Instruction: Generate impression based on findings.

Input: 28-year-old female with persistent neck and occipital headaches, low back pain and gait difficulty Cervical spine: Mild kyphotic angulation at C5-6 which may be in part positional. Alignment is otherwise anatomic. There are no fractures or subluxations. The visualized intracranial and paraspinal contents are unremarkable. No cord signal abnormality. No abnormal enhancement. Mild degenerative changes are seen with individual levels as below:C2/3: No significant disc disease. No spinal canal or neural foraminal stenosis.C3/4: No significant disc disease. No spinal canal or neural foraminal stenosis.C4/5: No significant disc disease. No spinal canal or neural foraminal stenosis.C5/6: Small disc bulge. No spinal canal or neural foraminal stenosis.C6/7: Minimal disc bulge. No spinal canal or neural foraminal stenosis.C7/T1: No significant disc disease. No spinal canal or neural foraminal stenosis.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at mid L2.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Facet arthropathy at L4-5 and L5-S1. No abnormal enhancement in the lumbar spine.

Output: 1. No abnormal signal or abnormal enhancement in the cervical spine.2. No spinal canal or neural foraminal stenosis in the cervical spine or lumbar spine.3. Mild C5-6 disc bulge. 4. Facet arthropathy at L4-5 and L5-S1.


Instruction: Generate impression based on findings.

Input: There are no T2/FLAIR abnormalities. There is normal ventricular size with no midline shift. The basilar cisterns are patent. There are no evidence of acute ischemic or hemorrhagic lesion.MRA of the brain demonstrates normal internal carotid arteries, anterior cerebral arteries, middle cerebral arteries, and posterior cerebral arteries. Basilar and vertebral arteries are within normal limits. No evidence of flow-limiting stenosis or aneurysm.

Output: 1. No evidence for acute intracranial hemorrhage, ischemic stroke, mass effect, or edema. There are no abnormalities in the T2/FLAIR sequences.2. The MRA of the brain demonstrates no evidence of flow-limiting stenosis or aneurysm.


Instruction: Generate impression based on findings.

Input: Episodic neck swelling. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is no evidence of soft tissue edema in the neck. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. The cervical flow voids appear to be grossly intact.

Output: 1. No evidence of mass lesions or edema in the neck.2. The cervical flow voids appear to be grossly intact, although the assessment is limited. Consider a Doppler ultrasound for further evaluation of the neck vessels if clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 75 year old male with a history of coronary artery disease, status post CABG. Referred for cardiovascular MRI due to recent development of frequent non-sustained ventricular tachycardia. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is apical thinning with corresponding hypokinesis. There is also asymmetric basal and mid-septal hypertrophy, with a maximum thickness of 1.8 cm. There is no evidence of accelerated flow in the subvalvular outflow tract. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 146 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 69 g/m2 (normal range 85+/-15), and the LV mass is 136 g (normal range 164+/-36). There is extensive abnormal enhancement throughout the left ventricular myocardium, patchy in character within the hypertrophied segments. It is sub-endocardial and mid-mycoardial in mid inferior and inferoseptal walls, basal inferior and inferoseptal walls. This pattern is suggestive of hypertrophic cardiomyopathy.At the apical 1/4 of the lateral wall, there is additional high signal, linear in character and transmural, which may represent an infarct. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 127 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 50 ml (normal range 54+/-17).No abnormal enhancement of the RV free wall.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mild chordal SAM. No anterior motion of the anterior leaflet of the mitral valve is present. A small regurgitant jet is consistent with mitral regurgitation, not quantified, but visually appears trace. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with anomalous right subclavian artery. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsSternal wires are noted. Exophytic cystic lesion left hepatic lobe stable in size since 2006, at which time was characterized as a hemangioma. Stable left lateral outpouching at distal esophagus suggestive of diverticulum or hiatal hernia.

Output: 1. Left ventricular cavity is normal in size with mildly reduced systolic function (LVEF 53%). Asymmetric basal and mid-septal hypertrophy measuring up to 18mm. Extensive enhancement which is patchy and atypical for infarct. Mild chordal SAM. No anterior motion of the anterior leaflet of the mitral valve is present. A small regurgitant jet is consistent with mitral regurgitation, not quantified, but visually appears trace. The constellation of findings is suggestive of hypertrophic cardiomyopathy.Additional transmural gadolinium enhancement at the lateral apex, which is akinetic, raises a question of infarct. This may contribute to the low EF, not the typical hyperdynamic state for HCM. 2. Normal right ventricular size and systolic function (RVEF 60%). No RV enhancement.3. Aberrant right subclavian artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 48 years old with a cavernous sinus meningioma. Evaluate for change. Again seen is a smoothly marginated, T2 hyperintense, homogeneously enhancing lesion in the right cavernous sinus extending slightly into Meckel's cave on the right. It measures 17 x 14 mm (series 801, image 19) and is not significantly changed in size or appearance. The lesion again partially encases and displaces the right internal carotid artery anteriorly and causes bowing of the lateral wall of the cavernous sinus. There is no significant narrowing of the right ICA flow void. Remainder of the visualized brain parenchyma is unremarkable aside from few punctate foci of T2 hyperintensity in the white matter of the cerebral hemispheres which are unchanged and nonspecific. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal parenchymal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no abnormal extra-axial collection, midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stable size and appearance of enhancing right cavernous sinus lesion. The differential diagnosis includes meningioma, schwannoma and hemangioma.


Instruction: Generate impression based on findings.

Input: Status post surgery and radiotherapy for left carotid cancer (carcinoma ex pleomorphic adenoma with perineural invasion), with left neck pain and spasm. There are post-treatment changes related to the left parotidectomy and radiotherapy, which may account for the persistent signal abnormality within the left mandible bone marrow. However, there are no mass lesions in this region suggestive of residual/recurrent disease. There is no significant lymphadenopathy in the neck. There is a small right upper lip skin excrescence. The remaining salivary glands, nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. There are unchanged nodules within the thyroid. There is a carious tooth number 19. The imaged intracranial structures are orbits are unremarkable. There is anterior surgical fusion of C4-6 and degenerative spondylosis of the cervical spine.

Output: Post-treatment findings related to left parotidectomy and radiation with no evidence of measurable locoregional tumor recurrence of significant cervical lymphadenopathy, although the assessment is limited by the lack of intravenous contrast. Persistent signal abnormality within the left mandible bone marrow may be treatment-related, such as osteonecrosis.


Instruction: Generate impression based on findings.

Input: History of perianal pain. Evaluate for pouchitis or perianal disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post proctocolectomy with an ileal pouch anal anastomosis (J-pouch). The J-pouch is nearly completely collapsed making evaluation suboptimal. There is a 3.4 x 1.4 cm intrinsically T1 and T2 hyperintense collection in the pelvis which is inseparable from the right lateral aspect of the collapsed J-pouch which demonstrates subtle peripheral enhancement. Although this may represent fluid in the lumen of the collapsed pouch, a definite bowel wall along the right lateral aspect of this collection is not delineated and an intramural or peri-enteric fluid collection cannot be excluded. Alternatively, this may represent mild pouchitis.Non-specific subcentimeter focal outpouching of the left lateral aspect of the collapsed pouch is only seen on a series 4 image 32 and may represent a small ulceration or redundant collapsed bowel wall. There may be submucosal fat deposition in portions of the pouch wall, suggestive of prior inflammation. BONES, SOFT TISSUES: There is a very subtle enhancing tract extending from the anterior aspect of the anal canal (approximate 12:00 position) extending anteriorly and towards the left for approximately 2 cm, best appreciated on the restricted diffusion images (series 7 image 30 through 33) and postcontrast images series 9 image 155 through 146). This terminates tract terminate caudal to the aforementioned collection without a direct communication. The tract does not extend tot he perineal skin surface. OTHER: No significant abnormality noted.

