Instruction: Generate impression based on findings.

Input: A 75 year old male with recent hospitalization because of pulmonary embolism and newly diagnosed left ventricular dysfunction (LVEF by echocardiography was 35%), left ventricular hypertrophy. The electrocardiography showed low voltage and cardiac amyloidosis was clinical suspected. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. There is global hypokinesis with regional variation. There is severe concentric hypertrophy (wall thickness 15-17mm). The overall LV ejection fraction is 42%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 142 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 109 g/m2 , and the LV mass is 215 g. There is extensive and diffuse late gadolinium enhancement involving the whole myocardium, it is worst at the basal inferolateral wall. Addition on the inversion scouts the LV cavity and myocardium null within 30 seconds of each other. The native myocardial T1 time is 1100-1200msec. These findings are diagnostic for cardiac amyloidosis. No evidence of iron overload. Left AtriumThe left atrium is moderately dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is normal in size with mild systolic dysfunction. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 147 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17). The RV is mildly hypertrophied. Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mild systolic dysfunction. The LVEF is 42%. There is global hypokinesis with regional variation. There is severe hypertrophy. There is extensive and diffuse late gadolinium enhancement involving the whole myocardium, abnormal gadolinium "kinetics," and elevated native myocardial T1. These MRI findings are diagnostic of cardiac amyloidosis.2. The left atrium is moderately dilated. 3. The right ventricle is normal in size with mild systolic dysfunction and hypertrophy. The RVEF is 45%. 4. The right atrium is mildly dilated.


Instruction: Generate impression based on findings.

Input: Dilated pancreatic duct on endoscopic ultrasound. Lack of intravenous contrast limits evaluation for solid organ, bowel and vascular pathology.ABDOMEN:LIVER, BILIARY TRACT: Hypotense liver parenchyma suggestive of iron deposition. The liver is normal in morphology. No intra or extrahepatic biliary ductal dilatation. Probable right hepatic lobe cyst, unchanged. No focal suspicious lesion. Normally distended gallbladder.SPLEEN: Probable iron deposition. The spleen measures 13 cm in length with a lobulated multicystic/multiseptated 2.7 cm lesion, likely benign hemangioma or lymphangioma.PANCREAS: The main pancreatic duct at the level of the body is dilated up to 7 mm without mural nodularity evident with mild narrowing and irregularity at the head, without a discrete lesion. Lack of contrast limits evaluation for enhancing components. The pancreatic parenchyma is not significantly atrophic. No focal pancreatic parenchymal lesion is apparent on this limited nonenhanced study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are mildly atrophic with the parenchyma replaced with innumerable T2 weighted hyperintense foci some of which are not simple appearing cysts, progressed from prior. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Main pancreatic ductal dilatation up to 7 mm without mural nodularity with irregular narrowing at the pancreatic head without a discrete lesion. Otherwise limited nonenhanced study. Correlate with the endoscopic ultrasound findings.2.Findings of acquired cystic kidney disease of dialysis with multiple cysts and several indeterminate lesions which are not completely characterized by noncontrast MRI.3.Hemosiderosis.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, previous intracranial tumor resection. Brain cyst with weakness and gait disturbance. Sensorimotor cortical activation of the hand and face maps as expected along the pre- and post-central gyri.

Output: Sensorimotor cortical activation of the hand and face maps to and identifies the pre- and post-central gyri. Sensorimotor cortical activation of the foot could not be visualized as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Chiari malformation, pseudotumor C, shunt, worsening symptoms, please check CSF flow and evaluate for syrinx. Signs and symptoms: Headache, vomiting, neck pain worsening. Nonenhanced brain MRI:Expected postoperative changes of Chiari decompression with resultant expansion of subarachnoid space at the level of foramen magnum remain similar to prior exam. There is a catheter/stent extends from the fourth ventricle into the subarachnoid space posteriorly similar to prior exam. There is mild posterior tenting of the cervical medullary junction of the cord similar to prior exam and suspected of adhesion.Negative diffusion-weighted images.Examination demonstrates normal anatomical morphology of the brain otherwise and with normal signal intensity on all MRI sequences. There is no evidence of ventriculomegaly which is a similar observation is prior study. The cortical sulci remain widely patent similar to prior exam.The signal void of major intracranial arterial branches are identified.Unremarkable signal intensity of paranasal sinuses, mastoid air cells and middle ear cavities and unremarkable images through the orbits.Nonenhanced cervical MRI:Examination redemonstrate stable suboccipital Chiari decompression.There is normal signal intensity and caliber of cervical cord without evidence of syrinx.There is normal signal intensity and alignment of the vertebral column.There is no spinal canal or neural foraminal compromise at any level.CSF flow study demonstrate presence of biphasic flow through the foramen magnum both anteriorly and posteriorly without significant change since prior exam.Nonenhanced thoracic MRI:There is normal anatomical development, signal intensity and alignment of vertebral column.There is normal signal intensity and caliber of thoracic cord and in particular without evidence of syrinx.No spinal canal or neural foraminal compromise at any level.No detectable paraspinal soft tissue abnormalities.

Output: 1.Nonenhanced MRI of brain demonstrate no acute or new finding since prior study. Stable postoperative changes of suboccipital Chiari decompression and unremarkable MRI exam otherwise.2.CSF flow study demonstrates presence of biphasic flow through the foramen magnum both anteriorly and posteriorly which remains stable since prior exam.3.Unremarkable nonenhanced cervical MRI other than expected Chiari decompression postop changes.4.Unremarkable nonenhanced MRI of thoracic spine and in particular no evidence of syrinx is detected.


Instruction: Generate impression based on findings.

Input: 35-year-old female with left knee pain. MENISCI: The lateral meniscus appears intact. The medial meniscus appears intactARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the medial femoral condyle. The articular cartilage along the lateral tibial femoral compartment is relatively spared. There is partial-thickness articular cartilage degeneration and superficial fraying along the lateral facet of the patella. There is a focal near full-thickness articular cartilage defect along the lateral facet of the femoral trochlea with areas nearly completely devoid of articular cartilage. Heterogeneous bone marrow signal abnormality is nonspecific but may represent residual islands of red marrow. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Mild osteoarthritic changes of the knee as described above including a near full-thickness articular cartilage defect along the lateral facet of the femoral trochlea.2. Small joint effusion extending posteromedially into a tiny Baker's cyst. Multiple foci of low signal abnormality within the joint space may represent loose bodies/articular cartilage fragments versus a synovitis as described above.


Instruction: Generate impression based on findings.

Input: 64 years, Female, Reason: eval for lseions, hepatic vessel patency History: s/p liver transplant 10/09 for HCV, recurrent cirrhosis. ABDOMEN:Limited DWI images show a right renal cyst and a mild amount of ascites. There is diffuse iron deposition, however the liver is not well evaluated on these images.

Output: Nondiagnostic terminated exam with limited images obtained. Patient will not be charged and will return for repeat examination with contrast.


Instruction: Generate impression based on findings.

Input: 64 year old female with a history of AL Amyloidosis. She is referred for cardiac MRI for follow-up. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 135 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 46 ml (normal range 31+/-10), the LV mass index is 69 g/m2 (normal range 67+/-11), and the LV mass is 143 g (normal range 114+/-24). There are no regional wall motion abnormalities present. No evidence of inflammation or edema on T2 stir. Normal gadolinium kinetics. There is left ventricular hypertrophy. Thebasal anteroseptum is 14mm (similar to reported on previous study dated 4/2015). Stable enhancement of the basal to mid inferior/inferolateral wall (when compared with 2013 and 2015 CMR). No intracardiac thrombus. T1(septum) 1141ms and T1 cavity 1599 ms. T1 values are slightly high in the septum where no late gadolinium enhancement was seen. This could be normal or related to diffuse fibrosis.Left AtriumThe left atrium is dilated.Right VentricleThe right ventricle isnormal in size and systolic function.The overall RV ejection fraction is 55%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 170 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation. The main PA is mild-moderately dilated and measures 36 mmTricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid arteries. The thoracic aorta is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsWell-circumscribed lesions noted in the liver. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and function. LVEF is 66%. There is stable enhancement of the basal to mid inferior wall. This is atypical for cardiac amyloid and for myocardial infarction. It could be related to prior scar from myocarditis. In this setting with small pericardial effusion, increase in wall thickness, the possibility of localized cardiac amyloid cannot be excluded. Elevated myocardial T1 time.3. The right ventricle isnormal in size and function. RVEF is 55%4. Biatrial enlargement5. At least mild mitral and tricuspid regurgitation


Instruction: Generate impression based on findings.

