mild chronic small vessel ischemic disease (which would be slightly advanced for age), prior inflammation or less likely a demyelinating process.


Instruction: Generate impression based on findings.

Input: 31 years Female (DOB:6/23/1985)Reason: first seizure History: right tonic clonic movements, unrinary incontinencePROVIDER/ATTENDING NAME: DAVID G BEISER KOUROSH V REZANIA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. These are unusual at this age. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: 57-year-old male with a history of Crohn's disease with an outside hospital CT enterography showing a 10 cm ileal stricture and proximal ileal short segment strictures with a history of intermittent obstructions and iron deficiency anemia. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter focus with associated fluid signal intensity in segment 8 of the liver, most consistent with a simple cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple cysts are identified bilaterally.RETROPERITONEUM, LYMPH NODES: There are multiple prominent mesenteric lymph nodes without evidence of lymphadenopathy. BOWEL, MESENTERY: There is wall thickening of a 5.4-cm segment of the terminal ileum consistent with the stated history of ileal stricture. There is associated wall enhancement on post contrast sequences consistent with active fibro-stenotic disease. Approximately 5 cm proximal to this stricture is an additional segment of distal ileum with associated wall thickening and enhancement, measuring approximately 10 cm, consistent with active fibro-stenotic disease. Immediately proximal to this segment of active disease is a segment of distal ileum which demonstrates wall thickening, without evidence of enhancement, consistent with chronic fibro-stenotic disease without active inflammation. Proximal to this segment is an additional 2 cm segment of wall thickening with enhancement, consistent with an additional segment of fibro-stenotic disease with active inflammation. There is mild distention of the distal ileum proximal to this stricture. There is no evidence of fistula formation or lymphadenopathy. There are no dilated loops of small bowel to suggest obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: There are multiple prominent mesenteric lymph nodes without evidence of lymphadenopathy. BOWEL, MESENTERY: There are multiple prominent mesenteric lymph nodes without evidence of lymphadenopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings consistent with acute on chronic inflammatory bowel disease including multiple long segment strictures affecting the distal and terminal ileum, with measurements provided above. No fistula or small bowel obstruction is identified.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: assess progression of infarct History: multiple CVAs There is a 20 mm x 46 mm sized right cerebellar intraparenchymal hemorrhage with surrounding edema. Ventricle size appears to be slightly enlarged however, comparing to prior CT scan, no significant interval change since prior scan considering the difference of imaging modality.There are multifocal diffusion restriction lesions on the right hemisphere including right superior frontal gyrus, right internal capsule posterior limb, right thalamus indicating multifocal acute ischemic infarct. There is no evidence of hemorrhagic conversion on above acute ischemic infarct lesions.There is evidence of chronic ischemic infarct with encephalomalacia on the right occipital lobe.The sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Intraparenchymal hemorrhage on the right cerebellar hemisphere with surrounding edema as described above.2. Multifocal scattered right hemispheric acute ischemic infarctions without evidence of hemorrhagic conversion.3. Chronic ischemic infarction with encephalomalacia, right occipital lobe.


Instruction: Generate impression based on findings.

Input: Reason: L arm pain, r/l R structuiral lesion History: L arm pain MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a very small central disk protrusion at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge associated with tiny uncovertebral osteophytes present at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No abnormal intracranial mass lesion is identified which can account for the patient's left arm pain.2.There are minor degenerative changes present in cervical spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 9-year-old male status post treatment of possible osteomyelitis of right calcaneus, continued pain TENDONS: The extensor and flexor tendons are intact.LIGAMENTS: The medial and lateral collateral ligaments are intactARTICULAR SURFACES AND BONE: Interval improvement in marrow edema within the calcaneus with a residual well defined focus of increased T2 and decreased decreased T1 signal along the inferior margin of the calcaneus adjacent to the inferior aspect of the apophyseal physis, measuring 6 mm in diameter. This focus corresponds to a lucency seen on prior CT which was also present on the CT biopsy exam and subsequent MRI. A linear tract of low T1 signal intensity within the posterior calcaneus likely represents a prior needle biopsy tract with minimal residual associated edema. The remaining bone marrow signal is normal.ADDITIONAL

Output: Interval improvement in marrow edema of the calcaneus. Persistent well-defined focus of increased T2 and decreased T1 signal within the calcaneus is nonspecific, but was present on prior CT and MR exams as described above.


Instruction: Generate impression based on findings.

Input: Reason: asees for HCC History: + cirrhosis ABDOMEN: Please note that postcontrast LAVA sequences are nondiagnostic as no enhancement is observed. Postcontrast in/out of phase images appeared to be obtained in the arterial phase.LIVER, BILIARY TRACT: Cirrhotic liver morphology with fissural prominence, compatible with cirrhosis. Bandlike increased T2 signal at the porta hepatis likely represents superimposed fibrosis and is similar to the prior exam. Subcentimeter nonenhancing right renal cyst is unchanged.There is new thrombosis of the splenic vein. Low signal extends within the main portal vein, likely representing partial thrombosis. There is thrombosis of a branch of the right portal vein. SMV is patent.Common bile duct is mildly prominent measuring 1 cm in diameter, however it tapers smoothly distally to the ampulla, appearing similar to the prior exam. Gallstones within the fundus are unchanged.SPLEEN: Splenomegaly measuring 19.5 cm in craniocaudal dimension. Trace splenic fluid is unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing subcentimeter T2 hyperintensities likely represent cysts and are unchanged. Subcentimeter left upper pole hemorrhagic cyst there is stable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Body wall collateral vessels are noted.OTHER: No significant abnormality noted.

Output: 1.Limited exam as only limited post contrast sequences were obtained, likely due to technical failure. Thus, this exam is nondiagnostic for evaluation of HCC. Patient will be advised to return for completion of postcontrast sequences.2.Given limited postcontrast imaging, there is new thrombosis of the splenic vein, partial thrombosis of the main portal vein and thrombosis of a branch of the right portal vein.3.Precontrast images again show a cirrhotic liver and findings of portal hypertension.