Output: 1. Blind-ending sinus tract extending from approximately 12:00 o'clock position of the anal canal.2. Suboptimal evaluation of the J-pouch due to collapse. 3.4 x 1.4 cm intrinsically T1 and T2 hyperintense collection in the pelvis which is inseparable from the right lateral aspect of the collapsed J-pouch which demonstrates subtle peripheral enhancement. Although this may represent fluid in the lumen of the collapsed pouch, a definite bowel wall along the right lateral aspect of this collection is not delineated and an intramural or peri-enteric fluid collection cannot be excluded. Alternatively, this may represent mild pouchitis and adjacent inflammation. Relatively collapsed appearance of J-pouch may be secondary in part to chronic inflammation. Correlation with pouchoscopy findings is recommended. Additional imaging may include a fluoroscopic pouchogram and/or CT study to help delineate the anatomy as clinically indicated.


Instruction: Generate impression based on findings.

Input: Altered mental status and unsteady gait x 3 days. Rule out ICH, CVA. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is strong clinical concern for acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain. Mild ductal dilatation at outside hospital.Cholelithiasis. Abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: Mild fatty infiltration of the liver. No suspicious lesion identified. The hepatic and portal veins are patent. There is no intra or extrahepatic biliary ductal dilatation. Cholelithiasis, without evidence of cholecystitis.SPLEEN: Splenule present.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cholelithiasis, without evidence of cholecystitis. Mild fatty infiltration of the liver.


Instruction: Generate impression based on findings.

Input: 8-year-old male with facial tics and hemiballism-like movements. Evaluate for structural abnormalities. The bilateral hippocampal regions are symmetric. There is no evidence of gray matter heterotopia or cortical dysplasia. In particular, the caudate nuclei appear to be intact. There is no evidence of acute intracranial hemorrhage or mass effect. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. No evidence of seizure focus. 2. No evidence of intracranial hemorrhage or mass effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 36-year-old female. History of multiple fistula. Evaluate for multiple fistula tracts. PELVIS:UTERUS, ADNEXA: Retroverted uterus with intrauterine device. No uterine or adnexal masses.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: High T2 signal transsphincteric fistula tract likely arising from the 3 o'clock position of the anus with enhancement in the left perineal soft tissues tracking to the skin surface of the left inner gluteal cleft. No perirectal abscess. Minimal asymmetrically increased enhancement and thickening along a reflection in the left ischioanal fat extending towards the inferior edge of the obturator internus muscle.OTHER: No significant abnormality noted.

Output: Transsphincteric fistula tract likely arising from the 3 o'clock position of the anus going posteriorly into the left inner gluteal cleft. No evidence of an abscess.


Instruction: Generate impression based on findings.

Input: Possible increased intracranial pressure on eye exam: pseudopapilledema versus papilledema. There appears to be mild prominence of the bilateral optic nerve discs. Otherwise, there is no appreciable signal abnormality in the optic nerves. There is no evidence of intraorbital mass lesions. There is a right lens implant. There is mild volume loss of the partially-imaged brain.

Output: 1. Apparent mild prominence of the bilateral optic nerve discs, which likely corresponds to papilledema. No evidence of intraorbital mass lesions. 2. Mild volume loss of the partially-imaged brain.


Instruction: Generate impression based on findings.

Input: 64-year-old with right upper lobe adenocarcinoma presenting with acute lumbar pain since one week. Evaluate for metastasis, radiculopathy, or other acute changes. Five lumbar type vertebral bodies are present. There is loss of normal lumbar lordosis with mild convex leftward curvature of the lumbar spine centered at the L2-L3 level. Conus is in normal position at the upper L2 level.Multilevel degenerative changes are seen with significant loss of disc space at the L2-L3, L3-L4, L4-L5, and L5-S1 levels with prominent areas of subchondral sclerosis and cyst formation as well as vacuum disc phenomena better appreciated on recent abdominal CT. Bone marrow signal is heterogeneous. There is abnormal enhancement involving the L4 and L5 vertebral bodies which is favored to be on a degenerative basis. There is somewhat more suspicious enhancement involving the L1 vertebral body with a rounded area of enhancement measuring approximately 16 mm x 14 mm in the AP and craniocaudal dimensions. No evidence of compression fractures or epidural tumor.Individual levels as below:L1-L2: Minimal disc bulge and prominence of the epidural fat. No spinal canal or neural foraminal stenosis.L2-L3: Disc bulge eccentric to the right and prominence of the epidural fat. No spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis.L3-L4: There is disc bulge and prominence of the epidural fat with mild spinal canal stenosis. There is moderate right and minimal left neural foraminal stenosis.L4-L5: Disc bulge, prominence of the epidural fat, ligamentum flavum thickening, and facet arthropathy result in moderate spinal canal stenosis. There is moderate right-sided neural foraminal stenosis and severe left neural foraminal stenosis.L5-S1: Mild disc bulge and prominence of the epidural fat. No significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes throughout the lumbar spine. Bone marrow signal is heterogeneous with edema and enhancement involving the L4 and L5 vertebral bodies which is likely on a degenerative basis. There is a more rounded focus of enhancement involving the L1 vertebral body which is slightly suspicious and measures approximately 16 x 14 mm. Consider short-term follow-up MRI to assess for stability or bone scan for further evaluation. There is otherwise no definite evidence of metastatic osseous disease. No evidence of pathologic compression fractures or epidural tumor.2. Degenerative changes resulting in up to moderate spinal canal stenosis at the L4-L5 level. There is also moderate right and severe left neural foraminal stenosis at L4-L5. Additional levels as detailed above.


Instruction: Generate impression based on findings.

Input: Nonspecific left arm pain which according to the ordering team seems to be distinct from the joint. Note that the examination is limited by motion artifact as well as the lack of intravenous contrast secondary to patient refusal. Also note that the exam was not tailored for the evaluation of the shoulder or elbow.The marrow signal intensity of the humerus is normal aside from small degenerative cysts within the humeral head.There is mild nonspecific soft tissue edema along the rotator cuff musculature which could reflect a strain injury or mild inflammation. A small amount of fluid is noted within the glenohumeral joint but there is no large effusion. Edema also extends more distally between the short and long heads of the biceps to the level of the proximal humeral diaphysis. Distal to this area, this signal intensity of the musculature is normal.There is osteoarthritis of the elbow (as seen on prior CT) with a moderate joint effusion. A small lipoma is noted within the triceps musculature.

Output: 1. Limited exam secondary to motion and the lack of administered contrast secondary to patient refusal.2. Edema along the rotator cuff musculature which extends into proximal third of the biceps and upper arm. These findings are nonspecific but could reflect a strain injury or mild inflammation. If further evaluation of the rotator cuff is desired, MRI can be obtained.3. Osteoarthritis of the elbow with moderate-sized joint effusion.


Instruction: Generate impression based on findings.

Input: 51-year-old female with a history of multiple sclerosis presents with paresthesias, evaluate for progression. Please note that differences in technique and magnet strength slightly limits comparison with the prior study.MRI brain: There is a moderate degree of periventricular and subcortical white matter lesions as well as minimal corpus callosum lesions with some lesions perpendicularly oriented to the lateral ventricles. A prominent left cerebellar lesion is again identified. Overall the previously described lesions are stable, with slight increased size and conspicuity of some lesions. There is corresponding T1 hypointensity. There is no significant contrast enhancement associated with these lesions. No new lesions are identified.Normal vascular flow is present in the distal carotid and vertebral arteries, basilar artery, and the proximal anterior, middle, and posterior cerebral arteries. There is also normal vascular flow voids in the internal cerebral veins and superior sagittal sinus.There is a bony excrescence arising from inner table of the right parietal bone which is hyperintense on T1 and T2 and may represent a benign bony lesion such as an osteoma.MRI cervical spine: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. Minimal central disc protrusions are again noted in the mid-cervical spine. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. MRI thoracic spine: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. Again seen is a subtle area of T2 hyperintensity within the dorsal cord at the T6-T7 level. There is no pathological enhancement. No additional lesions are identified. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Mild T1 burden and moderate T2 burden of demyelinating disease within the brain, including involvement of infratentorial structures. Overall, findings are stable with only minimal progression of a few lesions.2. Stable appearance of nonenhancing T2 hyperintense demyelinating cord lesion at T6-T7 without new spinal cord lesions identified.