Input: Ms. Coleman is a 45-year-old female with a history of left modified radical mastectomy for IDC/DCIS in 2007 treated with radiation and chemotherapy. Personal history of right breast reduction and left breast reconstruction in 2014. Family history of breast cancer in her maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Postsurgical changes consistent with recent breast reduction surgery are identified in the right breast. There is no abnormal enhancement seen in the right breast.Postsurgical changes consistent with modified radical mastectomy are identified in the left breast. There is no abnormal enhancement seen in the left chest wall. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Contrast rapidly opacified the radiocarpal joint and extended into the distal radioulnar joint indicating a tear of the triangular fibrocartilage complex. Please see subsequent MRI for further information. Multiple spot images were obtained following the injection.

Output: Successful arthrogram of the right wrist with findings indicating a tear of the triangular fibrocartilage complex.


Instruction: Generate impression based on findings.

Input: 57 year old male with a past medical history significant for atrial fibrillation/flutter with multiple ablations, non-ischemic cardiomyopathy, hypertension and ventricular tachycardia. Referred for cardiac MRI prior to further decision making. Left VentricleThe left ventricle is normal in size with mild to moderately depressed systolic function. The overall LV ejection fraction is 39%. The LVEDV is 189 ml (normal range 142+/-34), the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVESV is 114 ml (normal range 47+/-19) and the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9). The LV mass is 97 g (normal range 164+/-36) and the LV mass index is 39 g/m2 (normal range 85+/-15). The ventricular septum is hypokinetic. There is mid myocardial late gadolinium enhancement in the area of the basal septum suggesting an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%. The RVEDV is 159 ml (normal range 142+/-31), RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVESV is 66 ml (normal range 54+/-17), and the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is not well visualized.Mitral ValveThe mitral valve opens widely and there is at least mitral regurgitation.Pulmonic ValveThe pulmonic valve is not well visualized.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation. AICD lead is noted passing from the right atrium through the tricuspid valve and into the RV apex.AortaThere is a left sided aortic arch. The branches are not well seen due to AICD artifact.. Pulmonary VeinsThree pulmonary veins drain normally into the left atrium. The left upper pulmonary vein was not well visualized.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: Interpretation is limited by artifact from AICD/PM.1.Normal LV size with mild-moderately depressed systolic function (LVEF 39%). Septal hypokinesis noted.2.There is mid myocardial late gadolinium enhancement in the area of the basal septum suggesting an underlying fibrosing, infiltrative, or inflammatory process.3.Normal RV size with normal systolic function (RVEF 59%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62-year-old female with diabetic foot infection. Evaluate for osteomyelitis. 3 views of the right foot demonstrate diffuse demineralization. The margin of the medial aspect of the base of the fourth proximal phalanx is indistinct. This finding may simply reflect a combination of diffuse demineralization and overlying soft tissue swelling, but the possibility of osteomyelitis cannot be excluded. If this finding corresponds to the area of pain or concern, MRI is recommended for further evaluation. Mild osteoarthritis affects the first MTP joint, interphalangeal joints, and midfoot.

Output: Poor cortical definition of the base of the fourth proximal phalanx, which is of uncertain significance but could represent osteomyelitis in the appropriate clinical context. If further evaluation is clinically warranted, MRI is recommended.Findings were discussed with Dr. Huang of the ER via telephone on 8/26/2015 at 09:45.


Instruction: Generate impression based on findings.

Input: Reason: s/p Right knee arthroscopy microfracture patella and MFC evaluate healing History: right knee pain MENISCI: There is intrasubstance signal within the medial meniscus indicating intrasubstance degeneration. The body of the medial meniscus also appears slightly extruded. There is perhaps mild fraying of the undersurface of the body of the medial meniscus but we see no findings suggestive of an unstable tear.ARTICULAR CARTILAGE AND BONE: There has been progression of the degeneration of the articular cartilage in the medial compartment with areas of full-thickness cartilage loss along the medial femoral condyle and medial tibial plateau just posterior to the anterior horn of the medial meniscus. There is edema-type signal in the underlying subchondral bone that is likely degenerative in etiology and is perhaps slightly less pronounced in the tibia on the current study than on the prior study but slightly more extensive in the medial femoral condyle. There is extensive partial thickness degeneration of the articular cartilage of the medial facet of the patella as well as small foci of full-thickness degeneration that appears similar to that seen on the prior study. A 1 cm disc-shaped focus of low signal intensity in the adjacent joint fluid may represent a displaced cartilage fragment. The articular cartilage of the lateral patellar facet appears unusually thickened, which likely reflects degeneration. There are cysts in the underlying subchondral bone. Note is made of a bipartite patella with cyst formation appearing similar to the prior study. The articular cartilage of the lateral compartment appears relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. Patella alta is again noted, appearing similar to the prior study.ADDITIONAL

Output: 1. Progression of cartilage degeneration within the medial compartment as described above.2. Degeneration of the articular cartilage of the patella appears similar to that seen on the prior study although there may now be a displaced fragment in the adjacent joint fluid.3. Other findings as above.


Instruction: Generate impression based on findings.

Input: Increasing gait abnormality. There is no acute infarct or intracranial hemorrhage. There is confluent periventricular and patchy deep and subcortical T2-hyperintensity in the cerebral white-matter, predominantly frontoparietal. A few punctate T2-hyperintense foci are also present in the pons. There is no mass-effect or midline shift. The ventricles and the other CSF-containing spaces are enlarged, reflective of moderate global parenchymal volume loss. There is also dilatation of the perivascular spaces. The major intracranial vascular flow voids are preserved, reflecting gross patency. There is trace mucosal thickening involving the paranasal sinuses. The mastoid air cells are clear. There is no destructive skull lesion. There has been previous left enucleation and placement of ocular prosthesis. There is no gross right orbital abnormality. A partially empty sella is incidentally noted and within normal limits for age.

Output: 1.There is no acute infarct, intracranial hemorrhage, or mass. No hydrocephalus.2.Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is enhancement and mild thickening involving the orbital, canalicular, and perhaps the prechiasmatic segments of the left optic nerve, which measures up to approximately 5 mm in width. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no evidence of acute infarction. There are secretions and/or mucosal thickening in the right maxillary sinus. There are normal flow-voids in the major intracranial vascular structures. MRI LUMBAR SPINE: There is diffuse enhancement and nodularity in the skin and subcutaneous tissues in the lower back and buttock region. The lumbar spine is normal alignment. The vertebral body and disc heights are well-maintained. There is a 10 mm diameter right sacral perineural cyst. There is also mild sacral lipomatosis. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level. There is no significant disc bulge, herniation, spinal canal or neural foramen stenosis. There is mild urinary bladder distension.

Output: 1. An apparent lesion involving the left optic nerve that measures may represent an optic glioma. However, a dedicated orbit MRI may be useful for further evaluation.2. Diffuse enhancement and nodularity in the skin and subcutaneous tissues in the lower back and buttock region is compatible with superficial neurofibromatosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: low back pain, R side flank pain, s/p spinal surgery History: as above Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post left-sided hemilaminectomy at L5-S1.At L5-S1 there is loss of disk space height, disk desiccation and diffuse disk bulge associated with bilateral neural foramina narrowing and partial effacement of the fat surrounding the left sided exiting nerve roots. There is effacement of the fat of the left lateral recess.At L4-5 there is loss of disk space height, diffuse disk bulge, disk desiccation and ligamentum flavum hypertrophy. Effacement of the fat of the left lateral recess at this level. The exiting nerve roots within the neural foramina are surrounded by fat,At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a cystic lesion present in the right kidney could represent a simple cyst. Please refer to abdomen CT from 2/14/15 for further comments.