Instruction: Generate impression based on findings.

Input: 90 year-old female with altered mental status, evaluate for bleed. There is no evidence of intracranial hemorrhage or mass. Multiple scattered hypoattenuating foci in the left frontal, right occipital, and right temporal lobe consistent with cortical infarcts of indeterminate age. If there is clinical concern for an acute infarct, MRI may be obtained. Numerous hypoattenuating foci within the subcortical, deep, and periventricular white matter consistent with ischemic small vessel disease of indeterminate age. The ventricles and basal cisterns are prominent compatible with age-appropriate volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Multiple areas of cortical and subcortical infarcts, age indeterminate. If there is clinical concern for acute infarction, MRI may be obtained.


Instruction: Generate impression based on findings.

Input: 53 years, Female, acute delirium and bipolar episode. No restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage, intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few foci of T2/FLAIR hyperintensity are seen in the periventricular white matter, which are nonspecific, but probably secondary to chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. A left posterior frontal deep venous anomaly is incidentally noted.Sella and orbits are grossly within normal limits. A mucous retention cyst is present within the right maxillary sinus. The paranasal sinuses and mastoid air cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits.

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


Instruction: Generate impression based on findings.

Input: Fever, unspecified [R50.9], Reason for Study: ^Reason: 70 year old with orthotopic heart transplant, evaluate for brain parenchymal abnormalities History: elevated CSF protein There is no evidence of acute ischemic or hemorrhagic lesion on scan.Multifocal tissue losses indicating lacunar infarcts are seen on bilateral cerebellar hemispheres.Previously shown right occipital lobe FLAIR high signal intensity lesion is not as conspicuous on today's scan (series 5, image 14/35), thus may indicate evolving prior ischemic lesion. Multifocal bihemispheric susceptibility lesions are seen, unchanged in terms of size, distribution and numbers.Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter are again seen, unchanged, indicating non specific small vessel disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Unchanged multifocal susceptibility lesions.3. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 43 years, Female, breast cancer with brain metastases. Surveillance.. There is evidence of progression of intracranial metastatic disease:There is a 5 x 5 mm right frontal lobe lesion which is new, series 1101 image 119. There is surrounding FLAIR hyperintensity/edema.There are 2 adjacent right occipital lesions measuring approximately 6 x 7 mm and 6 x 5 mm, series 1101 image 82, which appear to be along the cortical surface and possibly along the leptomeninges. There is associated FLAIR hyperintensity/edema in the right occipital cortex. There is a left cerebellar lesion, series 1101 image 57 which measures 9 x 6 cm, 3 x 3 mm previously on 4/12/2016. There is surrounding edema which is increased. There is punctate focus of susceptibility associated with this lesion with was present previously and may be related to blood products and/or mineralization.No significant intracranial mass effect associated with the above-mentioned small lesions. No evidence of acute ischemia or new hemorrhage. No midline shift or herniation. No hydrocephalus. There is an enhancing lesion involving the right frontal dura, suspicious for metastasis, series 901 axial image 29, and measures approximately 4 to 5 mm in thickness, and abuts the adjacent calvarium. No significant mass effect on the underlying brain. Several foci of intrinsic T1 hyperintensity in the bilateral frontal and parietal calvarium are also noted. No definite evidence of calvarial metastasis, which can be better assessed with bone scan.

Output: Interval progression of metastatic disease with enlarged left cerebellar lesion as well as multiple new lesions, as described above. The right occipital lesions are along the cortical surface and may involve the leptomeninges. There also appears to be a small lesion along the right frontal dura.


Instruction: Generate impression based on findings.

Input: Left T2N2 nasopharyngeal carcinoma treated with CRT that was completed on 3/22/13. There is no evidence of recurrent nasopharyngeal tumor. There is mild residual diffuse pharyngeal mucosal space edema, but the airways are not significantly narrowed. There is no significant cervical lymphadenopathy. The major salivary glands appear unremarkable. The osseous structures appear unchanged. The major cervical arteries flow voids are grossly intact. The imaged intracranial structure are unremarkable. There is a small right nasal cavity polyp.Orbits: The bilateral globes, extraocular muscles, optic nerves, and orbital fat appear unremarkable. There is no evidence of intraorbital tumors or abnormal enhancement.

Output: Post-treatment findings in the nasopharyngeal region without evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Evaluate for osteomyelitis Examination left tibia-fibula was performed with and without intravenous contrast. There is diffuse anterior inflammation in the soft tissues. The bone marrow signal in the tibia and fibula is unremarkable. There is a linear tract seen on the T1 weighted images that probably secondary to instrumentation -series 1001, image 15.

Output: Bone marrow signal unremarkable. No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Slurred speechClinical question: strokeSigns and Symptoms: stroke MRI of the brainThere is a focus of diffusion restriction present in the right centrum semiovale. It measures approximately 10 x 8 mm axial dimensions.A punctate focus of susceptibility effect is present in the right thalamus. Another punctate focus is present along the right posterior temporal lobe. Another one is present along the left caudate nucleus. Another focus of punctate signal loss is present in the left cerebellar hemisphere.Small cystic fluid collections are present between the right superior frontal gyrus and falx as well as adjacent to the left parietal lobe. These most likely represent small arachnoid cysts.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The ACOMA is fenestrated. The vertebral arteries are similar in size. There is fetal origin of the posterior cerebral arteries bilaterally. The p1 segments are medium sized.The left vertebral artery is larger than the right vertebral artery.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. The left vertebral artery is larger than the right vertebral artery. The LCCA originates from the innominate artery.