Instruction: Generate impression based on findings.

Input: 11 year old male with diffuse ankle pain following injury 7/2015. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The achilles tendon is normal in appearance. LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized portions of the deltoid ligament appear intact. ARTICULAR SURFACES AND BONE: There is a nondisplaced, slightly comminuted, but predominantly sagittally oriented fracture through the sustentaculum tali of the calcaneus, extending to the middle facet of the subtalar joint. Edema extends into the medial aspect of the body of the calcaneus. There are tiny foci of edema seen within the subarticular marrow of the head of the talus which perhaps represent small bone contusions. We see no osteochondral defect.ADDITIONAL

Output: Fracture of the sustentaculum tali of the calcaneus and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: Alzheimer's disease No abnormal signal is seen on the T2, FLAIR or diffusion weighted images. There is no evidence of intracranial hemorrhage, mass or edema. Since the prior exam, there has been mild interval increase in symmetric dilatation of the occipital and temporal horns of the lateral ventricles bilaterally as well as the third ventricle. The cortical sulci of the medial temporal lobes appear more prominent, predominantly in the region of the sylvian fissure and hippocampus, consistent with some interval volume loss.

Output: Progressive symmetric bi-temporal lobe atrophy, consistent with reported history of Alzheimer's dementia.


Instruction: Generate impression based on findings.

Input: There is a mass in the right temporoparietal lobe measures 4.0 x 4.5 cm in transaxial view and approximately 3.1 cm in craniocaudal view. There is a surrounding vasogenic edema with mass effect and compression of the right frontal horn, right occipital horn and the right temporal horn. There is also compression of the brainstem, and the edema extends to the right basal ganglia, right external capsule and the right cerebral peduncle. There is approximately 3.6 mm leftward midline shift. The mass has heterogenous T2/FLAIR hyperintensity with faint central T1 hypointensity associated with restricted diffusion and has homogenous thick peripheral enhancement. The center of the mass is not enhancing suggestive of central necrosis. There is right-sided uncal herniation.In addition, there is a small satellite enhancing lesion in the right temporal lobe that measures 8 x 8 mm in transaxial view and 7 mm in craniocaudal view with no definite edema that surrounds this mass. However, in the right aspect of these enhancing lesion there is a confluent edema that is contiguous with the edema over the large mass.There is no evidence of hemorrhage.

Output: 1.There is a mass centered in the right temporal lobe associated with mass effect and uncal herniation which has a necrotic appearance. It is associated with a small satellite lesion in the right temporal lobe. Differential considerations include primary neoplasm of the brain as well as metastatic disease.2.Right-sided uncal herniation.


Instruction: Generate impression based on findings.

Input: Female 55 years old; Evaluate for bursitis or gluteal muscle tears around the right hip. Severe pain for years (since 2005) near the greater trochanter, with acute worsening in the past 4 months. The examination is limited by lack of complete series of sequences as the patient was not able to tolerate positioning. Moderate osteoarthritis affects the right hip. There is diffuse thinning of the articular cartilage superiorly and focal full thickness degeneration anteriorly with associated cyst formation at the anterior acetabular dome. Additional edema type signal within the acetabular dome is likely reactive though the possibility of a stress reaction is also considered. We see no discrete fracture line. There is suspicion of an incomplete tear of the anterior superior labrum; however, the labrum is not fully visualized due to the aforementioned limitations of the study. The ligamentum teres is intact. Small amount of fluid and/or synovitis is present in the right hip. The gluteal musculature appears normal, as does the remaining musculature of the right hip. We see no gluteal muscle tear. Minimal edema type signal is present along the posterior aspect of the greater trochanter at the gluteus medius insertion, which is of questionable clinical significance and may be seen in asymptomatic patients. Similar, if not more prominent, edema type signal is present on the left, which is also of questionable clinical significance. A small focus of increased signal at the ischium along the origin of the right hamstring muscles may indicate a small tear, however, this may also be seen in asymptomatic patients. More prominent signal abnormality is present on the left at the hamstring origin and may also reflect prior tearing, not necessarily of any current clinical significance.Moderate osteoarthritis affects the pubic symphysis. Mild osteoarthritis affects the left hip. A small amount of fluid signal at the anterior aspect of the left acetabulum may perhaps be in the iliopsoas bursa, though a paralabral cyst is also a possibility. Severe degenerative disk disease affects the L4/5 level. Sacralization of L5 is again seen. Moderate facet joint hypertrophy is present in the lower lumbar spine with spinal stenosis, which may be better evaluated with dedicated lumbar spine MRI, if clinically warranted.

Output: 1. Osteoarthritis of the right hip, as above. Edema within the acetabular dome is probably degenerative in etiology, although a stress reaction is also considered. Degenerative changes of the left hip, pubic symphysis, and lower lumbar spine.2. No findings suggestive of gluteal muscle tear or frank bursitis. Minimal edema type signal along the greater trochanters bilaterally is not necessarily of any clinical significance. 3. Additional findings, as above.


Instruction: Generate impression based on findings.

Input: 85-year-old female with severe back and leg pain for one month with new fever and chills since 9/10/2015, elevated inflammatory markers. There is diffuse areas of fat signal in the lumbar and sacral vertebrae, but no evidence of edema or abnormal enhancement to suggest acute osteomyelitis. There is enhancement within the L4-5 disc space centrally, where there is associated herniation into the L4 vertebral body (Schmorl node). There is also enhancement in the L3-4 disc space centrally. The vertebral column alignment is within normal limits. There are multilevel mild endplate concavities. There is mild multilevel degenerative spondylosis, but no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The facet joints show no excessive fluid or gross erosive change. The paravertebral soft tissues are unremarkable. However, there are small left renal cysts and the infrarenal aorta is mildly enlarged, measuring between 25 and 30 mm in width.

Output: 1. No evidence of lumbosacral osteomyelitis.2. Nonspecific enhancement in the L3-4 disc space may be degenerative in nature, as is the case at the L4-5 level, where there is an associated Schmorl node. 3. Diffuse fatty marrow signal may be indicative of osteopenia.4. No evidence of epidural collections or significant spinal canal stenosis.5. The infrarenal aorta is mildly enlarged, measuring between 25 and 30 mm in width.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is straightening of the thoracic kyphosis along with mild dextrocurvature of the thoracic spine. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is mild prominence of the central canal in the mid upper thoracic cord, but no evidence of a discrete syrinx or other gross cord signal abnormality within the limitations of motion degradation. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1.Mild straightening and mild dextrocurvature of the thoracic spine. These findings can be further evaluated with standing radiographs as clinically warranted.2.No significant disc disease, spinal canal, or neural foraminal stenosis.3.Moderately motion degraded study.


Instruction: Generate impression based on findings.

Input: Pregnant state, invasive cervical cancer PELVIS:UTERUS, ADNEXA: Heterogeneous enhancing rounded soft tissue mass visualized at level of cervix measuring 4.4 cm in the transverse dimension by 4 cm x 2.7 cm in the sagittal plane, centered in anterior wall with associated luminal narrowing, small intracanal fluid seen beyond this level inferiorly, element of obstruction present with pooling of fluid seen posteriorly, in presacral region. BLADDER: Underdistended bladder. LYMPH NODES: No pathologically enlarged adenopathy seen. BOWEL, MESENTERY: Cervical mass abuts rectum, image 20 series 6, no proximal bowel dilatation or evidence of bowel obstruction present. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small pelvic free fluid. Incompletely imaged intrauterine pregnancy with anteriorly located placenta, please note that this exam does not serve as a sufficient anatomic survey of the fetus.

Output: 1. Heterogeneous enhancing partially obstructing cervical mass, compatible with patient's history of cervical malignancy, mass abuts rectum.


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of sinusitis, sleep apnea and left-sided weakness. There is no evidence of intracranial hemorrhage, mass or edema. Scared foci of low density in periventricular, subcortical and deep white matter are seen. These foci are compatible with the findings from the recent MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.SINUS

Output: 1. No evidence of sinus disease.2. Scattered low density foci are compatible with the findings of the recent brain MRI and likely represent small vessel ischemia.


