Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: Evaluate for metastatic lesions History: History of breast CA, presenting with seizure and bilateral masses on HCT There are multifocal variable sized round enhancing lesions on bilateral hemispheres, brain stem as well as cerebellum. There is an enhancing lesion based on the left side falx around the area of the left postcentral gyrus. Most of these lesions show restricted diffusion with surrounding edema. Constellation of above findings indicate multifocal brain metastasis with surrounding edema.Bilateral lateral ventricles show effacement due to mass effects with minimal midline shift toward left side.There are nodular conglomerated susceptibility lesions on the left thalamus without evidence of T1 high signal intensity nor evidence of enhancement indicating possible chronic hemorrhages. Patchy FLAIR high signal intensities on bilateral periventricular white matter indicate underlying non specific small vessel ischemic disease. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal bihemispheric, supra and infratentorial metastatic lesions as described above with minimal midline shift toward left side. 2. Underlying non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.0 x 5.9 x 5.8 cmPeripheral Zone: No intrinsic T1-weighted signal hyperintensity. The peripheral zone is diffusely thinned with scattered linear regions of T2 weighted hyperintensity.In the left mid gland medial region there is a vague region of T2 weighted hypointensity measuring 1.1 x 0.5 cm (series 901/21).In the paramedial apex there is a 1.7 x 1.0 cm region of T2 weighted hypointensity (series 901/14). This lesion may be associated with early washout relative to the remainder of the peripheral zone on dynamic phase imaging (series 1 501/1 230).The diffusion weighted images are limited by artifact.Central Gland: Moderately enlarged due to hyperplasia. No discrete suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Several small external iliac lymph nodes. The largest is a right external iliac lymph node measuring 1.1 cm in short axis (series 160 0 1/108). Shotty subcentimeter retroperitoneal lymph nodes extending to the aortic bifurcation are are also noted but are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Left paramedial mid gland and paramedial apex lesions are suspicious for prostatic adenocarcinoma and are amenable to MRI/ultrasound fusion biopsy.2. Mildly prominent pelvic lymph nodes.


Instruction: Generate impression based on findings.

Input: Persistent low back pain. History L5-S1 microdiscectomy. There are postoperative findings related to the previous L5-S1 microdiscectomy through a left laminotomy/partial facetectomy. There is mild protrusion of the L5-S1 disc eccentric to the left with mild enhancement along the surgical defect in the disc. There is also mild enhancement in the epidural fat within the left lateral recess at this level surrounding the nerve roots. There is disc desiccation at L5-S1 and to certain extent L2-L3 and L4-L5, with mild disc height loss. There is facet hypertrophy at the L3 through S1 levels. However, there is no significant spinal canal or neural foraminal stenosis. The vertebral column alignment is within normal limits. There are multilevel small intravertebral disc herniations. The vertebral body heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1.There are expected postoperative findings related to the left L5-S1 microdiscectomy with minimal disc protrusion eccentric to the left as well as a small amount of probable granulation tissue and/or scar tissue formation in the surgical bed.2.No significant spinal canal or neural foraminal stenoses at the other lumbar spine levels.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with history of a left cerebellopontine angle meningioma status post resection, surveillance imaging. Findings are again seen compatible with left retrosigmoid craniotomy for resection of a left CP angle meningioma. Enhancing tissue within the left pontine cistern is unchanged measuring up to 7 mm in overall thickness. As before, this tissue exerts mild mass effect upon the left aspect of the pons but there is no evidence of pontine edema. Also similar to prior, there appears to be an enhancing dural tail which extends from this tissue into the left internal auditory canal.No new or concerning lesions are seen. A vague focus of enhancement within the midline pons is unchanged and favored to represent a capillary telangiectasia. Brain parenchymal morphology is otherwise unremarkable. No new areas of signal abnormally are seen. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.Redemonstration of postoperative findings related to prior left CP angle meningioma resection.2.Enhancing tissue within the left prepontine cistern, favored to represent residual meningioma, is unchanged.3.No new or concerning intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with history of metastatic endocrine adenocarcinoma, status post brain metastasis resection and stereotactic radiosurgery. A resection cavity is redemonstrated in the right anterior temporal lobe which has cleared of blood product and debris when compared to the immediate postoperative study. Encephalomalacia and T2 hyperintensity along the margin of the cavity is within expected postoperative limits. A band of enhancement along the posterior resection cavity margin seen on the prior examination has diminished in thickness with development of mild intrinsic T1 hyperintensity in the same area.No new areas of parenchymal signal abnormality or pathologic parenchymal enhancement are detected. A few scattered nonspecific foci of T2 hyperintensity within both hemispheres are unchanged. No edema or mass effect is observed. No new abnormal collections are detected. Apart from mild ex vacuo dilatation of the right temporal horn, the ventricular system is stable and normal in size.