Output: 1.There is a lacunar infarct in the right centrum semiovale.2.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 3.There are multiple microhemorrhages present . These are mainly but not exclusively in a distribution suggestive of hypertension.4.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.5.A couple small arachnoid cysts are present.


Instruction: Generate impression based on findings.

Input: 20 year-old male with left shoulder pain during weight lifting The distal pectoralis tendon is intact at its insertion on the humerus. However, there is edema within the sternal head of the pectoralis major muscle with mild retraction of the muscle fibers as well as slightly increased signal intensity on the T1 weighted images, suggesting a grade 2 myotendinous injury of the sternal head. Mild edema is noted within the clavicular head, which otherwise appears intact. There is also mild edema juxtaposed between the long head of the triceps and latissimus muscles suggesting a mild strain. The remaining muscles appear normal, including the contralateral pectoralis musculature. The bone marrow signal is within normal limits. Please note this exam was not protocoled for evaluation of the rotator cuff.

Output: Grade 2 myotendinous injury of the sternal head of the left pectoralis musculature as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Past pituitary adenoma. Evaluate for or regrowth of adenoma. Signs and symptoms: Worsening memory for a year. Pre-and post-enhanced pituitary MRI:Examination demonstrate stable post surgical changes of prior removal of pituitary adenoma. There is no convincing evidence of residual tumor which is a similar observation as prior study. There is revisualization of pituitary stalk with rightward course and termination to residual pituitary gland on the right similar to prior exam. Heart remarkable bilateral cavernous sinuses and similar to prior study. Unremarkable suprasellar visual complex.Pre-and post-enhanced brain MRI:Negative diffusion weighted images.T2 flair images demonstrate minimal punctate foci of hyperintensity in the periventricular white matter of cerebral hemispheres which are nonspecific however often represent microvascular ischemic changes. There are no prior dedicated brain MRI in particular of flair sequence which makes precise comparison difficult. However comparison with prior axial T2 weighted images demonstrate no convincing evidence of progression of findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination are brain otherwise. Post-enhanced images fail to demonstrate any abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.The signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses is within normal and with normal pattern of enhancement.

Output: 1.Stable post surgical changes of pituitary adenoma resection since prior exam and without evidence of residual tumor.2.Negative diffusion weighted images.3.Minute periventricular flair hyperintensity although nonspecific it could represent chronic microvascular ischemic changes of minimal degree.4.No detectable abnormal enhancement and unremarkable brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: BRAIN: There are unchanged postoperative findings related to suboccipital craniotomy for resection of a right cerebellar mass. There is minimal unchanged T2 hyperintensity within the right cerebellar hemisphere surrounding the resection cavity and no abnormal enhancement. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is moderate paranasal sinus mucosal thickening that is new since the prior exam including the maxillary, ethmoid, and sphenoid sinuses. SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is unchanged increased T1 and T2 hyperintensity throughout the central vertebral body bone marrow most compatible with posttreatment effects and increased yellow marrow. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at L1-L2. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable. There is asymmetric mild enlargement of the right renal pelvis and ureter, not present on the 2/9/2015 exam but similar to the 11/10/2014 exam.

Output: 1. Unchanged posttreatment findings without evidence of tumor recurrence within the head or spine.2. Nonspecific moderate paranasal sinus mucosal thickening that is new since the prior exam.3. Nonspecific mild asymmetric enlargement of the right renal pelvis and ureter that was not present on the 2/9/2015 exam but is similar to the 11/10/2014 exam. Findings can be correlated with renal ultrasound as clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 76 years Female (DOB:7/11/1939)Reason: eval for vascular malformations History: eval for vascular malformationsPROVIDER/ATTENDING NAME: JOSHUA D MOSS JOSHUA D MOSS MRI of the brainThe focus of questionable enhancement along the ependymal and intraventricular focus in the trigone of the left lateral ventricle contains the left lateral atrial vein extending into the vein of Galen as well as a portion of the left choroid plexus.A small amount of blood layers in the occipital horn of the left lateral ventricle.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is fenestration of the right A2 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is extracranial origin the left posterior inferior cerebellar artery.

Output: 1.The parenchymal lesion at the anterior aspect of the trigone of the left lateral ventricle appears to represent a confluence of the draining vein and choroid plexus. 2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm or arteriovenous malformation.4.A small amount of blood layers in the occipital horn of the left lateral ventricle. This was also identified in the recent CT exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out mass. Signs and symptoms Cone patient with worsening back pain on the left there Nonenhanced lumbar MRI: There is normal signal intensity of vertebral column.There is normal anatomical alignment of vertebral column. There is no evidence of spinal canal compromise or stenosis at any level.There is no evidence of neural foraminal compromise at any level.There is no appreciable degenerative disk disease at any level.Mild ligamentum flavum hypertrophy in the lower lumber spine at L4 -- L5 and L5 -- S1 levels are however present.There is normal signal intensity and morphology of the lower most visualized thoracic cord, conus and cauda equina.There is normal perispinal soft tissues.

Output: Unremarkable nonenhanced lumbar MRI.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, history of thyroid cancer with brain metastases, compare to examination of 6/30/2015 The rim-enhancing left paracentral lobule lesion has not significantly changed in size or morphology. T2/FLAIR hyperintensity surrounding this lesion also shows no significant or reliable change in extent.At least three small enhancing foci within the bilateral frontal lobes (see image 22 and image 21 of series 11) show no significant interval change. No definite evidence of any new intracranial lesion is seen.No significant generalized mass effect is observed. No abnormal extra-axial collections are seen. Ventricular size and morphology are stable and normal.

Output: 1.No significant change in the size of the left paracentral ring enhancing lesion.2.No significant change in multiple bilateral frontal lobe punctate enhancing foci.3.No evidence of any new intracranial lesion.


Instruction: Generate impression based on findings.