Instruction: Generate impression based on findings.

Input: Transphenoidal for pituitary adenoma: surveillance. There are postoperative findings related to transsphenoidal surgery. There is enhancing tumor within the sella, with extension into the right cavernous sinus and encasement of the internal carotid artery. The tumor measures up to 20 mm in height, 22 mm in length, and 21 mm in width. The pituitary stalk is intact, but deviated to the left. There is T2 hyperintensity and volume loss in the optic chiasm, but no mass effect upon the optic apparatus by the tumor. Rather, the supraclinoid right internal carotid artery segment abuts the prechiasmatic right optic nerve. The previously demonstrates sinonasal fluid has cleared, with residual small retention cysts in the bilateral maxillary sinuses. There are nonspecific scattered foci of T2 hyperintensity in the bilateral cerebral white matter.

Output: Residual pituitary tumor with extension into the right cavernous sinus and encasement of the internal carotid artery, as well as evidence of chronic neuropathic changes in the optic chiasm.


Instruction: Generate impression based on findings.

Input: Cervical cancer PELVIS:UTERUS, ADNEXA: 2.3 x 1.1 x 1.5 cm enhancing cervical mass demonstrating intermediate T2 signal, previously 2.5 x 3.3 x 3.8 cm. No evidence of parametrial, bladder, rectal, or vaginal invasion. The ovaries are not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Decreased size of the known cervical carcinoma.


Instruction: Generate impression based on findings.

Input: Female, 75 years old, with history of right nasal pharyngeal carcinoma, status post treatment with radiation and chemotherapy. Please note that fat-suppressed images are degraded in the region of the nasopharynx. The non-fat suppressed images, both T1 and T2, are of adequate quality.Since the prior examination, progressive thickening and surface irregularity is seen along the midline and right nasopharynx (see image 24 through 26 of series 1201). The tissue in question is of low signal on T2-weighted images and does not enhance suggesting a fibrous component. In association with this, progressive T1 hypointense marrow replacement is seen involving the basal clivus, the anterior arch and lateral masses of C1. The dura along the basal clivus may also be slightly thickened.Enhancement is seen within the right muscles of mastication but without any discrete masslike process. Elsewhere, there is mild aerodigestive mucosal edema likely related to prior therapy. No definite evidence of pathologic adenopathy is seen. One or two slightly prominent right level Ib lymph nodes have not significantly changed from prior. The salivary glands and thyroid are unremarkable. Patchy fluid signal is seen in the right mastoid air cells similar to prior. Lobular mucosal thickening in the maxillary sinuses has progressed at least on the right.Except as above, marrow signal characteristics are within normal limits. Cervical spondylosis is again seen with reversal of the lordosis and disc osteophyte disease from C4 through C6 resulting in at least mild spinal canal narrowing.

Output: 1.Since the prior examination, the midline and right nasopharyngeal soft tissues have thickened and become irregular in contour. This tissue is of low signal on T2-weighted images and does not enhance. In association, there is new marrow replacement involving the inferior clivus, anterior arch and lateral masses of C1. Findings are concerning for progressive tumor with osseous involvement. The possibility of a treatment related effect can also be considered, though the appearance is atypical for this. Direct visual inspection is highly recommended.2.New enhancement within the right masticator space is seen without any frank masslike lesion. This finding is nonspecific and could simply represent treatment related inflammation.3.No definite pathologic adenopathy is seen in the neck.


Instruction: Generate impression based on findings.

Input: A 48 year old female with personal history of hear failure (LVEF of 34%), high degree atrio-ventricular block with a dual-chamber pacemaker, mixed autoimmune disorder, diabetes mellitus. Referred to cardiac MRI for further evaluation. Left VentricleImage quality limits ability to determine LV volumes and LV EF. LV EF is visually moderately reduced. Delayed enhancement images are technically challenging, however there is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleImage quality limits ability to determine RV volumes and RV EF. RV EF is visually mildly reduced.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely aortic regurgitation could not be evaluated.Mitral ValveThe mitral valve opens widely and there is no obvious mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no obvious tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. There are pacemaker leads in the SVC.PericardiumThere is no pericardial effusion. There is pericardial fat..Extracardiac FindingsThere is a pacemaker in the anterior left chest. 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. Image quality limits ability to determine LV volumes and LV EF. LV EF is visually moderately reduced. 2. Delayed enhancement images are technically challenging, however there is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process3. Image quality limits ability to determine RV volumes and RV EF. RV EF is visually mildly reduced.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49-year-old female with lupus.Reason: SLE pt with thyroid enlargement, history of nodule. RIGHT LOBE MEASUREMENTS: 6.5 x 3.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 6.7 x 3.0 x 2.1 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Hypoechoic nodules again noted. The reference anechoic nodule near the isthmus measures 0.7 x 0.7 x 0.4 cm, unchanged.LEFT LOBE: Small hypoechoic lesions are stable. The reference slightly complex lesion in the superior pole measures 0.9 x 0.8 x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. Small lymph nodes again noted.OTHER: No significant abnormality noted.

Output: Stable examination. Previously described nodules appear unchanged.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:1/25/1961)Reason: tumor? Malformation? History: new onset persistent headache in a man at 55PROVIDER/ATTENDING NAME: HELENE G RUBEIZ HELENE G RUBEIZ The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of cavum septum pellucidum and cavum vergae.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.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Reason: Right knee pain, evaluate for meniscus tear vs chondral injury History: right knee pain MENISCI: There is increased signal abnormality within the anterior horn of the lateral meniscus which extends to the tibial articular surface which likely represents a combination of prior tearing and postsurgical changes from prior partial meniscectomy, appearing similar to the prior study. No fluid-filled tear is evident. There is deformity of the posterior horn of the lateral meniscus appearing similar to the prior study, also likely representing a combination of prior tearing and postsurgical change from prior partial meniscectomy. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is decreased signal abnormality within the articular cartilage along the anterior aspect of the medial femoral condyle which may represent partial thickness articular cartilage degeneration or an articular cartilage cleft. There is a partial thickness articular cartilage defect along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus. No full-thickness articular cartilage defects are identified. Note is made of multiple foci of decreased signal abnormality within the femoral diaphysis likely representing bone islands.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Deformity and increased signal abnormality within the lateral meniscus which likely represents a combination of prior tearing and postsurgical change. No fluid-filled tear is evident.


Instruction: Generate impression based on findings.

Input: Clinical question: Thunderclap headache. Signs and symptoms: Transient loss of focus while driving and thunderclap headache. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates scattered confluent and punctate foci of FLAIR/T2 hyperintensity in bilateral subcortical and periventricular white matter as well as minimally in the bilateral basal ganglia. Findings although nonspecific considering the stated age of 75 this appearance is often represent chronic microvascular ischemic changes. There is mild prominence of the supratentorial ventricular system which could at least be partially secondary to underlying parenchymal volume loss.The cerebral cortex and cortical sulci as well as CSF spaces unremarkable and there is no deviation of midline.No detectable abnormal parenchymal or leptomeningeal enhancement on post enhanced series.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are unremarkable and with normal pattern of enhancement.Unremarkable images through the orbits.Mild diffuse chronic sinus disease is noted. An 8 mm round T2/FLAIR hyperintensity lesion in the midline of superior nasopharynx suggestive of a benign Tornwaldt cyst is detected.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Findings of a without and with the procedure he cannot go for the wording of caliber abnormality is identified at the level of medicine moderate chronic nonhemorrhagic small vessel ischemic strokes in the supratentorial brain parenchyma.3.8 mm benign Thornwaldt cyst and mild diffuse chronic sinusitis as detailed above.


Instruction: Generate impression based on findings.