Output: 1.The patient is status post lumbar spine surgery in the lower lumbar spine. There is effacement of the fat of the left lateral recess at L5-S1 and L4-5. Differential considerations include scar formation as well as disk protrusion affecting the nerve roots at the left lateral recess at these levels. A contrast enhanced exam may help differentiate2.is encroachment of the exiting nerve roots within them left neural foramen at L5-S1 as a result of disk material


Instruction: Generate impression based on findings.

Input: History of primary central nervous system lymphoma, status post treatment. There are postoperative findings in the right frontal region, with unchanged right superior frontal gyrus encephalomalacia anteriorly. There is also persistent patchy white matter T2 hyperintensity in the periventricular regions bilaterally. There is a chronic left inferior cerebellar hemisphere subcentimeter infarct. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intraparenchymal enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Post-treatment findings without evidence of intracranial tumor recurrence.


Instruction: Generate impression based on findings.

Input: History of TBI (subarachnoid bleed) presented with simple partial seizure, found to have left occipital dislocation seen on EEG. There are a few scattered foci of subarachnoid susceptibility effect in the bilateral parietal regions, left more than right. There is volume loss in the right frontal lobe periventricular white matter with trace T2 hyperintensity associated ex vacuo dilatation of the frontal horn of the right lateral ventricle. There is no evidence of intracranial mass or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: 1. Sequale of prior subarachnoid hemorrhage in the bilateral parietal regions.2. Right frontal lobe periventricular leukomalacia.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: paresthesias. There are multiple supratentorial and infratentorial T2 hyperintense lesions, many of which demonstrate corresponding low T1 signal. The ventricles are unchanged in size and configuration. There is an unchanged subcentimeter pineal gland cyst. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the numerous supratentorial and infratentorial demyelinating lesions, accounting for differences in technique.


Instruction: Generate impression based on findings.

Input: Female, 90 years old, with subarachnoid hemorrhage. Assess for cause. Brain MRI:Trace T1 hyperintensity is seen within the left central sulcus correlating with suspected subarachnoid hemorrhage on prior CT. Sulcal FLAIR hyperintensity is also seen at this location, and within the left superior frontal sulcus and perhaps the right postcentral sulcus. No additional large areas of acute intracranial hemorrhage are suspected.Susceptibility weighted images reveal extensive hemosiderin staining along the surface of the cerebral hemispheres and very conspicuously within many of the cerebral sulci, most notably in the parietal lobes and along the cingulate gyri bilaterally. A focus of parenchymal susceptibility is evident at the gray-white junction in the right paracentral lobule with mild surrounding T2 hyperintensity. These abnormalities are limited to the upper cerebral hemispheres with sparing of the brainstem and posterior fossa structures.Mild leptomeningeal enhancement is seen in the left central and superior frontal sulci, and along the right postcentral sulcus. No enhancing masslike lesions are seen. Extensive patchy and confluent periventricular T2 hyperintensity is noted. In addition, there is a 4 mm focus of mild diffusion restriction in the white matter of the right parietal corona radiata. Diffusion hyperintensity surrounding the right precentral lobule lesion is felt to be artifactual.No large intracranial fluid collections are seen. There appears to be mild encephalomalacia along the right cingulate gyrus. The ventricles and sulci are prominent compatible with mild underlying parenchymal volume loss.Brain MRA:The distal right vertebral artery shows no flow related signal suggesting stenosis or occlusion. The mid to distal basilar artery also narrows at least moderately. No additional significant vascular stenosis or occlusion is seen within the limitations of image quality. The right A1 segment is hypoplastic. No clear evidence of an aneurysm or any vascular malformation is seen.Brain MRV:The superior sagittal sinus, transverse and sigmoid sinuses all demonstrate normal opacification compatible with patency. Likewise, the deep cerebral venous structures opacify normally. No evidence of any anomalous or pathologic venous structure is demonstrated.

Output: 1.Trace acute or subacute subarachnoid hemorrhage is seen within the left central sulcus, and perhaps also within the left superior frontal sulcus and the right postcentral sulcus.2.Extensive superficial siderosis is seen involving predominantly the upper aspect of the cerebral hemispheres with sparing of the brainstem and posterior fossa structures. This finding likely represents the sequelae of prior subarachnoid bleeding. However, the etiology for this prior bleeding is not evident on the present examination.3.A focus of parenchymal chronic hemosiderin is seen in the right paracentral lobule. Encephalomalacia is present at the right insula gyrus likely reflecting chronic ischemia. Also noted is a small, acute small vessel stroke in the right parietal white matter.4.Within the limitations of image quality, no aneurysm or vascular malformation is detected on MRA images. The right distal vertebral artery shows no flow related signal which may indicate stenosis or occlusion. In addition, the mid to distal basilar artery appears to be at least moderately narrowed.5.MRV imaging of the intracranial venous structures is within normal limits.


Instruction: Generate impression based on findings.

Input: 31 years Male (DOB:5/24/1985)Reason: 31 yo s/p resection of medullary tumor then RT, surveillance imaging History: as abovePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The patient status post posterior fossa surgery for a neoplasm centered in the posterior medulla. The neoplasm measures 20 x 12 mm axial dimensions on the current exam and on the 9/18/2007 exam measured 27 x 16 mm axial dimensions. On the 8/12/2014 exam measured 20 x 12 mm axial dimensionsNormal 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: The patient's neoplasm centered in the medulla remains stable in size compared to the 8/12/2014 exam.


Instruction: Generate impression based on findings.

Input: Male, 38 years old, with right arm tingling and pain on turning of the head. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.A small central disc protrusion is seen at C6-7 without significant spinal canal stenosis or cord impingement. No large or significant disc herniation is seen and the spinal canal is not compromised at any level. Mild right foraminal narrowing is evident at C3-4 due to uncovertebral hypertrophy.

Output: No findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Hand mass There is a lobulated mass centered within the webspace between the index and middle fingers volarly measuring 1.5 x 4 cm in the transverse and longitudinal dimensions, respectively. The proximal margin of the mass lies at the level of the second and third metacarpal necks between the flexor tendons of the index and middle fingers and volar to the transverse metacarpal ligament. The mass extends distally into the base of the middle finger along the radial aspect of the A2 pulley. The mass also appears to extend along the course of the neurovascular bundle, and does not appear to arise directly from a tendon. It is predominantly isointense to skeletal muscle with small foci of increased signal centrally which may reflect small foci of hemorrhage or slow flowing blood. On T2 sequences, the mass is more heterogeneous but predominantly hyperintense to skeletal muscle with small tubular foci of low signal which may reflect flow voids. There is prominent enhancement following administration of gadolinium. No additional masses are identified. A small focus of abnormal signal is noted in the third metacarpal head which does not enhance and may represent a cyst. Tiny focus of fluid signal is noted between the flexor tendon and neck of the third proximal phalanx which could represent fluid in the tendon sheath or a small ganglion. This also does not enhance.

Output: Hand mass as detailed above. The mass does not demonstrate signal characteristics consistent with lipoma or cyst. Although nonspecific in nature, the lobulated contour and close proximity to the neurovascular bundle suggests the possibility of a vascular malformation. A nerve sheath tumor or tenosynovial giant cell tumor are also in the differential diagnosis but considered to be less likely etiologies.


Instruction: Generate impression based on findings.

Input: 22 years, Female, bilateral blurry vision, right face droop. Evaluate for MS worsening versus PML.. Again seen are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with morphology and distribution consistent with known demyelinating disease. Compared to 4/1/2016, there has been interval development of multiple, at least 5, new T2/FLAIR hyperintense lesions involving the bilateral frontal and parietal lobes. There is associated peripheral enhancement including some with incomplete rim of peripheral enhancement, characteristic of demyelinating lesions. Restricted diffusion is also evident, particularly of a left frontal lesion. No intracranial mass effect. No midline shift or herniation. Ventricles are normal in size. Brain parenchymal volume is preserved. Calvarium and extracranial soft tissue structures are unremarkable.