Input: Female, 51 years old. Reason: Right shoulder pain x 1 year limited motion, evaluate for rotator cuff tear. Frozen shoulder History: pain ROTATOR CUFF: The rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears normal within the limits of non-augmented imaging. The glenohumeral joint appears normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Widening of the acromioclavicular joint is most likely postsurgical in etiology and less likely related to erosive disease.2.No significant abnormalities to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 22-year-old male with medial shin pain. Rule out stress fracture. Markers were placed along the medial aspect of the leg at the level of the mid to distal tibial diaphysis. There is focal edema within the tibial diaphysis, deep to the markers, compatible with stress reaction. We see no discrete fracture line. There is minimal periosteal edema along the medial margin of the tibia. There is also subcutaneous edema affecting the ankle, particularly medially. On the large field-of-view coronal images, there is slightly less pronounced edema noted within the left tibial diaphysis compatible with stress reaction as described in the previous report.

Output: 1. Stress reaction of the right tibia.2. Stress reaction of the left tibia as seen on the prior study.


Instruction: Generate impression based on findings.

Input: 56 year old man with history of recurrent VT with dual chamber ICD, non-obstructive CAD, referred for cardiac MRI to evaluate for possible etiologies of VT. Left VentricleThere is a significant amount of artifact on cine images related to the presence of a dual chamber defibrillator but it is a diagnostic test with the following observations made: The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 230 ml (normal range 142+/-34), the LV end systolic volume index is 54 ml/m2 (normal range 25+/-9), the LVESV is 125 ml (normal range 47+/-19), the LV mass index is 49 g/m2 (normal range 85+/-15), and the LV mass is 113 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is extensive late gadolinium enhancement involving epicardium of the basal to mid anterolateral and inferolateral wall which is atypical for previous myocardial infarction, and suggests the presence of an infiltrative, inflammatory or fibrotic process.Left AtriumThe left atrium is moderately dilated. Right VentricleThere is a defibrillator lead in the right ventricle. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 166 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium contains a device lead. It appears mild-moderately dilated.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 Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function (EF 46%). There is a significant amount of artifact on the cine images related to the presence of a dual chamber defibrillator which may limit assessment of LV ejection fraction.2. There is extensive late gadolinium enhancement involving epicardium (and mostly sparing the endocardium) of the basal to mid anterolateral and inferolateral wall which is atypical for previous myocardial infarction, and suggests the presence of an infiltrative, inflammatory or fibrotic process. 3. The right ventricle is normal in size with mildly systolic function (EF 46%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:7/2/1944)Reason: L side weakness History: L side weaknessPROVIDER/ATTENDING NAME: DAVID HOWES DAVID HOWES MRI brain:There is a small focus of diffusion restriction present in the right frontal lobe and insular cortex of the top of the operculum measuring 11 x 9 mm axial dimensions. 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.There is a punctate focus of signal loss and susceptibility imaging in the right pons. Another focus of punctate signal loss is present subcortical white matter of the left cingulate gyrus and another in the left periventricular white matter. Another is present in the medial aspect of the right temporal lobe subcortical white matter. Several foci of punctate signal loss and susceptibility are present in the cerebellar hemispheres. Another is present in the right frontal lobe subcortical white matter. Still another one is present in the periventricular white matter adjacent to the trigone of the right lateral ventricle. Another 0 scattered in the subcortical white matter of the temporal lobes and occipital lobesThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are patchy T2 and FLAIR hyperintense lesions present in the brainstem. There are punctate foci of T2 and FLAIR hyperintensity in the thalami and basal ganglia.On susceptibility imaging there is prominent transmitted medullary veins which are lower in signal and appear larger than the left-sided counterparts. Additionally couple cortical veins that are more prominent on the right side versus the left. This corresponds to the precentral and prefrontal territories. This may represent hypoxia.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a relative paucity of vasculature in the right middle cerebral artery territory versus the left. A separate superior division branches not clearly identified. Some the supply to the superior division originates from a small branch of the distal M1 segment which includes a frontal opercular branch, however, prefrontal and precentral arteries are not clearly depicted on this exam distally. There is an occluded the right precentral artery present at the distal M2 segment on the right side. The left posterior communicating artery is medium-sized. The right posterior communicating artery is not readily visualized. Anterior communicating artery is small.There is no evidence for intracranial aneurysm.

Output: 1.Occlusion of the right precentral artery at the distal M2 segment and suspected more proximal occlusion of the right prefrontal artery.2.Small focus of infarction is present in the right frontal lobe extending to the insular cortex near the top of the operculum which corresponds to the occluded right precentral artery.3.Findings were discussed with clinical service.4.Periventricular and subcortical white matter lesions as well as some patchy lesions in the brainstem of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Punctate lesions in the thalami and external capsules are suspected to be related to old lacunar infarcts.6.There multiple microhemorrhages present. Anomaly in cerebellum and brainstem but also periventricular white matter and subcortical white matter. The pattern is nonspecific. It could represent a combination of hypertension and amyloid angiopathy.


Instruction: Generate impression based on findings.

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

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Otherwise, please consider a dedicated angiography imaging study for further evaluation of vascular abnormalities.


Instruction: Generate impression based on findings.

Input: Pituitary macroadenoma status post resection. Acromegaly and MEN1. There are postoperative findings related to transsphenoidal surgery. There is a small amount of residual pituitary gland tissue, but no discernible tumor in the sella. The pituitary infundibulum is intact, but deviated slightly to the right. The cavernous sinuses and optic apparatus are intact. Aside from the surgical alterations, the imaged sinonasal compartments are unremarkable. There is mild nonspecific periventricular cerebral white matter T2 hyperintensity.

Output: Postoperative findings related to transsphenoidal surgery without discernible residual or recurrent pituitary macroadenoma.


Instruction: Generate impression based on findings.