Input: BRAIN: There are posttreatment findings related to prior embolization and radiosurgery of a left hippocampal / thalamic arteriovenous malformation that appears to be fed by the left posterior cerebral artery. There is persistent T1 hyperintensity and susceptibility effect within the lesion compatible with blood products. There is however decreased surrounding T2 hyperintensity within the left hippocampus and posterior thalamus compatible with decreasing edema. 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. The skull and scalp soft tissues are unremarkable. There is mild paranasal sinus mucosal thickening.MRA HEAD: There is unchanged flow related signal within the lesion arising from the left posterior cerebral artery. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis.

Output: Decreased edema surrounding the treated left hippocampal / thalamic arteriovenous malformation that appears otherwise unchanged.


Instruction: Generate impression based on findings.

Input: Left knee pain and swelling, microfracture surgery MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is thickening and increased signal intensity of the articular cartilage of the lateral patellar facet. While this may in part reflect changes of prior microfracture, we suspect that this is primarily degenerative, as there also appears to be delamination of the cartilage and relative thinning of the articular cartilage along the facet inferiorly with additional fissuring. There is also a full-thickness defect along the medial facet of the patella inferiorly. Subjectively, femoral trochlea appears shallow suggesting some dysplasia. The articular cartilage of the lateral and medial compartments is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The patella and quadriceps tendons are intact. There is thickening of the lateral retinaculum at its attachment upon the patella which appears similar to the contralateral side. ADDITIONAL

Output: Articular cartilage degeneration of the patella as described above.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with history of metastatic breast cancer, lesion seen in the right cerebellar hemisphere on head CT from 11/30. Post contrast images are degraded by motion artifact. Nevertheless, the finding in the right cerebellum as demonstrated on prior CT is visualized as a smudgy area of enhancement. On review of a prior CT angiogram from 2015, a developmental venous anomaly is evident in this location. There is no edema in the surrounding parenchyma to suggest that this may represent a metastatic lesion.No additional intracranial enhancing lesions are appreciated within the limitation of motion artifact. Parenchymal T2 hyperintensity and encephalomalacia is evident in the right inferior frontal lobe. There is also a slitlike area of encephalomalacia involving the right basal ganglia with mild ex vacuo dilatation of the right frontal horn. Findings are seen compatible with prior right frontal approach instrumentation.No evidence of active parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Except as above, the ventricular system is within normal limits. Ectasia and tortuosity of the right proximal MCA were better appreciated on prior studies.

Output: 1.Findings in the right cerebellum most likely representing a developmental venous anomaly.2.No definite evidence of intracranial metastatic disease is seen.3.Areas of encephalomalacia involving the right basal ganglia and inferior frontal lobe may reflect prior ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with back pain, leg weakness and incontinence. Assess for cord compression. No evidence of significant spinal canal stenosis or cord compression is seen. A mild narrowing of the spinal canal is seen at the L5 level secondary to facet and ligamentum flavum hypertrophy.Multiple areas of marrow replacement are seen within the spine including the C7, T9, T12 and L4 vertebral bodies. None of these lesions appears to extend into the epidural or paraspinal spaces. There is no significant loss of vertebral body height allowing for concavity of the inferior T12 endplate which may be degenerative in nature.

Output: 1.No evidence of acute cord compression or any other areas of high-grade spinal canal stenosis.2.Areas of marrow replacement are seen within several vertebral bodies compatible with metastatic disease. There is no significant associated epidural or paraspinal disease spread. If clinical concern warrants, findings can be further assessed with dedicated contrast-enhanced spine imaging.


Instruction: Generate impression based on findings.

Input: Myelopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild straightening of the cervical spinal curvature. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild developmental narrowing of the mid cervical spine. There are mild superimposed degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge. Minimal narrowing of the left neural foramen. No significant compromise to the spinal canal or right neural foramen.C5-6: Minimal disc bulge eccentric to the right. Mild left neural foraminal stenosis. Minimal right neural foraminal narrowing.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: There is developmental narrowing of the mid cervical spinal canal with mild superimposed degenerative changes including minimal disc bulges at C3-C4, C4-C5, C5-C6. There is no high-grade spinal canal or neural foraminal stenosis at any level. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Reason: 49 y/o with headache with left weakness numbness, r/o stroke vs mass History: headache, left arm anda leg weakness 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 demonstrate couple minor mucous retention cysts in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for ischemic stroke, hemorrhage or intracranial mass. No lesions which would explain the patient's symptoms are appreciated.


Instruction: Generate impression based on findings.

Input: Low back and bilateral leg pain. There is a central disc extrusion at L4-5 with associated impingement of the bilateral descending nerve roots in the lateral recesses. There is no significant disc herniation at the other levels of the lumbar spine. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Central disc extrusion at L4-5 with associated impingement of the bilateral descending nerve roots.


Instruction: Generate impression based on findings.

Input: 36 year old with history of hypertension and lymphoma s/p chemotherapy presenting with acute onset back and chest pain. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 214 ml (normal range 109+/-23), the LV end systolic volume index is 56 ml/m2 (normal range 18+/-5), the LVESV is 125 ml (normal range 31+/-10), the LV mass index is 71 g/m2 (normal range 67+/-11), and the LV mass is 159 g (normal range 114+/-24). The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly enlargedRight VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 145 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern. The aortic root, ascending aorta, aortic arch and descending aorta are normal in size. There is no evidence of large dissection present (study not optimized to definitively rule out aortic dissection). 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 FindingsMediastinal lymph nodes present. Breast nodule, likely a benign "oil cyst". 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 mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 42%. The left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%. 3. The aortic root, ascending aorta, aortic arch and descending aorta are normal in size. There is no gross evidence of aortic dissection present in the thoracic aorta (study not optimized to definitively rule out aortic dissection).


Instruction: Generate impression based on findings.

Input: 78-year-old man with history of prostate cancer. Additional history as per chart: PSV of 4 ng/mL in 2013, status post biopsy demonstrating Gleason 6 prostate cancer. PELVIS:PROSTATE:Prostate Size: 52 x 33 mmPeripheral Zone: Two areas of low T2 and ADC signal are seen: A 9 x 9 mm focus in the midline anterior apical transition zone (series 901, image 8) and a 6 x 6 mm focus in the left mid-gland posterior peripheral zone (series 901, image 17).Central Gland: Hypertrophied with BPH nodules.Seminal Vesicles: The seminal vesicles are not invaded.Extracapsular Extension: There is questionable extraprostatic spread of the apical lesion.BLADDER: The bladder appears thick-walled and trabeculated.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two suspicious foci in the prostate gland as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out hemorrhage. Signs and symptoms: Post op. Nonenhanced CT of brain:Examination demonstrates expected postoperative changes of left suboccipital craniotomy. There is minimal residual fluid and air under the craniotomy flap, minimal residual air within the subarachnoid space in both supra-and infratentorial space. Minimal punctate high density at the expected level of the left foramina of Luschka is noted. There was tumor at this site on prior exam. This findings has the appearance of calcification and or hemorrhage which may be a postop change or represent residual tumor. This finding measures approximately 7 mm times 14-mm in size and should be further followed with an MRI examination. Subtle mass effect on the fourth ventricle with minimal deviation to the right is similar to prior study. There is no evidence of any opacification of mastoid air cells although the craniotomy line traverses the posterior mastoid air cells. Middle ear cavities are well pneumatized and unremarkable. A retention cyst within the left chamber of the sphenoid sinus is noted.

Output: 1.Expected postoperative changes of left suboccipital craniotomy for removal of left cerebellopontine angle tumor.2.Suspect small residual tumor in the left cerebellopontine angle and follow-up with an MRI is recommended.3.No evidence of acute hemorrhage or cerebral edema.


Instruction: Generate impression based on findings.

Input: The bilateral cerebral convexity subdural fluid collections have resolved with mild interval re-expansion of the ventricles. There is no evidence of acute intracranial hemorrhage or acute infarct. There are no areas of abnormal parenchymal signal and the myelination is appropriate for age. There is no midline shift or herniation. The major cerebral flow voids are intact. The midline structures and craniocervical junction are within normal limits.

Output: Interval resolution of the bilateral cerebral convexity subdural fluid collections with re-expansion of the ventricles.


Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:7/28/1940)Reason: TIA workup History: TIAPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.There are a couple periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Given their small number they are likely of little clinical significance.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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. The right eye lens is thin.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 small. The posterior communicating arteries are very small.. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The origin of the left vertebral artery and the origin of the left subclavian artery were no included on this exam.

Output: 1.No evidence for intracranial or extracranial cerebrovascular occlusive disease.2.The origin of the left vertebral artery and the origin of the left subclavian artery were no included on this exam.3.No evidence for cerebral infarction or intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 79-year-old female with history of chronic ankle pain. TENDONS: There is fusiform thickening of the Achilles' tendon compatible with moderate tendinosis. Signal abnormality within Kager's fat pad likely represents edema and scarring. There is extensive tearing of the tibialis posterior tendon including a large longitudinal tear that extends along nearly the entire length of the visualized tendon as well as from the anterior surface to the posterior surface indicating a complete longitudinal tear. The tibialis posterior tendon is markedly thinned posterior to the medial malleolus, but we see no full-thickness transverse rupture at this time. There is thickening of the tendon at its insertion. There is a small amount of fluid within the flexor hallucis longus tendon sheath posterior to the talus as well as proximal and distal to the knot of Henry which may represent tenosynovitis. The peroneal tendons appear intact. There is a small amount of fluid adjacent to the tibialis anterior tendon as it courses anterior to the distal tibia indicating mild tenosynovitis.LIGAMENTS: The anterior talofibular ligament is thinned, but otherwise intact. The calcaneofibular and posterior talofibular ligaments are intact. The distal syndesmotic ligaments are unremarkable. The visualized portions of the deltoid ligament are intact. The spring ligament is thickened, but there is no discrete tear identified.ARTICULAR SURFACES AND BONE: There is multifocal bone marrow edema within the head, neck, and body of the talus, the medial aspect of the tibial plafond, the anterior aspect of the distal fibula, and the anterior process of the calcaneus. This finding is nonspecific and may be degenerative in etiology, represent a stress reaction or bone contusion, or a combination of the above. There is a small amount of fluid within the tibiotalar and talonavicular joints, which is nonspecific. There is mild diffuse edema of the subcutaneous fat around the ankle. Signal abnormality within the heel pad is also nonspecific but may represent callus, although we see no signal abnormality in the underlying bone to suggest acute osteomyelitis. Mild osteoarthritis affects the ankle and midfoot.

Output: 1.Soft tissue swelling with extensive tearing of the tibialis posterior tendon and mild tendinosis of the Achilles' tendon as well as findings compatible with tenosynovitis of the tibialis anterior and flexor hallucis longus tendons.2.Mild thickening of the spring ligament, but the fibers appear intact.3.Multiple foci of bone marrow edema type signal which are nonspecific and may be degenerative in etiology or represent bone contusions/stress reactions or a combination of the above.4.Mild osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: Hearing loss and developmental delay. Brain: 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.Interval Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or ventriculomegaly. 2. No evidence of cochlear nerve deficiency or internal auditory canal tumors.


Instruction: Generate impression based on findings.

Input: Evaluate hyperintensity seen on MR neck. T1N2b right hypopharyngeal SCC diagnosed in 2/2013 s/p radical right neck dissection and adjuvant cis/RT from 5/2013-7/2013. Right posterior neck recurrence in 9/2013 s/p right posterior neck dissection was performed in 12/2013 c/w well differentiated SCC, with second skin recurrence in right supraclavicular region s/p neck dissection with positive margins on 4/22/2014. Neck: There are postoperative findings related to right neck dissection with no significant change in diffuse enhancement in the right lower neck subcutaneous tissues and paraspinal muscles. Likewise, there is mild ill-defined diffuse hypopharyngeal swelling and enhancement. These findings are most likely treatment related. There is no discrete measurable mass lesion or significant lymphadenopathy in the neck. Please refer to separate CT report for findings in the chest.The thyroid and major salivary glands appear unchanged. The right internal jugular vein appears to have been scarified. The other major cervical flow voids appear to be grossly intact, with a left sided central venous catheter in position. The osseous structures are unchanged with T1 hypointensity involving the inferior C5 vertebral body on the right unchanged and likely on a degenerative basis. There is minimal mucosal thickening involving the paranasal sinuses. Tiny left maxillary mucous retention cyst. Mastoid air cells are clear.Brain: No intracranial mass or mass-effect. There is mild diffuse enhancement of the dura along the left frontoparietal convexity. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with advanced chronic small vessel ischemic disease. Major flow-voids are preserved. There is global parenchymal volume loss. Sella and orbits are grossly within normal limits. Diffuse T1 shortening involving the bone marrow compatible with prior radiation treatment.

Output: 1. No significant change in diffuse enhancement in the right lower neck subcutaneous tissues and paraspinal muscles, which is likely related to prior surgery and radiation treatment. No discrete mass or significant lymphadenopathy in the neck to suggest disease recurrence. 2. T2/flair hyperintensity in the bilateral periventricular and subcortical white matter is nonspecific but most consistent with moderate chronic small vessel ischemic disease.3. Mild smooth thickening and enhancement of the left frontoparietal dura which is nonspecific and may be related to prior surgery, radiation to the area, or possibly remote prior subdural hematoma, for example. Unlikely to represent neoplastic etiology.


Instruction: Generate impression based on findings.

Input: 39-year-old female with history of right pre-auricular area mass. Please evaluate. Examination demonstrates no definitive evidence of any masses or pathologic adenopathy of the the soft tissues of the neck. The parotid glands appear prominent bilaterally however may be minimally larger on the right side. The density and morphology of the parotid glands however remain within normal limits. No definite evidence of any masses is detected. This area is somewhat obscured by artifact from the mandible. If clinical concern for tumor exist an MRI examination is highly recommended.The bony density of the area of the exam remains essentially unremarkable for any pathology.

Output: 1.No definitive evidence of any masses or pathologic adenopathy in the neck.2.If clinical concern persist an MRI examination is highly recommended.3.4.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with recent history of worsening mental status, impulsivity, poor concentration and headaches. No evidence of restricted diffusion is seen. There are numerous scattered foci of T2 hyperintensity in the cerebral white matter. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collections are seen. Ventricular size and morphology are within normal limits. The volume of the brain is within normal limits. Marrow signal characteristics are unremarkable.

Output: 1.No acute abnormalities or other specific findings which would account for the patient's symptoms.2.Multiple scattered foci of signal abnormally are seen, a nonspecific finding which statistically most likely represents chronic small vessel ischemic disease. However, the differential would include sequelae of migraine headache, demyelination and vasculitis among other possibilities.


Instruction: Generate impression based on findings.

Input: Diagnosis: Sleep disturbance, unspecifiedClinical question: seizuresSigns and Symptoms: seizures 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 demonstrate some mucosal thickening in the frontal sinuses opacification of the right maxillary sinus, air-fluid level in the left maxillary sinus associated with mucosal thickening, opacification of the anterior and middle ethmoid air cells and hypoplastic sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are no abnormal mass lesions appreciated within the brain parenchyma to account for the patient's seizures.2.Exam is degraded due to motion artifact which may obscure more subtle abnormalities3.There is an air-fluid level in the left maxillary sinus. The possibility of acute sinusitis cannot be excluded.


Instruction: Generate impression based on findings.

Input: 16-year-old female with single thyroid nodule. Evaluate. RIGHT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.6 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The right thyroid lobe is normal in echogenicity without evidence of nodules.LEFT LOBE: The left thyroid lobe is normal in echogenicity. In the inferior left thyroid lobe, there is an anechoic focus with thin wall measuring 0.4 x 0.2 x 0.3 cm and internal foci of increased echogenicity. No increased vascular flow to this lesion is present.ISTHMUS: The isthmus is normal in echogenicity without evidence of nodules.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered benign-appearing subcentimeter lymph nodes.OTHER: No significant abnormality noted.

Output: Findings consistent with subcentimeter left thyroid lobe colloid cyst.


Instruction: Generate impression based on findings.