Output: Evidence of progression of demyelinating disease since prior MRI. There are multiple new lesions with enhancement which are compatible with active demyelination.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with intracerebral hemorrhage. Assess for resolution of hemorrhage and possible metastases. The previously demonstrated hematoma centered on the precuneus of the left posterior parietal lobe has evolved and now appears as an area of curvilinear hemosiderin staining. Mild residual T2 hyperintensity is seen in the adjacent corpus callosum.No new intracranial hemorrhage is demonstrated. Again seen is curvilinear hemosiderin staining along the right putamen compatible with chronic hemorrhage.Numerous scattered foci of T2 hyperintensity are demonstrated within the cerebral white matter. One lesion within the left centrum semiovale is new, but the lesions are otherwise not grossly changed.On postcontrast imaging, no evidence of any pathologic parenchymal or extra-axial enhancement is observed. In particular, no evidence of pathologic enhancement is seen in the vicinity of the prior hematoma. A developmental venous anomaly is seen in the right frontal lobe.No abnormal extra axial fluid collections are seen. The ventricles are normal in size and morphology.Opacification of the left maxillary sinus has significantly improved with only a small residual fluid level demonstrated. The right maxillary sinus, right ethmoid air cells and right frontal sinus remain completely opacified similar to prior with corresponding mucosal enhancement.

Output: 1.Expected evolution of the previously demonstrated left posterior parietal hematoma. The area now demonstrates only a thin layer of hemosiderin staining and mild residual signal abnormality in the adjacent corpus callosum.2.No enhancing lesions are identified to suggest the presence of metastatic disease.3.An area of chronic hemosiderin staining along the right putamen is unchanged. No new intracranial bleeding is seen.4.Extensive scattered white matter lesions are redemonstrated, most of which appear unchanged. However, one lesion in the left centrum semiovale is new. These findings may represent microvascular ischemia.5.Findings are seen compatible with active paranasal sinus inflammation with improvement in the left maxillary sinus.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of coiling right MCA artery, anterior temporal artery, and basilar artery aneurysms. Follow-up for progression. 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.The patient is status-post stent-assisted coiling of basilar tip aneurysm. There is no MRA evidence for aneurysm recurrence.The previously demonstrated left clinoidal segment aneurysm present measuring 4 mm in size is better appreciated on the comparison MRI, however appears stable when compared to the prior exam. A 2-mm right clinoidal segment aneurysm is also stable.The right m1 segment, clipped MCA aneurysm, and anterior temporal artery origin from the former base of the MCA aneurysm is obscured by metal artifact.

Output: 1.No MRA evidence for recurrence of basilar tip aneurysm.2.Stable clinoidal segment aneurysms bilaterally.3.The patient's right middle cerebral artery aneurysm is not evaluated on this exam due to metal artifact


Instruction: Generate impression based on findings.

Input: Postoperative changes from previous left parietal occipital craniotomy are again seen, with a left occipital resection cavity with scattered peripheral hemosiderin deposition. The resection cavity is again filled with FLAIR hyperintense material. Overall, the cavity appears contracted compared to prior examination. There is redemonstration of peripheral enhancement surrounding the parieto-occipital cavity. The reference nodule located along the posterior aspect measures 9 mm, unchanged. Again, the enhancement is seen extending anteriorly to the posterior horn of the left lateral ventricle with involvement of the ependyma.There is extensive surrounding T2/FLAIR hyperintensity which extends slightly more anteriorly in the left frontal lobe. In addition, there is increased T2/FLAIR signal extending along the splenium of the corpus callosum across the midline. There is however decreased mass effect upon the posterior horn of the left lateral ventricle. There is no evidence for hydrocephalus, with interval slight increased size of right lateral ventricle likely back to baseline with resolved mass effect. The rightward midline shift has decreased slightly since prior examination now measuring 6 mm. New mild patchy diffusion restriction is now present anterior to the cavity and minimally involving the splenium of the corpus callosum. New foci of gradient susceptibility likely related to hemosiderin deposition is demonstrated along the superior aspect of the cavity. Scattered new areas of leptomeningeal enhancement are demonstrated, most prominent involving the posterior fossa and spinal cord. Several new enhancing nodular lesions are identified and likely related to carcinomatous spread through the subarachnoid space with parenchymal infiltration. For example, there are nodules involving the inferior aspects of the left frontal lobe, the pontomedullary junction, the cerebellar vermis, and the partially visualized cervical spinal cord. The largest nodule measures 8 x 8 mm located in the left frontal lobe (series 11, image 15). Majority of these nodules are associated with running T2/FLAIR hyperintensity, most prominent involving the brainstem. In addition, there is new enhancement within the bilateral internal auditory canals underlying post contrast images suggestive of additional leptomeningeal tumor involvement. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1. Overall, findings are concerning for leptomeningeal carcinomatosis with multiple new enhancing subarachnoid lesions identified in the inferior left frontal lobe, posterior fossa, and brainstem, and spinal cord. Some of these nodules appear to invade the adjacent parenchyma.2. There is slight retraction of the left parieto-occipital cavity with persistent peripheral enhancement extending anteriorly to the posterior horn of the left lateral ventricle with ependymal involvement. Overall there appears to be slightly increased T2/FLAIR signal extending anteriorly in the left frontal lobe as well as approximately corpus callosum although with decreased mass effect and midline shift.3. New enhancement involving the internal auditory canals is favored to relate to cranial nerve leptomeningeal involvement.4. Patchy mild diffusion restriction anterior to the resection cavity, as well as susceptibility likely related to hemosiderin deposition along the superior aspect of the cavity, may be related to treatment.


Instruction: Generate impression based on findings.

Input: No definite new intracranial metastases are identified. Multiple stable small to punctate intra-axial high intrinsic T1 signal lesions with enhancement are again seen consistent with known metastases. While some of the metastases enhance (for example in the left frontal lobe), enhancement is difficult to ascertain for the remaining lesions which are also intrinsically T1 hyperintense. Largest lesion in the left cerebral hemisphere measures up to 7 mm, unchanged on series 1001 image 13. The largest lesion in the right cerebral hemisphere measures up to 4 mm in the right temporal lobe on series 1001 image 13. None of the lesions exhibit vasogenic edema. There is no hydrocephalus. There is stable somewhat gyriform susceptibility effect in the left precentral gyrus and in the left middle frontal gyrus without enhancement. There is no acute infarct.

Output: No new lesions with stable multiple small pre-existing metastases without vasogenic edema or significant mass-effect.


Instruction: Generate impression based on findings.

Input: 43 years Female (DOB:5/17/1973)Reason: demyelinating lesion? History: weakness, hx ms PROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a T2 signal hyperintense focus present along the right posterior lateral aspect of the spinal cord at the C3-4 vertebral level. This was also present on the 9/21/2015 exam. There is no associated mass effect. This does not enhance following gadolinium administration.There is a T2 hyperintense lesion present along the left posterior lateral aspect of the spinal cord at the C2-3 disc space level. This was also present on the prior exam. There is no mass effect associated with it. This does not enhance following gadolinium administration.There is a punctate size T2 hyperintense focus at the right lateral aspect of the spinal cord at the C4 vertebral body level which is also unchanged. This does not enhance following gadolinium administration. This does not enhance following gadolinium administration.There is a T2 hyperintense ill-defined focus present at the left hemicord at the C6 vertebral body level. There is some vague contrast enhancement associated with this. This was not clearly present on the prior exam.There is a T2 hyperintense enhancing lesion present at the right hemicord at the C7-T1 disc space level . This was not clearly present on the prior exam.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level associated bilateral uncovertebral osteophytes and mild narrowing of the neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is small.MRI thoracic spine:There is a contrast enhancing lesion present within the posterior midline aspect of the spinal cord at the T6-7 disc space level. This is associated with T2 signal hyperintensity and mild mass effect. Additional lesions are present in the thoracic spinal cord at the T5-6 level along the anterior and right side of the peripheral spinal cord, at the T5 vertebral level along the left posterior lateral hemicord at the right posterior lateral aspect of the spinal cord with some punctate enhancement, at the T3 vertebral level at the right hemicord where there is some contrast enhancement and at the C7-T1 level there is also some contrast enhancementNonenhancing lesions are also present in the lower thoracic spinal cord at T8-9 level, T9-10 level and T10 level which are not associated with the mass effect or contrast enhancement..The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.Since the prior exam patient has accumulated new lesions in the lower cervical spinal cord which display contrast enhancement suggestive of active plaque formation. 2.There are multiple lesions throughout the thoracic spinal cord which are compatible with demyelinating disorder some of which display contrast enhancement at C7-T1, T3 and T6-7. Additional nonenhancing lesions suggestive of nonacute plaque are present elsewhere in the thoracic spinal cord.