Output: 1.Findings are redemonstrated compatible with tumor resection from the right anterior temporal lobe.2.A band of enhancement along the posterior cavity margin first noted on the prior examination has diminished in thickness likely representing expected evolution of postoperative change.3.No additional intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Ms. Unkovich is a 31-year-old female enrolled in the research breast cancer screening study for high-risk individuals. Family history of breast cancer in mother, diagnosed at the age of 36. Patient is BRCA1 positive. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: ICH and vascular malformation excision (many years ago). MRI: There is extensive encephalomalacia involving much of the temporal lobe and a small portion of the adjacent occipital lobe with ex vacuo dilatation of the left lateral ventricle. There is a small amount of susceptibility effect in the left lateral temporal lobe. There is a small area of encephalomalacia in the left cerebellar hemisphere as well. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions or aneurysm.

Output: 1. Extensive encephalomalacia involving much of the temporal lobe and a small portion of the adjacent occipital lobe with a small areas of residual chronic blood products and small chronic left cerebellar hemisphere infarct. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarction.2. No evidence of significant cerebral steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: Hysterectomy with bladder sling/mesh. Intermittent constipation. Please evaluate for herniation or mesh out of place. PELVIS:UTERUS, ADNEXA: Surgically absent. No significant abnormality is noted otherwise.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal appearance of the imaged bowel loops.BONES, SOFT TISSUES: No significant abnormality noted. Please see separate MRI lumbar spine report from the same day.

Output: No evidence of postsurgical complication or specific findings otherwise to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 10-year-old female patient with pain in the right hip for 3 years, evaluate for impingement. ACETABULAR LABRUM: The acetabular labrum appears intact for nonarthrographic technique.ARTICULAR CARTILAGE AND BONE: The marrow signal appears appropriate for age. There is physiological fluid in the bilateral hip joints.SOFT TISSUES: There is muscle edema of the obturator externus near the right ischium at the myotendinous junction, indicating muscle strain. There is no muscle atrophy. The tendinous insertions of the adductors, hamstrings, and gluteal muscles are intact. The sciatic nerve appears normal without entrapment. There is trace fluid in the pelvis, which may be physiologic.ADDITIONAL

Output: Strain of the obturator externus muscle.


Instruction: Generate impression based on findings.

Input: Low back pain. There is a background of congenital spinal canal narrowing. There is also multilevel degenerative spondylosis. At L2-3, there is a slight disc bulge with minimal bilateral neural foraminal stenosis, but no significant spinal canal stenosis. At L3-4, there is a mild posterior osteophyte disk complex with bilateral facet arthropathy and ligamentum flavum thickening with moderate spinal canal stenosis and bilateral foraminal narrowing. At L4-5, there is a small disc herniation and a subcentimeter right facet joint synovial cyst effaces the right lateral recess, with impingement upon the cauda equina nerve roots in this area. At L5-S1, there is bilateral facet arthropathy and ligamentum flavum thickening with mild-to-moderate bilateral foraminal narrowing. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Congenital narrowing of the lumbar spinal canal with superimposed degenerative spondylosis that is most pronounced at L3-L4, where there is moderate central spinal canal stenosis and at L4-5, where a right facet joint synovial cyst and disc herniation efface the right lateral recess.


Instruction: Generate impression based on findings.

Input: Female 70 years old Reason: r/o cord compression History: acute b/l LE weakness The spinal cord has normal signal characteristics and overall morphology. There is no evidence of acute cord compression. Compression fracture of the T7 vertebral body which is hypointense on both STIR and T1 sequences, suggesting it is likely chronic. There is no definite retropulsion of fragments. Kyphosis of the thoracic spine is centered at the T7 vertebral body. There are also mild posterior disc bulges in the cervical spine without significant compression on the spinal cord.