Input: 29-year-old male with anterior knee pain. Evaluate quadriceps tendon status. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Subcentimeter focus of low signal abnormality in the lateral femoral condyle likely represents a bone island. No additional bone marrow signal abnormality is identified. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. Specifically the quadriceps tendon appears intact. There is thickening and increased signal abnormality within the distal quadriceps tendon suggesting mild to moderate tendinosis. There is mild increased signal abnormality within the quadriceps fat pad which is nonspecific.ADDITIONAL

Output: Mild to moderate quadriceps tendinosis as described above. The quadriceps tendon appears intact.


Instruction: Generate impression based on findings.

Input: 80-year-old male presents with insidious cognitive impairment. There appears to be diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal amount of periventricular cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. Mild mucosal thickening in the paranasal sinuses. The skull, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. Apparent diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes. This may indicate the possibility of Alzheimer dementia. A PET scan may be useful for further evaluation.2. Minimal amount of periventricular cerebral white matter T2 hyperintensity is nonspecific, but may reflect chronic small vessel ischemic changes.3. Mild mucosal thickening in the paranasal sinuses.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Dysmenorrhea. Vulvar pain. PELVIS:UTERUS, ADNEXA: Retroflexed uterus measuring approximately 8.6 x 4.0 cm in the sagittal plane. C-section scar noted.The endometrium/endometrial cavity is normal in signal intensity and thickness. The inner myometrium/junctional zone measures 8 mm, within normal limits. Small nabothian cysts. There appears to be cervical fullness without a discrete mass lesion.The endometrium and vaginal canal are unremarkable.The right and left adnexa are normal in morphology and size measuring 1.8 x 1.7 cm and 3.4 x 1.4 cm, respectively. They contain physiologic cysts.BLADDER: The bladder is normally distended.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: There appears to be cervical fullness without a discrete mass lesion, correlate with pelvic examination. Otherwise, no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:10/10/1946)Reason: evaluate for cortical damage History: SDHPROVIDER/ATTENDING NAME: AGNIESZKA ANNA ARDELT AGNIESZKA ANNA ARDELT On diffusion-weighted imaging there is no convincing evidence for cerebral infarction. Some signal hyperintensity is present along the right middle frontal gyrus which does not display diffusion restriction.The patient is status post right parietal craniotomy. There is redemonstration of a subdural collection adjacent to the right hemisphere measuring up to 9 mm in thickness. There is an additional right tentorial leaf subdural hematoma measuring 5 mm which is also unchanged compared to the prior exam. There is a small amount of intracranial air within the subdural space.There is associated mass effect with 10 mm shift of the septum pellucidum towards the left side which was also present on the prior exam and hasn't changed. There is subfalcine herniation present and mild uncal herniation.There is redemonstration of 2 small intraparenchymal hematomas in the right occipital lobe one measuring 8 x 5 mm and the other measuring 12 x 10 mm sagittal dimensions. These too are stable.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells demonstrate scattered opacities bilaterally.. The visualized portions of the orbits are intact.

Output: 1.There is redemonstration of subdural and intraparenchymal hematomas which are stable compared to the prior exam. There is associated subfalcine and uncal herniation which is also stable compared to the prior exam.2.Findings are compatible with a small contusion along the right middle frontal gyrus which is not readily identified on the CT3.The patient is status post right-sided craniotomy


Instruction: Generate impression based on findings.

Input: Spastic left hemiparesis, abulia. History of hypertension, DM, developmental delay, and stroke causing left hemiparesis, and high grade right > left carotid stenosis. MRI: There has been interval evolution of diffuse right cerebral hemisphere white matter infarction, particularly in the corona radiata, with associated encephalomalacia, susceptibility effect, and Wallerian degeneration. There are also diffuse left cerebral hemisphere white matter T2 hyperintensities, mainly in a periventricular distribution, which are not significantly changed. There is diffuse cerebral volume loss, right more than left. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are right maxillary and left sphenoid sinus retention cysts.MRA: There is redemonstration of high-grade steno-occlusive disease involving the bilateral cavernous through supraclinoid internal artery segments with reconstitution of flow at the circle of Willis via the left posterior communicating artery. There is nevertheless paucity of flow-related enhancement to the right middle and anterior cerebral arteries. There is irregularity involving the left P2 segment. The bilateral cervical internal carotid arteries are diffusely diminutive. The posterior intracranial circulation and major cervical arteries are otherwise intact.

Output: 1. Diffuse chronic right cerebral hemisphere white matter hemorrhagic infarction, particularly in the corona radiata. There are also diffuse left cerebral hemisphere white matter T2 hyperintensities, mainly in a periventricular distribution, likely related to chronic small vessel ischemia, which are not significantly changed. Otherwise, no evidence of acute infarct. 2. Redemonstration of high-grade steno-occlusive disease involving the bilateral cavernous through supraclinoid internal artery segments with reconstitution of flow at the circle of Willis via the left posterior communicating artery. There is nevertheless paucity of flow-related enhancement to the right middle and anterior cerebral arteries. There is also irregularity involving the left P2 segment. The bilateral cervical internal carotid arteries are diffusely diminutive. The posterior intracranial circulation and major cervical arteries are otherwise intact.


Instruction: Generate impression based on findings.

Input: Choroid plexus papilloma of 4th ventricle and hydrocephalus. Evaluation for drop metastases is requested. There are partially imaged postoperative findings in the posterior fossa and an enhancing mass in the fourth ventricle with associated dilatation of the superior portion of the fourth ventricle. However, there is no evidence of intraspinal mass or abnormal enhancement. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is loss of disc space height and an associated disc bulge at L5-S1 without significant spinal canal stenosis.