Instruction: Generate impression based on findings.

Input: Nonspecific biliary dilation of the common bile duct noted on ultrasound. History of hepatitis C. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter liver cysts. A subcentimeter arterially enhancing T2 hyperintense lesion in the inferior left hepatic lobe (series 11, image 52) likely represents an hemangioma. A nonenhancing T2 hyperintense lesion in the right hepatic lobe (series 11, image 62) is indeterminant though likely of benign etiology. The common bile duct is prominent up to the level of the ampulla. No definite ampullary mass is identified. No intrahepatic biliary ductal dilation is present.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is prominent up to the level of the ampulla. The pancreas is of normal signal and enhancement, without pancreatic mass identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, some of which are hemorrhagic. Otherwise no abnormality noted.RETROPERITONEUM, LYMPH NODES: A peripancreatic retroperitoneal lobulated nodule measures 2.5 x 2.3 cm (series 4, image 20), likely representing an enlarged lymph node. An additional enlarged portocaval lymph node is identified (series 4, image 21).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Prominent common bile duct and pancreatic duct up to the level of the ampulla. Enlarged retroperitoneal lymph nodes. Although a definite ampullary mass is not identified on MR, ERCP is may be helpful for further evaluation given these findings.


Instruction: Generate impression based on findings.

Input: Recurrent base of tongue cancer, status post induction chemotherapy. There is interval decrease in size and enhancement of an infiltrative mass centered in the tongue base, measuring up to approximately 15 mm, previously approximately 20 mm, although precise delineation is limited due to superimposed treatment effects and apparent inflammatory changes in the pharynx. The lymph nodes in the neck are not significantly changed in size or enlarged by size criteria. For example, a left level 2B lymph node measures 6 x 8 mm in axial section, previously also 6 x 7 mm, and a left supraclavicular lymph node measures 9 x 12 mm in axial section, previously also 9 x 12 mm. The thyroid and major salivary glands are unremarkable. There is mild scattered paranasal sinus mucosal thickening. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Interval decrease in size and enhancement of an infiltrative mass centered in the tongue base, suggesting treatment response, although precise delineation is limited due to superimposed treatment effects and apparent inflammatory changes in the pharynx. 2. No significant enlargement or change in the neck lymph nodes.


Instruction: Generate impression based on findings.

Input: Male 51 years old with headaches and dizziness and decreased right-sided hearing abnormality. Visual disturbances on the right for the past 2-3 years. No trauma reported. The patient is claustrophobic. The bilateral globes are round and symmetric. The extraocular muscles demonstrate normal morphology and enhancement. The optic nerves are normal in caliber and free of pathological signal change and enhancement. The intraconal tissues are unremarkable.No evidence of intracranial hemorrhage or mass. With contrast, there is no evidence of abnormal parenchymal enhancement. There appear to be flow voids consistent with patency of the major proximal intracranial arteries. No enhancing extra-axial mass is seen.Right maxillary retention cyst noted. Paranasal sinuses and mastoids are grossly clear.

Output: No evidence of orbital abnormality or intracranial mass.


Instruction: Generate impression based on findings.

Input: Female, 66 years old. Reason: knee pain. Eval meniscus and cartilage History: same MENISCI: The posterior horn of the medial meniscus appears blunted, with a horizontal tear. The medial meniscus is also medially extruded.The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There are medial compartment predominant osteophytes. Bone marrow signal is normal. There is marked loss of the articular cartilage medially. The lateral articular cartilage is normal. There is generalized thinning of the patellar cartilage without focal defect.LIGAMENTS: The ligaments of the knee appear normal. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Horizontal tear of the posterior horn of the medial meniscus. The medial meniscus also appears blunted and medially extruded.2.Marked loss of the medial articular cartilage, and thinning of the patellar cartilage, without focal defect.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: Reason: eval calcaneus History: pain TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No osteochondral defect is seen. There is increased bone marrow signal abnormality within the plantar aspect of the calcaneus at the level of the insertion of the plantar aponeuroses. Note is made of increased bone marrow signal abnormality within the cuboid and lateral cuneiform indicating degenerative changes with subchondral cyst formation. ADDITIONAL

Output: 1. Findings suggestive of a mild plantar fasciitis involving the medial and lateral plantar aponeuroses at the level of their insertion on the calcaneus.2. Mild osteoarthritis of the midfoot articulations. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Left tonsil cancer status post treatment. There is no residual measurable tumor in the left tonsillar fossa. There is no residual significant cervical lymphadenopathy. The parotid, submandibular, sublingual, and thyroid glands are unremarkable. The cervical arterial flow voids are grossly intact. There is mild degenerative spondylosis of the cervical spine. There is mild paranasal sinus mucosal thickening, most notably in the maxillary sinuses. There is a small right temporomandibular joint effusion. The orbits and imaged intracanal structures are unremarkable. There are nodular opacities in the imaged portions of the lungs.

Output: 1. Continued interval decrease in size of some cervical lymph nodes compatible with treatment response.2. No evidence of residual or recurrent tumor. 3. Nodular opacities in the imaged portions of the lungs likely represent sarcoidosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Inflammatory breast cancer and headaches. Evaluate for metastatic disease The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The visualized bone in the upper cervical spine and clivus appears relatively low in signal.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.Marrow replacement in the visualized upper cervical spine and clivus is a nonspecific finding. This could be related to chronic disease, anemia, lymphoproliferative disorder, myeloproliferative disorder or metastases in the appropriate clinical setting. Please correlate with clinical findings and bone scan exam.


Instruction: Generate impression based on findings.

Input: Rectal cancer status post chemoradiation therapy. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: The reference lymph node at the level of the rectosigmoid junction on the left measures 2 mm in short axis (series 5/45), compared to 3 mm previously.BOWEL, MESENTERY: Diverticulosis. Small volume of fluid in the left pericolic gutter and adjacent to the bladder dome.Demonstrated again in the low/mid rectum is a region of very low T2-weighted signal intensity involving approximately 90 degrees of the left lateral rectal wall mucosa/submucosa compatible with post-treatment related fibrotic scarring. The region of signal abnormality measures approximately 1.5 x 8 mm (series 5/26) in cross-section, compared to 1.6 x 0.9 cm previously. No measurable discrete intermediate T2-weighted signal abnormality, focal postcontrast enhancement or restricted diffusion. No evidence of extramural extension.No enlarged mesorectal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild interval decrease in size of posttreatment residual of the rectal mass with imaging characteristics suggestive of post radiation scar tissue without residual restricted diffusion or appreciable focal postcontrast enhancement.2.No enlarged pelvic lymphadenopathy, appearing similar to the prior. Small amount of free fluid in the pelvis.


Instruction: Generate impression based on findings.

Input: 38 year-old female with history of breast cancer. ABDOMEN:LIVER, BILIARY TRACT: There is a T2 hyperintense lesion within segment 2 measuring 17 x 14 mm without contrast enhancement. There are several other subcentimeter cystic lesions with similar imaging characteristics noted throughout the liver parenchyma. No enhancing lesions are identified. No intrahepatic biliary ductal dilatation.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Mild fatty atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small amount of bilateral perinephric fluid, likely chronic in etiology.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: Multiple bilobar hepatic lesions with imaging characteristics of benign cysts. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: History of recurrent nasopharyngeal carcinoma and oral cavity squamous cell carcinoma, status post treatment. There are post-treatment findings in the neck. There is ill-defined heterogeneity of the right tonsillar fossa region, but no evidence of discernible residual measurable mass in the oral cavity. There is mildly prominent enhancement of the upper aerodigestive track mucosa diffusely, which likely represents mucositis. There are no significantly enlarged lymph nodes in the neck. Indeed, the left level 2A lymph node measures up to 6 mm in short axis, previously 10 mm. The salivary glands and thyroid are unchanged. The imaged intracranial structures and orbits are unremarkable. The osseous structures are unchanged. There is a subcentimeter retention cyst in the right maxillary sinus.