Output: 1.No cord compression is identified. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. 2.Compression fracture of the T7 vertebral body is favored to be chronic in etiology.Findings discussed between on-call radiology resident and Dr. Wali at approximately 1945 on 11/13/2016.


Instruction: Generate impression based on findings.

Input: Clinical question: Mass signs and symptoms: Headaches Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass, mass effect, midline shift or hydrocephalus.Cortical sulci and ventricular system are within normal range for patient's stated age of 43. There is subtle crowding of the cerebellar tonsils at the level of foramen magnum concerning for mild ectopia of the cerebellar tonsils. Please correlate with history and follow-up with an MRI.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial process.2.Minimally ectopic cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: Female, 66 years old. Status post cervical fusion There are anterior fixation devices at C4-5 and C5-6 with intervertebral bone graft at these levels. We see no hardware complications. There is minimal anterolisthesis at C4. There is swelling in the prevertebral soft tissues with foci of gas indicating recent surgery.

Output: Postoperative changes of cervical spine fixation as described above.


Instruction: Generate impression based on findings.

Input: 16 year old presenting with history of exertional syncope presenting for evaluation for structural anomaly. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 116 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 50 ml (normal range 31+/-10), the LV mass index is 29 g/m2 (normal range 67+/-11), and the LV mass is 45 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is increased signal intensity within the intrasubstance of the supraspinatus tendon likely reflecting some intrasubstance tearing and tendinosis but there is no evidence of a full-thickness rotator cuff tear. The infraspinatus, teres minor, and subscapularis tendons are intact. There is minimal atrophy of the supraspinatus tendon along the myotendinous junction but otherwise the rotator cuff musculature is intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is moderate osteoarthritis of the glenohumeral joint with degenerative tearing of the superior and anterior labrum. There is a small amount of fluid within the glenohumeral joint. Degenerative signal intensity is identified within the greater tuberosity at the attachment of the rotator cuff.BICEPS TENDON: Small amount of fluid surrounds the biceps tendon reflecting extension from the glenohumeral joint. ADDITIONAL

Output: Intrasubstance tearing and tendinosis of the supraspinatus tendon but otherwise there is no evidence of rotator cuff tear. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: 46-year-old male with left lateral (just above the knee): Evaluate for cyst versus solid mass. Pain and nodule on left lateral knee. Patient fell one month prior. Effusion of the left knee measuring approximately 8 cm in length. Within this left knee effusion, there is a 4.4 x 1 x 3.6 cm internal echogenic focus.

Output: Complex effusion of the left knee. Repeat MRI of the left knee is recommended for further evaluation. Patient trauma occurred 1 month ago and prior knee MRI was 3 months ago.


Instruction: Generate impression based on findings.

Input: Male 15 years old Reason: Knee pain and swollen History: knee pain and swelling MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact. T2 hyperintense bone contusion involving the lateral aspect of the distal femur and the medial aspect of the patella. The patella is displaced laterally.LIGAMENTS: Cruciate and collateral ligaments are intact. T2 hyperintense signal and partial tearing of the MPFL.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1. Lateral distal femoral and medial patellar bone contusion with partial tearing of the MPFL, consistent with transient patellar dislocation.2. Large joint effusion.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:11/19/1946)Reason: encephalopathy History: encephalopatyPROVIDER/ATTENDING NAME: BRYAN A CAMPBELL SANDEEP S PULIMI MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal 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 partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is loss of signal present at the petrous segments of internal carotid arteries which is suspected to be artifactual. There are mild foci of narrowing without significant stenosis at the cavernous segments of the internal carotid arteries. There is loss of signal present at the proximal intracranial right vertebral artery just distal to the extracranial origin of the right posterior inferior cerebellar artery.There is mild narrowing of the left M1 segment with approximately 50% stenosis.At the proximal right M1 segment there is a 1.5 mm saccular extension protruding superiorly. No perforators are identified cessation this.The right A1 segment is hypoplastic.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are medium-sized. There is an infundibulum at the origin of the posterior communicating artery bilaterally.. The vertebral arteries are similar in size.

Output: 1.There is some intracranial cerebrovascular narrowings present without significant stenosis on the basis of WASID criteria. There is 50% narrowing at the left M1 segment.2.At the proximal right M1 segment there is a 1.5 mm saccular extension suspected to represent an aneurysm. It could also represent an infundibulum of the perforators not visualized on this exam. If clinically appropriate a CT angiogram may be helpful here.3.There is signal loss along the petrous segments of the internal carotid arteries as well as the right vertebral artery. As a result evaluation of these specific locations is suboptimal on this exam.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.There is no evidence for acute ischemic cerebral infarction on this exam.