Input: 52-year-old female with worsening left shoulder pain over the last few months. ROTATOR CUFF: There is a full-thickness tear of the anterior fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring 12 mm in the AP dimension associated with minimal retraction. There is thickening and increased intermediate signal abnormality affecting the supraspinatus tendon consistent with moderate tendinosis. The supraspinatus muscle appears intact. Infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small to moderate amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study. Mild degenerative changes affect the glenohumeral joint including minimal osteophyte formation.BICEPS TENDON: The tendon of long head biceps appears intact. ADDITIONAL

Output: Full-thickness tear of the rotator cuff, as described.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: Interval mild to moderate progression of the previously identified medial meniscal abnormality observed on the anterior aspect and junction between the body and posterior horn (image 21 series 4). Increased ghosting and poor visualization of the meniscus without discrete linear components correlate with suspected continued degeneration. Lateral meniscus remains intactARTICULAR CARTILAGE AND BONE: Progressed and now moderate degenerative changes are observed with increased cartilaginous loss more pronounced than medial compartment with increased thinning. Interval development of new subchondral cysts are now preserved the medial aspect of the medial tibial plateau. The undersurface of the patella is otherwise similar with mild fraying and previously described minimal fissuring.Marrow signal remains essentially otherwise unremarkable.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Progressing and now moderate osteoarthritic changes with increased degeneration of the posterior body and horn of the medial meniscus, as described.


Instruction: Generate impression based on findings.

Input: 39-year-old woman with history of abdominal pain and diarrhea, evaluate for chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: There is agenesis of the dorsal pancreas with normal appearance of the ventral pancreas parenchyma. Mild, generalized diffusion restriction within the remaining pancreatic parenchyma is noted without secondary signs of inflammation or loss of normal parenchymal lobulations.The pancreatic duct is not well visualized on MRCP images, however on the venous postcontrast images (series 1205) the pancreatic duct is seen and nondilated. Exocrine function appears normal on post-secretin images (1901).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace bilateral pleural effusions.

Output: 1.Dorsal pancreatic agenesis with normal post-secretin exocrine response.2.Pancreatic duct not well visualized, but without gross abnormality and nondilated on the venous phase images.


Instruction: Generate impression based on findings.

Input: Reason: Rule out stroke History: Gait change MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These have accumulated more since the prior exam.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.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. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Periventricular and subcortical white matter changes of a mild degree have increased in number over the past 10 years. they are nonspecific. At this age they are most likely vascular related. 2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: 19-year-old female runner with right leg pain. Bone marrow signal intensity within the right tibia and fibula is normal. No periosteal edema to suggest a stress reaction. The musculature of the right leg is normal. Tiny focus of increased signal intensity is noted within the proximal left tibial diaphysis on the large field-of-view images. This is nonspecific although could conceivably represent a stress reaction but may represent normal vascular blush.

Output: 1.No evidence of stress fracture or stress reaction of the right leg.2.Tiny focus of increased signal within the proximal left tibial diaphysis is nonspecific and may represent normal vascular blush although could conceivably represent a stress reaction.


Instruction: Generate impression based on findings.

Input: 31-year-old female with pelvic mass. PELVIS:UTERUS, ADNEXA: Round, well-circumscribed mass with smooth borders demonstrating mildly heterogeneous T2 signal and homogeneous enhancement in the expected location of the uterus, presumably due to a uterine fibroid and measuring up to 8.3 x 7.5 cm (series 8/17); this mass is mildly increased in size since prior study in 2012. Again, this mass compresses the bladder and rectum. Uterine parenchyma is not well visualized, suggesting severe atrophy of unclear etiology given the patient's age. Both ovaries are not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple bony exostoses with the largest extending from the left iliac wing, not significantly changed. Multiple nonspecific small sclerotic lesions in the visualized bones are not significantly changed since prior exam. A lesion within the superior left femoral head has mildly increased in size since prior study, and this lesion may be related to degenerative arthritic change (series 3/23).OTHER: Extensive artifact involving the lower lumbar spine and sacrum from orthopedic hardware.

Output: 1.Well-circumscribed pelvic mass is presumably a uterine fibroid and has mildly increased in size since 2012.2.Severe atrophy of the uterus and nonvisualization of both ovaries, as described above.3. Multiple nonspecific small sclerotic lesions are not significantly changed aside from mild increase in a superior left femoral head lesion, which may be degenerative in etiology. In light of the patient's extensive cancer history, bone scintigraphy may be helpful for further characterization if there is clinical concern for osseous metastatic disease.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology with the conus terminating at L1. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable.L1-L2: Unremarkable.L2-L3: Unremarkable.L3-L4: Unremarkable.L4-L5: There is disc desiccation mild disc height loss, and a mild disc bulge with a small superimposed central disc protrusion. There is no significant spinal canal or neural foramen stenosis.L5-S1: Unremarkable.

Output: 1.No evidence of intraspinal mass or abnormal enhancement.2.Mild degenerative changes at L4-L5 without significant spinal canal or neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: 70-year-old female with altered mental status. Evaluate for stroke or central nervous system infection. The patient has hypertension at baseline and was reported to have had a episode of hypotension prior to presentation. There are multifocal punctate areas of restricted diffusion involving the bilateral MCA territories with the largest in the left centrum semiovale and right frontal lobe. Additional examples of small foci are located in the posterior periventricular parietal regions and right medial cerebellar hemisphere. There are underlying patchy T2 signal abnormalities which are nonspecific but most likely represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass effect, midline shift, hydrocephalus or herniation. The post-contrast sequences are severely limited by motion. Within this limitation, there is no gross abnormal intracranial enhancement. There is diffuse cerebral volume loss. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1.Multifocal punctate areas of supratentorial and infratentorial restricted diffusion are compatible with recent watershed infarcts or less likely embolic infarcts.2.Underlying mild degree of chronic small vessel ischemic disease.Findings were discussed with Dr. Browning (pager 1234) by Dr. Veronesi at the time of the finding on 7/8/2016 at 1530.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI:There is patchy diffusion restriction in the left MCA distribution involving the left posterior frontal lobe corona radiata extending to the left insula compatible with acute infarct. This is associated with mildly increased T2 signal. There is additional periventricular and subcortical T2 hyperintensities without associated diffusion restriction which likely represent chronic small vessel ischemic disease. Ventricles and sulci are slightly prominent which may reflect a mild degree of volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA:There is evidence of intracranial atherosclerotic disease without high grade stenosis. There is ectasia of the bilateral cavernous and supraclinoid carotid arteries with multiple areas of apparent outpouching measuring 2-3-mm. Extracranial internal carotid are patent. There is slightly diminished flow within the distal left MCA branches compared to the right at the level of the sylvian fissure. No proximal high grade occlusion is visualized. The anterior cerebral arteries are patent. The vertebro-basilar system is patent without aneurysm or high-grade stenosis.

Output: 1.Acute infarcts in the left posterior frontal lobe in the left middle cerebral artery territory. 2.Mild chronic small vessel ischemic disease.3.Motion degraded MRA. Slightly diminished flow within the left distal MCA branches compared to the right. No proximal large vessel occlusion. 4.Multiple apparent 2-3 mm outpouchings within the cavernous and supraclinoid carotid arteries may possibly represent small aneurysms versus artifact. CTA or repeat MRA at 3T should be considered.


Instruction: Generate impression based on findings.

Input: Subdural hemorrhage [432.1], Reason for Study: ^Reason: eval for cause of lt temporal seizures, possibly infarction vs lesion, pt s/p sdh evac History: lt temporal seizures Brain MRI:Motion artifact significantly degraded image quality. There bihemispheric subdural hematoma, more on the right side than left with mass effect and midline shift toward left side (9.9 mm at the level of foramen of Monro). There is evidence of right frontal burr hole with evacuation of hematoma on the right side. There is no evidence of acute ischemic lesion on the scan.The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain without and with gadolinium enhanced scans with maximum intensity projections demonstrate normal flow enhancement in the superior sagittal sinus, internal cerebral veins, vein of Galen and straight sinus.The left transverse sinus and left sigmoid sinus as well as left jugular bulb appear to be hypoplastic. This could represent normal variation.