Output: 1. No evidence of drop metastases in the spinal canal.2. Partially imaged fourth ventricular choroid plexus tumor associated with obstructive hydrocephalus.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for compression fracture, DDD, lower back pain with left leg weakness. Signs and symptoms: Lower back pain radiating to left buttock and down leg. Nonenhanced lumbar MRI:T11-T12 is unremarkable.T12-L1 demonstrate chronic approximately 50% compression fracture of L1 vertebral body with resultant mild bulge of the superior aspect of compressed vertebrae into the spinal canal without definitive central spinal stenosis. Signal intensity of the adjacent cord and conus is within normal. There is also no detectable neural foraminal compromise.L1-L2 demonstrate mild disc disease, loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis and mild right neural foraminal compromise is present.L2-L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild to moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet disease. Degenerative changes also results in mild grade 1 anterolisthesis at this level and with resultant moderate central spinal stenosis with significant (right greater than left) neural foraminal compromise.L4-L5 demonstrate mild disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is a central small disc protrusion projecting into the ventral epidural space and without mass effect on the thecal sac. No evidence of spinal stenosis and patent bilateral neural foramina.L5-S1 demonstrate mild degenerative disc disease and facet/ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. Diffuse T1 and T2 hyperintense and T2 STIR isointense signal intensity of the L5 vertebral body consistent with fatty deposit.Unremarkable paraspinal soft tissues.

Output: 1.Chronic approximately 50% compression fracture of superior endplate of L1 vertebrae with mild bulge into the spinal canal without spinal stenosis or clinically significant neural foraminal compromise.2.Moderate degenerative changes at L3-L4 and including mild grade 1 anterolisthesis with resultant moderate central spinal stenosis.3.Tiny central disc protrusion at L4-L5 without mass effect on the thecal sac, central spinal stenosis as detailed.4.Multilevel mild neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: History of left lumpectomy in 2011 for breast carcinoma. Patient received radiation therapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post-surgical changes including scarring seen as low T2 signal are again noted in the left outer breast. Other low T2 signal areas in each breast are also stable and without suspicious enhancement. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male 71 years old Reason: Evaluate recurrent rotator cuff tear History: pain and weakness ROTATOR CUFF: The supraspinatus muscle is atrophic. There is increased signal in the supraspinatus tendon at the insertion compatible with severe tendinopathy. No discrete tear is identified.SUPRASPINATUS OUTLET: Severe degenerative changes about the acromioclavicular joint. Small amount of fluid is noted in the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Periarticular cyst adjacent to the superior glenohumeral joint has homogeneous T2 intense signal and is multilobulated. The glenoid labrum is grossly normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Severe supraspinatus tendinopathy with no discrete rotator cuff tear. Supraspinatus muscle atrophy. Severe degenerative changes of the AC joint.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: eval ventricular mass; compare to previous mri scans History: brain mass The exam is limited due to patient intolerance.Previously seen proximal third ventricle mass lesion with blood products is again demonstrated with decreased size and decreased the surrounding edema. The lesion show low signal intensity rim on T2 weighted image indicating hemosiderin deposition as well as central high signal intensity on T1 and T2-weighted images indicating late subacute stage of hemorrhage. In particular, the superior aspect of the lesion appears to be multi-compartmentalized on FLAIR/T2 images, thus suggest the diagnostic possibility of cavernous malformation of the 3rd ventricle. Again the differential diagnosis include papillary craniopharyngioma, choroid plexus papilloma, meningioma with hemorrhages or hemorrhagic colloid cyst. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no evidence of acute ischemic lesion.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Interval decrease in size of the 3rd ventricle hemorrhagic mass lesion with decreased surrounding edema since prior scan. Interval demonstration of multi-compartment appearance suggest possible diagnosis of cavernous malformation with differential diagnosis of papillary craniopharyngioma, choroid plexus papilloma, meningioma with hemorrhages or hemorrhagic colloid cyst.


Instruction: Generate impression based on findings.

Input: 65 year old with loss of consciousness rule out bleed The examination is somewhat compromised by patient motion. In several areas there is poor differentiation of gray white junction with the suggestion of subcortical hypodensity. In addition the sulci and basilar cisterns are small and I cannot rule a possibly of some increased intracranial pressure.I recommend obtaining an MRI with diffusion weighted imaging to evaluate.There is no evidence of intracranial hemorrhage as clinically questioned.Bone windows reveal no osseous abnormality.

Output: Somewhat compromised examination by patient motion does demonstrate poor definition of the gray white junction as well as suggestion of subcortical hypodensities. Cerebral sulci and basilar cisterns are somewhat small for the patient's stated age and the possibility of diffuse edema cannot be excluded. MRI of the brain is recommended to fully evaluate.


Instruction: Generate impression based on findings.

Input: Cystic mass superior to the right ovary with debris. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Anteverted uterus. The uterus is normal in size measuring 7.0 x 3.8 cm in the sagittal plane.The endometrial cavity is normal in thickness and signal intensity. The inner myometrium/junctional zone is well-defined and normal in thickness measuring approximately 9 mm.No discrete uterine mass.The cervical stroma is normal in signal intensity.The vaginal canal is unremarkable.The right ovary measures 2.7 x 2.2 cm with several physiologic follicles.The left ovary measures approximately 2.2 x 2.0 cm with several physiologic follicles.Immediately anterior to the uterine body/fundus and above the urinary bladder is a 8.1 x 5.7 x 8.2 cm cystic lesion composed of one large and one smaller encapsulated components. It has very high intrinsic T2-signal and no increase in T1-weighted signal intensity. The mass displaces the uterus towards the left and has mass effect on the dome of the bladder. There is a very thin rim enhancement lesions but no mural nodularity or internal enhancement. The lesion abuts and is partially marginated by the right broad ligament.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large paraovarian cyst without internal complexity. Follow-up ultrasound is recommended to monitor the lesion.