Instruction: Generate impression based on findings.

Input: There is no suspicious enhancement, acute infarct, mass, or cerebral edema. There are a few small scattered periventricular and subcortical white matter T2 signal abnormalities which are nonspecific. There is diffuse low T2 signal with susceptibility effect in the bilateral dentate nuclei and basal ganglia likely representing mineralization probably related to a metabolic etiology. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.No intracranial mass or suspicious enhancement.2.Possible minimal chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 40 year-old male referred for cardiac MRI to assess for etiology of cardiomyopathy. Stress portion of MRI had to be aborted due to patient size. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 335 ml (normal range 142+/-34), the LV end systolic volume index is 96 ml/m2 (normal range 25+/-9), the LVESV is 247 ml (normal range 47+/-19), the LV mass index is 90 g/m2 (normal range 85+/-15), and the LV mass is 231 g (normal range 164+/-36). The left ventricular dysfunction is global with regional variation. There is patchy mid-wall late gadolinium enhancement in the septum and inferolateral wall which is atypical for coronary artery disease and which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 19%, the RV end diastolic volume index is 199 ml/m2 (normal range 82+/-16), the RVEDV is 507 ml (normal range 142+/-31), the RV end systolic volume index is 161 ml/m2 (normal range 31+/-9), and the RVESV is 412 ml (normal range 54+/-17).Right AtriumThe right atrium is severely.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 26%.The left ventricular dysfunction is global with regional variation. There is patchy mid-wall late gadolinium enhancement in the septum and inferolateral wall which is atypical for coronary artery disease and which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.2.The right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 19%3.Biatrial enlargement


Instruction: Generate impression based on findings.

Input: Male, 20 years old, with history of paranoid schizophrenia. Functional MRI requested for identification of the sensorymotor language area, primary auditory cortex, and area Spt (Sylvian parietotemporal) with external anatomic correlates for transcranial magnetic stimulation. Sensorimotor cortical activation observed during the hand, foot and face/tongue motor tasks maps to its expected locations along the pre- and post-central gyri.Passive auditory stimulation induces cortical activation bilaterally in the superior temporal gyri (Heschl's gyrus and to a small degree the planum temporale).All tested language paradigms produced reliable language related cortical activation. Language is left dominant with task-dependent minor contributions from the right hemisphere.Broca's area cortical activity is identified in the pars opercularis of the left inferior frontal lobe, again with minor contributions from the right. Wernicke's area cortical activity is identified along the posterior aspect of the left superior temporal sulcus, best seen on the verb generation paradigm.A candidate for area Spt is identified only on the verb generation paradigm where cortical activation is present on the left along the Sylvian fissure at the junction of the parietal and temporal lobes.Most language paradigms elicit robust bilateral secondary language activation, particularly in the middle frontal gyri, though again with some left predominance. Language related SMA activation is also seen.

Output: Sensorimotor cortical activity maps as expected along the pre- and post-central gyri.Language is left dominant with some minor task dependent contributions from the right hemisphere. Broca's area is identified as expected in the pars opercularis of the inferior frontal lobe. Wernicke's area is identified as expected along the posterior aspect of the superior temporal sulcus.Passive auditory stimulation identifies primary auditory cortex mapping to the superior temporal gyri (Heschl's gyrus and the planum temporale).A candidate region for area Spt is identified on the verb generation paradigm where cortical activity is seen on the left, along the Sylvian fissure, at the junction of the parietal and temporal lobes.


Instruction: Generate impression based on findings.

Input: 37 year old woman with history of tethered cord and pseudomeningocele, presenting with back pain. Again seen is evidence of spinal dysraphism and postsurgical changes related to multiple cord untethering and pseudomeningocele repair. Unchanged appearance of the low-lying cord with the distal neural tissue terminating at the S2 level with mild focal thickening which may be due to scarring. There is no significant change in contour of the expanded distal thecal sac. The position of the distal cord is unchanged with prone repositioning, which may represent cord retethering in the appropriate clinical setting. No syrinx is evident. A previously described focal fluid collection immediately dorsal to the thecal sac at the S2-S3 level is no longer present. Edematous changes affecting the subcutaneous tissues have improved, although are not completely imaged on today's examination. There is no new or enlarging fluid collection to suggest CSF leak. Alignment of the lumbar spine is anatomic. There is a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. A hemangioma within the L4 vertebral body is unchanged in appearance. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. Lower thoracic body Schmorl's nodes are again noted.