Output: Post-treatment findings in the neck without convincing evidence of measurable tumor.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out infarct. Signs and symptoms: Generalized weakness, and veering to right. Nonenhanced brain MRI:No evidence of acute ischemic stroke on diffusion weighted series.Examination demonstrates diffuse periventricular and to a lesser degree subcortical foci of flair hyperintensity with mild ex vacuo dilatation of lateral ventricles. Minute similar findings are noted in the pons. Findings are nonspecific however likely representing mild degree of chronic nonhemorrhagic small vessel ischemic strokes considering patient's stated age of 77.There is no detectable cortical signal abnormality. There is normal signal intensity of bilateral basal ganglia and thalami as well as vermis and cerebellar hemispheres.

Output: 1.No evidence of acute ischemic stroke.2.Findings suggestive of mild nonhemorrhagic small vessel ischemic strokes in the periventricular and to a lesser degree subcortical white matter and minimally in the pons as detailed.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis presents for stricture follow-up. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion.Scattered mild intrahepatic biliary ductal stricturing and dilatation in both lobes of the liver with more focal stenosis involving Klatskin's point and the central left bile duct. Mild intrahepatic biliary ductal dilatation most notably in the lateral segment of the left hepatic lobe with mild atrophy. Long segment mild stricture of the common hepatic duct and the intrapancreatic portion of the common bile duct. There is mild postcontrast enhancement of the proximal common hepatic duct.The overall appearance is similar to the prior study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Relatively stable appearance of the biliary tree with findings compatible with primary sclerosing cholangitis without a new dominant stricture or focal mass.


Instruction: Generate impression based on findings.

Input: Knee pain Due to the patient's body habitus, the appropriate knee coil was unable to be utilized and a flex coil was substituted. As a result, image quality is suboptimal. The examination is also limited by motion artifact. MENISCI: There is a large complete radial tear of the posterior horn of the lateral meniscus with associated mild lateral extrusion of the body of the lateral meniscus. Subjectively, the body and anterior horn of the lateral meniscus appears slightly attenuated which may reflect additional chronic attritional tearing or changes from partial meniscectomy. There is slight attenuation and medial extrusion of the body of the medial meniscus but we see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage along the lateral tibial plateau and lateral femoral condyle posteriorly. There is also full-thickness degeneration of the articular cartilage of the medial patellar facet with additional partial thickness degeneration of the articular cartilage of the lateral facet and femoral trochlea. There is relatively mild degeneration of the articular cartilage of the medial tibiofemoral compartment with focal near full-thickness degeneration of the medial femoral condyle posteriorly. LIGAMENTS: The patient has undergone ACL reconstruction and the graft appears intact. The remaining cruciate and collateral ligaments also appear intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Osteoarthritis of the knee with large complete radial tear of the posterior horn of the lateral meniscus.2. ACL reconstruction with intact ACL graft.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for traumatic injury of cervical spinal cord History: right arm weakness, tingling, neck pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There are left-sided uncovertebral osteophytes associated with the left-sided facet hypertrophy at this level and encroachment of the left-sided exiting nerve root. There is mild narrowing of the right neural foramen at this level as a result of disk material and uncovertebral osteophytes. This level is unchanged since the prior exam.At C4-5 there is no significant compromise to the spinal canal. There are endplate reactive changes at this level which were also present on the prior exam but has evolved and are now mostly in a chronic stage. There are uncovertebral osteophytes present at this level and some endplate osteophytes as well some posterior ligamentous hypertrophy. There is a uncovertebral osteophyte formation bilaterally right more than left with bilateral encroachment of the exiting nerve roots. Compared to previous exam the degree of exiting nerve root encroachment as mildly progressed.At C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes at this level associated with posterior ligamentous hypertrophy and encroachment of the exiting nerve roots within the neural foramina. These findings were also present on the previous exam and have not progressed substantially.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is some small uncovertebral osteophytes at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Examination is mildly degraded on the axial imaging due to some patient motion

Output: 1.There are multilevel degenerative changes present in the cervical spine which demonstrates little progression and compared to the 2013 exam. Degenerative changes at C4-5 appear to be in a more chronic stage and there is slightly more encroachment of the exiting nerve roots at this level. There continues to be encroachment of exiting nerve roots on the left-sided C3-4 and at C5-6 as detailed above. There is no evidence for spinal stenosis.


Instruction: Generate impression based on findings.

Input: Evaluate for rotator cuff pathology, infraspinatus atrophy. ROTATOR CUFF: There is a full thickness, transverse tear of the supraspinatus tendon with retraction and atrophy of the muscle. There are questionable residual fibers anteriorly. There is a complete transverse tear of the infraspinatus tendon with retraction and atrophy of the muscle. The teres minor muscle and tendon are intact. There is marked thickening and increased T2 signal within the subscapularis tendon compatible with marked tendinosis. SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint with joint space narrowing and subchondral cyst formation.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is superior subluxation of the humeral head from the glenoid. There is a moderate glenohumeral joint effusion.There is diffuse degenerative changes of the labrum.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Full thickness tearing of the supraspinatus and infraspinatus tendons with retraction and associated muscle atrophy.2. Marked subscapularis tendinopathy.3 Diffuse degenerative changes of the labrum.


Instruction: Generate impression based on findings.

Input: Male, 8 years old, with slurred speech, facial droop and aggressive behavior. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The medial temporal lobe structures are free of any focal lesions or abnormal signal intensity. However, the left hippocampus demonstrates a relatively more rounded configuration along its body compared to the right side (see image 78 and image 83 of series 1502), with very slight asymmetric prominence of the temporal horn and a vertically oriented collateral sulcus.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: 1.No acute intracranial abnormality.2.Findings are seen suggestive of the possibility of incomplete hippocampal inversion on the left. The significance of this finding is uncertain as it is an occasional asymptomatic incidental finding.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. There is moderate disc narrowing at C5-C6. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.At C2-C3, there is right facet arthropathy.At C3-C4, there is right-sided uncovertebral hypertrophy and facet arthropathy with mild right foraminal narrowing. There is also a shallow central disc protrusion which indents the ventral thecal sac without stenosis.At C4-C5, there is no significant disk pathology or stenosis.At C5-C6, there is a mild diffuse posterior osteophyte disk complex bilateral uncovertebral hypertrophy and left facet arthropathy. There is moderate left foraminal narrowing.At C6-C7, there is a left paracentral/foraminal posterior osteophyte disk complex as well as left-sided facet arthropathy and uncovertebral hypertrophy contributing to overall moderate-severe left and minimal right foraminal stenosis.At C7-T1, there is no significant disk pathology or stenosis.There is moderate fluid opacification of visualized right mastoid air cells.THORACIC SPINE

Output: 1.Mild-moderate cervical spondylotic changes with findings most prominent at C6-C7 where there is moderate severe left foraminal narrowing.2.No evidence of abnormal cord signal or enhancement.3.Very minimal thoracic spondylotic changes with no significant stenosis.


Instruction: Generate impression based on findings.

Input: 33 years, Female, chronic daily headache. Right-sided tingling. Brain: No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical white matter which are nonspecific. Cerebellar tonsils are normal position. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Partially empty sella is incidentally noted. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis; alignment is otherwise maintained. Bone marrow signal is within normal limits. There is no abnormal enhancement in the cervical spine.The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Tiny dorsal annular fissure and central disc protrusion without significant compromise to the spinal canal or neural foramina.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. 7 mm right thyroid nodule incidentally noted. There is a 1 cm benign-appearing lesion with low T1 and low T2 signal within the prominent subcutaneous fat of the left posterior neck, which is nonspecific and of doubtful clinical significance.