Instruction: Generate impression based on findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0] / Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: 3T scanner, please evaluate for AVMs, HHT, and evaluate known aneurysm (please compare to outside images uploaded to PACS) Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. There is a retention cyst on the right maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate left Pcom origin infundibulum which demonstrated patent left Pcom artery and smooth luminal bulge at the right Pcom area. The bulge at the right Pcom area is measured about 0.8mm x 2.6mm which most likely represent right Pcom infundibulum. Comparing to prior scan performed at outside hospital, there is no significant interval change.Otherwise bilateral ICAs, MCAs and ACAs appear to be normal. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of abnormal enhancement. No acute ischemic or hemorrhagic lesion.2. Right Pcom area luminal bulging most likely represent infundibulum, the left pcom origin infundibulum. No change since prior scan.3. No evidence of intracranial arterial aneurysm. No evidence of unusual vascularity or evidence of arteriovenous shunt.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: pain and paresthesias legs. There are persistent T2 hyperintense lesions in the spinal cord, particularly at the T1-2 and T12 levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are multilevel upper thoracic subcentimeter neural foraminal perineural cysts. There are disc protrusions at L4-5 and L-S1 with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. There are multilevel degenerative changes in the cervical spinal cord, which are depicted only on the limited localizer images. The paravertebral soft tissues are unremarkable. There are multiple adnexal lesions, perhaps including hemorrhagic cysts.

Output: 1. Persistent demyelinating lesions in the spinal cord.2. Multiple adnexal lesions, perhaps including hemorrhagic cysts. A pelvic ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Evaluate for etiology headaches, intractable : intractable migraine, right facial pain . Brain: There are multiple, at least 10, foci of T2 hyperintensity in the cerebral white matter, mainly in a periventricular distribution, without associated enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. Cervical Spine: The vertebral column alignment is straightened in the sagittal plane. 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. There is no abnormal enhancement in the spine. There is a lipoma in the subcutaneous tissues of the right upper neck that measures up to 12 mm in thickness.

Output: 1. Multiple foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent a demyelinating process, stigmata of migraines, or vasculitis, for example.2. No evidence of cervical spinal cord lesions.


Instruction: Generate impression based on findings.

Input: 84 year old female with loss of consciousness. Persistent headaches Examination demonstrates extensive findings consistent with advanced small vessel disease of indeterminate age. In comparison to prior exam no gross interval change is detected.New since prior exam are 2 small foci of increased signal intensity one been interval left basal ganglia measuring approximately 5 mm in AP axis and 4-mm in transverse axis (axial image 13 which is suspected of a small area of hemorrhage. The second lesion is within the cortex of right parietal lobe and measures approximately 4 mm x 4 mm and is best the patient on axial image 18. This lesion is also suspected of a small hemorrhage. Further evaluation with an MRI is recommended to exclude possibility of hemorrhagic metastatic lesions. Neither one of these demonstrates any surrounding edema.The findings were reported to measure number 9239 at the time of interpretation.

Output: 1.Advanced small vessel disease of indeterminate age.2.Two very small foci of increased signal intensity new since prior study as detailed.3.Further evaluation with an MRI is highly recommended to exclude hemorrhagic metastatic lesions.


Instruction: Generate impression based on findings.

Input: 61-year-old male with HCV cirrhosis status post TACE RFA. Evaluate for obstruction ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with multiple regenerative nodules and reticular T2 hyperintensity consistent with fibrosis. No evidence of arterially enhancing and washing out lesions suggest hepatocellular carcinoma. The previously noted punctate arterial enhancing foci in segment 8 was likely perfusional anomaly and is no longer present. No evidence of recurrent or residual tumor in the segment 6 ablation cavity.Stigmata of portal hypertension including extensive perisplenic collateral vasculature and splenomegaly.There is mildly dilated common bile duct which smoothly tapers to the level of the ampulla without evidence of a lesion or stricture.SPLEEN: Marked splenomegaly with spleen measuring 17 cm in craniocaudal dimension. Splenorenal shunt is 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: Small volume perihepatic ascites.

Output: 1.No evidence of recurrent or residual tumor in the segment 6 ablation cavity.2.Cirrhosis with multiple regenerative nodules and fibrosis; no arterially enhancing and washing out lesions to suggest HCC.3.Splenomegaly and perisplenic collateral vessel formation.4.Mildly dilated common bile duct which smoothly tapers to the level of the ampulla without evidence of a lesion or stricture.


Instruction: Generate impression based on findings.

Input: Ms. Massarsky is a 61-year-old female with a family history of breast cancer in her sister (diagnosed at the age of 26) and BRCA2 positive. Personal history of benign left breast MR-biopsy in 2009 for fat necrosis. She has no current breast related complaints. Breast parenchyma is almost entirely fat in both breasts. Mild background parenchymal enhancement is noted bilaterally.There is new linear non-mass enhancement identified in the right superior breast, mid depth, measuring approximately 1.4 cm in the AP dimension. There is no new abnormal enhancement seen in the left breast. Susceptibility artifact from prior benign left breast biopsy is stable.No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1.4 cm linear non-mass enhancement identified in the right breast. MR-guided biopsy with clip placement is recommended for further evaluation. All results and recommendations were discussed with Dr. Romero on 3/17/2016.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Female, 16 years old, with history of chronic intermittent headaches. Please evaluate for structural abnormality, especially the craniocervical junction. The right cerebellar tonsil demonstrates a pointed configuration and descends approximately 4 mm below the level of the foramen magnum. The CSF space is effaced around the right tonsil. The left cerebellar tonsil seems to terminate at the level of the foramen magnum and shows a normal round morphology.The remainder of the brain demonstrates normal morphology and signal characteristics. No restricted diffusion is seen. No parenchymal edema or mass effect is identified. There is no evidence of intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricular system is normal.

Output: Descent of the right cerebellar tonsil approximately 4 mm below the level of the foramen magnum is at least compatible with ectopia. Although the strict imaging criteria for a Chiari I malformation are not met, the fact that the tonsil is relatively pointed with effacement of the surrounding CSF space would nevertheless suggest the possibility of a Chiari I-type process.The remainder of the examination is unremarkable with no additional findings to account for the patient's headaches.