Output: 1.Interval resolution of a previously described focal fluid collection immediately dorsal to the thecal sac at the S2-S3 level. Mild persistent edematous changes affect the subcutaneous soft tissues overlying this region. 2.Unchanged appearance of the low-lying cord. The position of the distal cord is unchanged with prone repositioning, which may represent cord retethering in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Drop attacks, with seizure. There is a curvilinear area of susceptibility effect in the region of the right hippocampal tail and posterolateral thalamus. There are mild areas of cerebral white matter T2 hyperintensity bilaterally, predominantly in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration, without evidence of colloid cyst. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: A curvilinear area of susceptibility effect in the region of the right hippocampal tail and posterolateral thalamus may represent prior hemorrhage. Areas of cerebral white matter T2 hyperintensity bilaterally, may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 56 year old male patient with biopsy proven prostate cancer. Evaluate for extracapsular spread. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.7 x 3.9 cm. Peripheral Zone: There is a 1.0 x 1.4 cm region of T2 hypointensity, ADC hypointensity, and early enhancement within the right base of the peripheral zone compatible with tumor (image 58, series 301). The overlying capsule is indistinct with likely focal extraprostatic extension.Central Gland: BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: As described above.BLADDER: No significant abnormality noted.LYMPH NODES: Non-specific small bilateral external iliac and left internal iliac lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat-containing bilateral inguinal hernias.

Output: Tumor within the right base of the peripheral zone with focal extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with paresthesias and history of multiple sclerosis. Evaluate for progression. Extensive confluent T2 hyperintensity within the subcortical and periventricular white matter is again seen without significant interval change from the prior examination. No definite new lesions are seen. The affected parenchyma demonstrates moderate to marked T1 hypointensity, similar to prior. Thinning of the corpus callosum and moderate generalized parenchymal volume loss appear to be stable as well. Ventricular size and morphology are unchanged. No abnormal extra-axial collections are seen.

Output: Stable extensive white matter disease compatible with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 57-year-old female with meningioma and seizures, follow-up. Increased T2/FLAIR signal and expansion of the left amygdala without enhancement appears similar to the prior exam. An enhancing extra-axial lesion in the left frontal convexity adjacent to the left inferior frontal gyrus is unchanged in size measuring 1.1 x 0.7 x 1.0 cm. No additional enhancing lesions are identified. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is a left maxillary mucous retention cyst/polyp.

Output: 1.Gyral thickening and increased signal in the left amygdala appears similar to the prior exam. While this could still be post ictal in etiology if clinically appropriate, its stability from the prior exam raises the concern for a low-grade infiltrating glioma or encephalitis.2.Left frontal meningioma is stable.


Instruction: Generate impression based on findings.

Input: Angiosarcoma, post resection of epidural mass at T5-7 in 04/2011 followed by adjuvant radiation therapy. Absence of intravenous gadolinium again slightly limits evaluation. Again seen are postoperative changes of laminectomy and epidural tumor resection at T5 through T7 levels. Mild thoracic kyphosis is similar to prior. Epidural scarring without any significant mass effect on the thecal sac remains similar to prior exam. There is no evidence of spinal stenosis at this level. There is no detectable signal abnormality or change in the caliber of the cord.There is marrow signal replacement with low T1 and high T2 signal involving the left aspect of T5 and T6 vertebral bodies posteriorly extending into the left pedicle and surrounding the neural foramina at T5-T6 and T6-T7 levels similar to prior. Also similar to prior exam there is a centrally located disk protrusion at T8-T9 level with subtle indentation on ventral aspect of the cord. No new marrow signal abnormality or new epidural mass.

Output: 1. Stable post-treatment changes with unchanged marrow signal abnormality involving the left T5 and T6 posterior lateral vertebral bodies, pedicles, and neural foramen. Lack of intravenous gadolinium limits evaluation; however, findings are compatible with stable treated tumor. No new epidural mass. No findings to suggest tumor progression.2. Unchanged central disc protrusions at T5-6 through T8-T9 with effacement of CSF space and subtle cord impression at T8-9.