Output: 1. MRI of the brain essentially within normal limits for age. Few small foci of T2/FLAIR hyperintensity are seen in the bilateral frontal subcortical white matter which are nonspecific and may be related to prior inflammation or associated with migraines, for example.2. Partially empty sella, which may be a normal variant but can also be seen with intracranial hypertension in the appropriate clinical setting.3. Evaluation of the cervical spine demonstrates minimal, degenerative changes without spinal canal or neural foraminal stenosis at any level.4. 7 mm right thyroid nodule.


Instruction: Generate impression based on findings.

Input: 15-year-old male with laceration to toe. Cannot move toe after injury. TENDONS: There is increased STIR signal in the dorsal soft tissues overlying the third toe. Abnormal STIR signal surrounds the third extensor tendon, and focal thinning of the tendon is noted on T1-weighted images in this area of swelling/edema (series 12, image 15). Findings may represent a partial tear or trapping of the 3rd extensor tendon. LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Findings suggestive of partial tear or trapping of the third extensor tendon with surrounding edema as described above.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for bilateral proximal biceps tendinitis and/or ischial bursitis, left hip pain There is some asymmetric increased T2/STIR signal at the insertion of the right hamstring tendons, but there is no evidence of tendinous retraction.BONE MARROW: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Increased signal at the insertion of the right hamstring tendons may represent partial tear at its insertion, however there is no evidence of tendinous retraction.


Instruction: Generate impression based on findings.

Input: 65 year old male status post right craniotomy for tumor. Expected postsurgical changes are noted including right superior frontoparietal craniectomy, with residual pneumocephalus and edema. Few punctate areas of hyperdensity consistent with petechial hemorrhage detected within the surgical cavity. Hypodensity within the right caudate is unchanged when compared to the previous MRI and represents an old lacunar infarct.The ventricles and basal cisterns are normal in size and configuration.The calvaria demonstrate stable post surgical change and skull base is radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Expected postoperative changes as described above.


Instruction: Generate impression based on findings.

Input: 75-year-old woman with history of myelofibrosis, please evaluate spleen size. ABDOMEN:LIVER, BILIARY TRACT: The liver is markedly hypointense on T2 images. Additionally, the liver is large measuring 20 cm in craniocaudal dimension. No focal hepatic lesion identified. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: Paradoxical signal loss on the opposed phase images indicates iron deposition. The spleen is enlarged measuring 21 centimeters in craniocaudal dimension by 14.9 x 7.8 cm in axial dimension. Additionally, there are scattered splenic lesions which are hypointense on T1 images and do not enhance, indeterminate in etiology.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is mild scoliosis of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The marrow signal in the pelvis is abnormal with diffuse, patchy areas of increased T2 signal and decreased T1 signal.OTHER: There is trace free fluid in the pelvis.

Output: 1.Splenomegaly with dimensions provided above.2.Marrow signal abnormality compatible with history of myelofibrosis.


Instruction: Generate impression based on findings.

Input: 48 year-old male with history of profound right and mild left sensorineural hearing loss. Evaluate for possible LEFT cochlear hydrops. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. There appears to be thinning of the bone overlying the right superior semicircular canal, which is otherwise inconspicuous in some parts. The bilateral endolymphatic ducts are not discernible. The other inner ear structures otherwise appear unremarkable. There is fluid within the bilateral mastoid air cells. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The bilateral endolymphatic ducts are not discernible. This can be due to technical factors or may be a manifestation of Meniere disease. A dedicated temporal bone CT may be useful for further evaluation.2. Possible dehiscence and dyplasia of the right superior semicircular canal. A dedicated temporal bone CT may also be useful for further evaluation.3. The bilateral cochleas and cochlear nerves are intact. 4. Probable bilateral mastoid air cell effusions.


Instruction: Generate impression based on findings.

Input: 52-year-old man with history of low back pain. Five lumbar type vertebral bodies are present on this study. The vertebral body heights are within normal limits. There is normal lumbar lordosis. Small, scattered foci of T1 and T2 hyperintensity likely represent hemangiomata and the bone marrow signal is benign. The conus medullaris is normal in position.There is mildly decreased signal in the L3/L4 and L4/L5 discs suggesting desiccation. Throughout the lumbar spine, there is developmental narrowing of the spinal canal. Additional multilevel degenerative changes are seen, as described below:L1-L2: There is no significant disc disease. There is no spinal canal or neural foraminal stenosis.L2-L3: There is no significant disc disease. There is no spinal canal or neural foraminal stenosis.L3-L4: There is mild disc bulge along with mild facet arthropathy and ligamentum flavum thickening. There is mild to moderate left neural foraminal stenosis with mild right neural foraminal stenosis. There is mild spinal canal stenosis, mostly due to developmentally narrow canal.L4-L5: There is a mild bulge along with moderate facet arthropathy and ligamentum flavum thickening. There is moderate to severe right neural foraminal stenosis with mild to moderate left neural foraminal stenosis. There is mild to moderate spinal canal stenosis, mostly due to developmentally narrow canal.L5-S1: There is a minimal disc bulge and mild bilateral facet arthropathy. There is mild right neural foraminal stenosis and minimal left neural foraminal stenosis. There is no spinal canal stenosis.The paraspinous soft tissues are within normal limits.

Output: 1.Multilevel degenerative changes in the lumbar spine along with a developmentally narrow spinal canal which results in stenosis which is, at worst, mild to moderate at L4/L5. No high-grade spinal canal stenosis.2.Multilevel neural foraminal stenoses as detailed above.3.Facet arthropathy at L3/L4, L4/L5, and L5/S1, which may also be contributing to the low back pain.


Instruction: Generate impression based on findings.

Input: Decubitus ulcers Note that the exam is limited by the presence of only the axial T1 and axial T2 fat sat sequences.BONE MARROW: The marrow demonstrates a diffusely heterogeneous appearance however there is no discrete low T1 signal to confirm osteomyelitis. Sclerotic changes noted within the femoral head bilaterally likely relate to avascular necrosis. The right femoral head is superiorly migrated but remains within the acetabulum.SOFT TISSUES: There is diffuse fatty atrophy of the pelvic musculature. There is mild decubitus ulceration of the subcutaneous tissues of the right buttock. Underlying this area is a heterogeneous collection containing low peripheral signal with central areas of fluid signal intensity. A similar appearing collection is seen within the left gluteal tissues again demonstrating a low peripheral signal with areas of fluid signal centrally. These findings are thought to represent hematomas although the possibility of superimposed infection cannot be excluded. Note that the collection along the left gluteal musculature does not demonstrate a fistulous tract with the skin surface.

Output: 1. No definite evidence of osteomyelitis. The marrow signal is heterogeneous in nature with probable avascular necrosis of the femoral heads although correlation with recent CT is recommended.2. Ill-defined collections within the gluteal musculature bilaterally are thought to represent hematoma, likely chronic, although the presence of superimposed infection cannot be excluded.3. Additional chronic findings described above.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: Headaches, neck pain C3 -- C4. Clinical question: Is there evidence of fracture/dislocation. Non-enhanced CT of brain:M. there is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray -- white matter differentiation remains to be normal.Calvarium is intact.CT of the cervical spine:There is no evidence of fracture or subluxation. Very minimal degenerative changes of cervical spine is noted. Reformatted images demonstrate normal alignment the vertebral column. No definitive neural foramina compromise or central spinal stenosis. Limited images through the apices of the lungs demonstrate emphysematous pole I bilaterally. Multi-level subtle bulge of disk material is present. This is more pronounced at C3 -- C4 and apparent subtle mass effect on the cord. This findings can be better evaluated with an MRI exam.

Output: 1.Unremarkable nonenhanced CT of brain.No evidence of fracture or subluxation of cervical spine. Minimal degenerative disk disease.


Instruction: Generate impression based on findings.

Input: History of extraosseous Ewing sarcoma of the right hand. Surveillance 18 months off therapy. A marker was placed along the dorsum of the hand overlying the space between the heads of the second and third metatarsals. Small foci of subcutaneous signal abnormality deep to the marker likely reflects metallic susceptibility artifact related to prior surgery. I see no mass or abnormal enhancement in the underlying soft tissues to indicate tumor recurrence. The musculature of the hand appears normal. There is minimal enhancement of the second metacarpophalangeal joint perhaps representing a very mild synovitis, of questionable clinical significance. Bone marrow signal intensity is normal.