Output: 1. Bihemispheric Acute SDH with post burr hole evaluation of the right SDH.2. Midline shift toward right side, no significant interval change since prior CT scan.3. No evidence of acute ischemic lesion.4. Hypoplastic left transverse and sigmoid sinuses as described above.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, history of meningioma, resection in 2013 Again seen is sequelae of a right suboccipital craniotomy for right posterior fossa tumor resection. The resection cavity is unchanged in size and morphology. T2 hyperintensity within the surrounding cerebellar parenchyma, likely representing gliosis, is also unchanged. No suspicious enhancement is seen within or around the resection cavity to suggest recurrent tumor.Minimal scattered foci of cerebral white matter T2 hyperintensity are again seen, unchanged. No restricted diffusion is evident. No mass effect or parenchymal edema is noted.Post contrast images are within normal limits. No evidence of acute intracranial hemorrhage or any new pathologic fluid collections are detected. Small foci of susceptibility within the frontal lobes likely represent chronic microhemorrhage is unchanged. The ventricles are stable and normal in size.There is diminished flow-void involving the right vertebral artery which may represent high-grade stenosis and seen previously.There is a left paramedian disc protrusion at the C2-C3 level which demonstrates mild mass effect on the left hemicord and grossly similar to prior cervical spine MRI from 7/17/2015.

Output: Postoperative changes related to right posterior fossa meningioma resection. No evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: Glioblastoma. Status post surgery followed by concomitant chemoradiation treatment and subsequent adjuvant chemotherapy. Now off treatment. There are postoperative changes from previous left parietotemporal tumor resection. The irregular contrast enhancement in the treatment bed is largely similar to prior allowing for slight differences in technique/reduced contrast dose. There is however contrast enhancement along the lining of the occipital horn of the left lateral ventricle which is minimally increased compared to the two previous examinations. The extensive T2-hyperintensity involving a significant part of the left cerebral hemisphere remains unchanged as well as the more widespread, nonspecific scattered foci of T2 FLAIR hyperintensity in the periventricular white matter. Numerous foci of susceptibility in the treatment bed related to chronic blood products remains unchanged. There is unchanged mild mass-effect surrounding the treatment bed while the remainder of the brain shows moderate brain volume loss. There is no new mass effect or new foci of abnormal enhancement aside from the left occipital horn. The presence of susceptibility effect in the treatment bed limits the value of the dynamic MR perfusion study.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a partially empty sella. The orbits are grossly unremarkable.

Output: Posttreatment changes with irregular enhancement in the left parietal and temporal lobes is largely similar to prior study. There is however mild interval increase in enhancement along the ependymal surface of the left occipital horn compared to 1/28/2016 and 11/25/2015 which is suspicious for subtle tumor progression. Suggest close attention on follow-up. No abnormal enhancement involving the ventricular wall remote from this region or abnormal leptomeningeal enhancement to suggest CSF dissemination. Extent of FLAIR signal abnormality is not significant changed.


Instruction: Generate impression based on findings.

Input: Altered mental status. The left temporal lobe and left parietal lobe inferior lobe shows encephalomalacia seen indicating chronic ischemic infarct.In addition, there are gyriform restricted diffusion areas especially posterior aspect of left temporal lobe indicate subacute ischemic infarct.There is no evidence of hemorrhagic transformation.There is no evidence of surrounding edema.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate nonvisualization of left MCA M1 segment indicating possible occlusion. Right MCA M1 segment as well as vertebrobasilar system show multifocal irregularity of intracranial arteries indicating atherosclerotic changes. The basilar artery is not seen on MRA, suggesting possible occlusion or severe stenosis, however, this could be an artifactual due to patient's motion. Therefore, for further evaluation, CT angiography is recommended if clinical indicated. 3D MRA neck TOF images with maximum intensity projections of the cervical vasculature demonstrate significant (probably more than 70%) stenosis of the left extracranial ICA just above the bifurcation. Distal to the stenosis, the left ICA luminal diameter appears to be smaller than that of the right side indicating possible long standing low flow through the cervical segment of the left ICA.The right CCA, bifurcation and extracranial right ICA appear to be normal.

Output: 1. Chronic ischemic infarction with encephalomalacia on the left temporo-parietal lobe with posterior temporal subacute ischemic infarction. There is no hemorrhagic transformation.2. The left MCA M1 segment appears to be occluded.3. The basilar artery is not seen on TOF MRA, this may indicate severe stenosis or occlusion but also could be related to artifacts. Head and neck CTA is recommended for further imaging evaluation.4. Significant luminal stenosis on the left extracranial ICA just above the bifurcation, CTA of neck or Carotid Doppler is recommended for more precise stenosis evaluation. 5. Atherosclerotic changes of intra and extracranial arterial system.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with transient right arm and right leg weakness and numbness. MRI brain:Mild striated restricted diffusion is seen within the left aspect of the pons (image 112 series 506). There may be very subtle corresponding FLAIR hyperintensity though this is equivocal.Elsewhere no restricted diffusion or other significant parenchymal signal abnormality is detected. No parenchymal edema or generalized mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology.MRA brain:No significant intracranial stenosis is seen. In particular, the posterior circulation is within normal limits. Fetal origin of the right PCA is noted. No aneurysms are detected.MRA neck:Conventional aortic branching. No significant vascular stenosis is detected in the carotid circulation by NASCET criteria. Likewise, the vertebral arteries are free of significant stenosis or occlusion.

Output: Mild striated apparent restricted diffusion is seen within the left aspect of the pons. Given the clinical history, this could potentially represent mild pontine ischemia. However, the transverse pontine fibers sometimes produce an artifact which looks similar to this on DWI images. Considering the otherwise normal appearance of the brain, and the normal MRA examinations of the head and neck, the possibility of an artifact should be considered. If clinical suspicion remains high, a follow-up examination can be considered at 1.5T which may decrease the potential for artifact.


Instruction: Generate impression based on findings.

Input: 58 year-old female with cirrhosis. Evaluate for worsening hyperbilirubinemia. Rule out obstruction. ABDOMEN:LIVER, BILIARY TRACT: Note is made of a cirrhotic liver morphology. No enhancing mass lesions are identified. There is no evidence of intra-or extrahepatic biliary ductal dilation. No evidence of focal stricture or obstruction. Note is made of multiple punctate dependent gallstones without evidence of acute cholecystitis. No common duct stones are identified. Again seen is a filling defect at the level of the confluence of the portal vein consistent with the patient's known history of chronic nonocclusive thrombus. There is a small amount of perihepatic free fluid.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral subcentimeter foci of fluid signal intensity are most consistent with simple cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is subcutaneous edema most pronounce along the left posterior hemiabdomen.OTHER: Small left pleural effusion.

Output: 1.No evidence of intra- or extra-hepatic biliary ductal dilation to suggest obstruction, as clinically questioned. 2.Cirrhotic liver morphology without evidence of enhancing mass lesion. Chronic nonocclusive thrombosis of the portal venous system, as detailed above.3.Small left pleural effusion and small amount of perihepatic ascites.


Instruction: Generate impression based on findings.

Input: 68-year-old male. HCC, cirrhosis, HCV. Status post TACE/RFA. Evaluate liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Ablation defect in the right hepatic lobe measures 1.8 x 3.6 cm (series 9, image 136). There is a anterior and superior peripheral nodule of arterial enhancement in the cavity measuring 1.1 x 0.9 cm (series 9, image 40), concerning for residual tumor. New 1.2 x 1.3 cm arterial focus of enhancement in segment 6 (series 9, image 55) that becomes isointense to liver parenchyma on later phases and does not have associated T2 signal abnormality; does meet criteria for HCC, special attention on follow-up scans.No biliary ductal dilatation. Patent hepatic artery, hepatic vein, and portal vein. Cirrhotic liver morphology.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mildly atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Interval ablation of segment 8 lesion with a small nodular focus of arterial enhancement in the ablation cavity concerning for residual tumor. 2. New 1.2 cm arterially enhancing focus in segment 6 that does meet criteria for HCC; special attention on follow-up scans.