Instruction: Generate impression based on findings.

Input: BRAIN MRI: There are postoperative findings related to frontal craniotomy without evidence of residual or recurrent fluid collections. There is no acute infarct, abnormal intracranial enhancement, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is moderate mucosal thickening in the bilateral frontal and right maxillary sinuses. There is trace left maxillary sinus mucosal thickening. The mastoid air cells are clear. There are unchanged prominent adenoids.BRAIN MRV: There is unchanged lack of flow related enhancement in the left superior ophthalmic vein. There is a hypoplastic left transverse sinus. There is no venous sinus thrombosis.ORBITS: There is unchanged lack of flow-related enhancement in the left superior ophthalmic vein. There may be minimal scar tissue in the right superotemporal orbit. The ocular adnexa otherwise appear unremarkable. There is no suspicious intraorbital enhancement or fluid collection. The optic nerves are intact. There are unchanged deformity of the bilateral globes.

Output: 1.Persistent lack of flow related enhancement in the left superior ophthalmic vein is likely due to chronic thrombosis without evidence of cerebral venous sinus thrombosis.2.Stable postoperative findings without no new intracranial or scalp abscessI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ankle pain TENDONS: There is thickening and increased signal of the distal portion of the posterior tibialis tendon with an area of mild interstitial tearing measuring less than 50%. This is best seen on series 301 image 22/35. There is mild increased fluid signal surrounding the posterior tibialis tendon representing mild tenosynovitis. The remaining flexor and extensor tendons are intact. There is increased signal intensity and caliber of the mid Achilles tendon representing mild tendinosis.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is mild osteoarthritis and associated degenerative edema of the tibial plafond posteriorly. ADDITIONAL

Output: 1. Mild interstitial tearing and tenosynovitis of the posterior tibialis tendon.2. Mild Achilles tendinosis.


Instruction: Generate impression based on findings.

Input: 12-year-old male patient with headaches, vomiting, left-sided weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: History of recurrent ovarian cancer status post resection of upper abdominal mass. New pelvic mass on pelvic ultrasound. Pathology is high-grade poorly differentiated serous carcinoma. Recent splenectomy with metastatic disease. Left upper abdominal peritoneal implant. ABDOMEN:LIVER, BILIARY TRACT: Best seen on the postcontrast images is a 4 mm hypoattenuating lesion (series 30/81). This is associated with moderate T2 hyperintensity (series 9/25) and mild restricted diffusion (series 8/75). There may be a thin rim of enhancement. Although the lesion was present on the 10/27/2015 CT it was not present previously. There are nonspecific wedge-shaped regions of T2-weighted mild signal hyperintensity without associated focal lesion (series 9/23 and series 9 image 9). Additionally on postcontrast imaging there is a nonspecific tubular peripheral region of hypoenhancement in segment 7/8 of the liver without a discrete mass which may represent a segmental portal vein thrombus. No additional suspicious lesions. No biliary ductal dilatation. The vessels are patent.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted. KIDNEYS, URETERS: Left renal superior pole cyst.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes including left periaortic/peri-adrenal lymph nodes. These are not pathologically enlarged but are new from 2014 CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy. In the right surgical bed there is a 3.6 x 3.0 x 2.4 cm multilobular mass with internal hypo-enhancement and surrounding thick rind of soft tissue enhancement, compatible with recurrent/residual tumor. The margins of the tumor are poorly defined and the lesion abuts the adjacent rectosigmoid and vaginal cuff.BLADDER: No significant abnormality noted.LYMPH NODES: Hyperenhancing left external iliac lymph node measuring 0.9 cm in short axis (series 24/237).BOWEL, MESENTERY: Small volume of pelvic ascites with septations (series 18/31). There is mild enhancement of the involved peritoneal surface without a discrete nodular implant.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.3.6 cm multilobular mass in the right hemi-pelvis surgical bed is very suspicious for local recurrent tumor. 2.Small volume pelvic ascites with septations and mild peritoneal enhancement with a discrete nodular implant.3.Hyper-enhancing prominent left external iliac lymph node.4.Non-specific right hepatic lobe subcentimeter lesion is too small to definitively characterize, however is suspicious and attention to this lesion on subsequent imaging is recommended. Questionable subsegmental portal vein thrombus.5.Shotty retroperitoneal lymph nodes, slightly increased from 2014.


Instruction: Generate impression based on findings.

Input: 67-year-old female with bilateral hip pain. Bilateral total hip arthroplasties are noted in gross anatomic alignment. The visualized bony structures are unremarkable, without evidence of acute fracture or dislocation. No significant soft tissue edema or fluid collection. Diffuse fatty atrophy of the gluteal and proximal thigh muscles is redemonstrated.

Output: Bilateral total hip arthroplasties in gross anatomic alignment without acute findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with history of GBM, on CCNU. The resection cavity incorporating the right anterior temporal lobe, a portion of the right insula on the right inferior frontal lobe has not significantly changed in size or morphology. T2 hyperintensity surrounding the resection cavity is unchanged.Thin enhancement along the medial edge of the resection cavity is unchanged. Thin ependymal enhancement along both frontal horns has diminished. Thin ependymal enhancement seen previously along the right atrium is no longer detected.No new enhancing or T2 hyperintense lesions are demonstrated. Ill-defined periventricular T2 hyperintensity along the left lateral ventricle has not significantly changed. Ventricular size and morphology are unchanged.

Output: 1.Stable appearance of the resection cavity.2.Diminished ependymal enhancement along the frontal horns could represent response to treatment.3.No new lesions are detected.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with right hip pain. Evaluate for labral tear. ACETABULAR LABRUM: The labrum is intact and normal in appearance. ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits.SOFT TISSUES: The soft tissues are unremarkable. ADDITIONAL

Output: Normal evaluation of the right hip.