Output: No evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Vision and weakness of right leg. Evaluate for multiple sclerosis burden of disease. There are multiple ovoid T2 hyperintense lesions within the cerebral white matter. Although some lesions are no longer identified, there is an overall increase in size and number of T2 hyperintense lesions, with several lesions diffusely enhancing, while other are peripherally enhancing. For example, a new ring-enhancing lesion within the right superior frontal gyrus measures 0.7 x 0.6 cm. There are multiple new T2 hypertense lesions within the corpus callosum, one of which demonstrates enhancement (series 701, image 19; series 1201, image 19). There also appears to be an enhancing lesion in the left optic nerve. There is also a new T2 hyperintense focus within the right cerebellum, which does not exhibit restricted diffusion or enhancement. There is no evidence of intracranial hemorrhage or acute infarction. There is an unchanged partially empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Increased number of demyelinating lesions, many of which demonstrate enhancement.


Instruction: Generate impression based on findings.

Input: Nausea, metastatic NSCLC. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered nonenhancing punctate foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracerebral hemorrhage in hemisphere, unspecified [I61.2], Reason for Study: ^Reason: eval ?meningioma, etiology of ICH History: left weakness Brain MRI:There is evidence of restricted diffusion on the right occipital lobe indicating acute ischemic infarct. In addition, there is a linear circumscribing susceptibility effects around the restricted diffusion area which suggest prior hemorrhage. The right occipital lobe shows volume loss with surrounding white matter high signal intensity on FLAIR images indicating chronic ischemic infarction. There is 34mm x 33mm x 33mm sized right frontal ICH with surrounding edema and mass effects.Underlying brain shows patchy high signal intensities on periventricular white matter and centrum semiovale indicate non specific small vessel disease.There is about 20mm x 22mm x 17.5mm sized anterior cranial fossa meningioma. No change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The right vertebral artery origin shows about 50% of luminal stenosis and the left vertebral artery origin appears to be normal.

Output: 1. Acute ischemic infarction within the area of chronic ischemic infarction with chronic hemorrhages on the right occipital lobe.2. Acute ICH on the right frontal lobe with surrounding edema and mass effects.3. No change of anterior cranial fossa meningioma since prior scan.4. No fluid limiting luminal stenosis on both intracranial and extracranial arterial system. No intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: Female, 2 years old, with hypotonia and developmental delay. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.The pituitary region is within normal limits. The corpus callosum is fully formed and normal. White matter myelination is appropriate for age. The brainstem, cerebellar vermis and cerebellar hemispheres are all within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. An incidental right parietal developmental venous anomaly is noted.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 22 years old Male. History of repeated shoulder dislocation (4 dislocations in the last 4 months). Evaluate for glenoid bony loss. IMAGE ACQUISITIONS: CT of the right shoulder without contrast The osseous structures of the glenoid are intact with no evidence of osseous Bankart's fracture.Depression at the superior lateral aspect of the humeral heads is consistent with Hill-Sachs deformity which was noted on prior MRI dated 7/15/2010

Output: 1.No abnormalities in the osseous components of the glenoid.2.Hill-Sachs deformity of the humeral head is noted.


Instruction: Generate impression based on findings.

Input: Follow-up left renal angiomyolipoma. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic left inferior pole fat-containing renal lesion measures approximately 1.1 x 1.0 cm (series 8, image 67), not significantly changed from the prior exam, remaining compatible with angiomyolipoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression deformities of L1 and L2 are redemonstrated.OTHER: No significant abnormality noted.

Output: No significant interval change in size or signal characteristics of a 11 mm left inferior pole renal mass, consistent with angiomyolipoma.


Instruction: Generate impression based on findings.

Input: History of lupus, presumed tuberculosis on treatment, with new cavitary brain and pulmonary lesions transferred from the MICU after initially presenting with 1 week of left sided weakness and hematemesis. There is interval decrease in size of a peripherally-enhancing lesion with central restricted diffusion in the periventricular region of the right frontal lobe, which measures up to 11 mm, preciously 13 mm. There is also decrease in the degree of surrounding vasogenic edema. There is also decrease in size of the peripherally enhancing right cerebellar hemisphere lesion, which measures up to 10 mm, previously 12 mm. There is also decreased vasogenic edema associated with this lesion. The left occipital lobe peripherally enhancing lesion is not significantly changes in size, measuring up to 6 mm, but the associated vasogenic edema appears to have diminished. There is decreased debris with restricted diffusion within the right lateral ventricle, but there appears to be more pronounced enhancement and T2 hyperintensity along the ventricular margin. Furthermore, the punctate focus of debris in the left occipital horn has resolved. The ventricular system is not dilated. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: Interval evolution of the multiple cerebral abscesses and ventriculitis, which appear to be largely subsiding.


Instruction: Generate impression based on findings.

Input: 52 year old male patient with complaints of nocturia, 2-3 times at night, and elevated PSA. PELVIS:PROSTATE:Prostate Size: 5.1 x 3.3 x 3.8 cm.Peripheral Zone: There is a 6 x 3 mm focus of T2 hypointensity with corresponding mildly decreased ADC values within the left mid gland (image 43, series 301). An additional foci of T2 hypointensity with mild ADC hypointensity within the right apex is also identified.Central Gland: The central gland is hypertrophied with BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: No definite extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two small sites of signal abnormality within the right apex and left mid gland of the peripheral zone are indeterminate for tumor.


Instruction: Generate impression based on findings.

Input: 38 year old woman with history of right sided heart failure and nephrotic syndrome, with new biventricular dysfunction and hypertrophy on echocardiogram; now referred for cardiac MRI to evaluate for possible infiltrative disease. Left VentricleThe left ventricle is upper normal in size with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 148 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 99 ml (normal range 31+/-10). LVH is present. LV wall motion is globally reduced. There is no delayed enhancement to suggest an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload. Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is moderate-severely dilated with reduced systolic function . The overall RV ejection fraction is 28%, the RV end diastolic volume index is 122 ml/m2 (normal range 69+/-14), the RVEDV is 205 ml (normal range 110+/-24), the RV end systolic volume index is 87 ml/m2 (normal range 22+/-8), and the RVESV is 147 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated . Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely with at least mild mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (33mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere are bilateral pleural effusions, right greater than left. There is an area of consolidation in the right lower lobe. 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. Upper normal sized left ventricle with global moderately reduced systolic function (EF 33%)2. Moderate-severely dilated right ventricle with severely reduced function (EF 28%). 3. Biatrial dilatation4. At least moderate tricuspid regurgitation 5. Bilateral pleural effusions. 6. Dilated main pulmonary 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: 68-year-old female with left deltoid pain and throbbing after intramuscular flu shot on 12/14. The imaged musculature of the right shoulder and arm is normal in appearance. Specifically, the deltoid muscle is unremarkable. Note is made of irregular enhancing synovium about the glenohumeral joint suggestive of synovitis. There is circumferential fluid within the tendon sheath of the long head of the biceps with associated irregular enhancement, indicating a mild tenosynovitis. Moderate osteoarthritic changes affect the left glenohumeral joint with apparent near full-thickness to full-thickness articular cartilage degeneration. There are multiple small erosions affecting the humeral head. The glenohumeral joint alignment is anatomic. No focal fluid collection to suggest abscess formation.

Output: 1. Erosions of the humeral head and glenohumeral joint synovitis, which are nonspecific but may be related to the patient's history of rheumatoid arthritis. 2. Tenosynovitis involving the long head of the biceps tendon. 3 .The deltoid musculature is normal in appearance, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Fluctuating Wiernicki and persistent right face and arm weakness. There is an area of high T2 signal and restricted diffuse in the medial left thalamus that measures up to 20 mm. There may be punctate foci of susceptibility effect within this lesion. There is a small chronic infarction in the left cerebellar hemisphere. The rest of the brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Small left medial thalamus acute infarct with possible petechial hemorrhages, although assessment is limited by patient motion artifact. Small chronic infarction in the left cerebellar hemisphere.