Instruction: Generate impression based on findings.

Input: Reason: hx of spine lesion, evaluate for change in size History: back pain The thoracic vertebral bodies have heterogeneous signal throughout which has not changed since the prior exam. There is a low T1 and T2 signal present along the superoanterior aspect of the T11 vertebral body which is not associated with any contrast enhancement.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: 1.The examination is stable. There is redemonstration of a T11 vertebral body lesion which remains stable since prior exams. There is diffuse marrow heterogeneity present which is a nonspecific finding.


Instruction: Generate impression based on findings.

Input: There is a diffusely anomalous gyration pattern of the bilateral posterior perisylvian regions, which is compatible with polymicrogyria. There are also more focal areas of grey matter that extend toward the margins of the lateral ventricles bilaterally, which are compatible with transmantle dysplasia. There is an absent septum pellucidum and mild focal prominence of the temporal horn of the right lateral ventricle associated with mild malrotation of the right hippocampus. The ventricular system is otherwise not significantly enlarged. The corpus callosum, posterior pituitary bright spot, as well as the optic nerves and optic chiasm are grossly intact. There is a small focus of encephalomalacia in the lateral aspect of the inferior right cerebellar hemisphere and perhaps mild hypoplasia of the inferior cerebellar vermis. However, the brainstem appears to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is ethmoid sinus mucosal thickening and fluid within the mastoid air cells bilaterally.

Output: 1. Congenital bilateral perisylvian syndrome. 2. Nonspecific ethmoid sinus mucosal thickening and fluid within the mastoid air cells bilaterally.


Instruction: Generate impression based on findings.

Input: New onset headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are unchanged in size and configuration, including septum cavum pellucidum and vergae and choroid plexus cysts, which are anatomic variants. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive paranasal sinus mucosal thickening.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or Chiari malformation.2. Findings suggestive of sinusitis.


Instruction: Generate impression based on findings.

Input: 35-year-old female with cervical cancer, status post treatment now with changes on exam concerning for recurrence versus scar tissue. Back pain and increased vaginal discharge. PELVIS:UTERUS, ADNEXA: The cervical tumor measures 6.8 cm in transverse and 5.1 cm in AP diameter with central necrosis (series 1204 image 304). The tumor also demonstrates restricted diffusion (series 705 image 324). There is new enhancing inferior extension of the cervical mass into the vagina and periurethral region (series 1203 image 158). Associated outward fingerlike extensions and stranding are suspicious for parametrial invasion. BLADDER: There is wall thickening and T2 hyperintense signal intensity of the posterior urinary bladder wall (sagittal series 801 image 21) suggestive of submucosal edema.LYMPH NODES: Mildly enlarged enhancing lymph nodes in the bilateral pelvic sidewall regions (series 1204 image 354) are noted as well as a centrally necrotic lymph node in the right external iliac chain (series 1205 image 395).BOWEL, MESENTERY: Mild ascites.BONES, SOFT TISSUES: Small enhancing foci of the right posterior iliac bone (series 1202 image 537), right lower sacrum (series 1202 image 352), and bilateral inferior pubic rami (series 1202 images 142, 202) correlate with increased FDG activity on the same day PET/CT exam consistent with osseous metastases. These osseous lesions also demonstrate restricted effusion. Adjacent to the right inferior pubic rami osseous lesions, there are small enhancing foci (axial series 1204 image 134), and soft tissue metastatic disease cannot be excluded.OTHER: No significant abnormality noted.

Output: 1.Large cervical tumor with evidence of parametrial extension and new inferior extension of the enhancing tumor into the vagina and periurethral region. 2.There is nodal and osseous metastatic disease as described above.


Instruction: Generate impression based on findings.

Input: Female, 36 years old, history of GBM. Findings are redemonstrated related to left parietal craniotomy for tumor resection. A small epidural collection subjacent to the craniotomy is not significantly changed in thickness. A small surgical cavity within the posterior lateral left temporal lobe is stable in size and morphology. T2 hyperintensity surrounding this cavity, and extending superiorly into the parietal lobe, is also unchanged.On postcontrast images, irregular enhancement along the periphery of the resection cavity is unchanged. Two or three nodules of enhancement anterior to the resection cavity are also stable in size and morphology. More superiorly, a thick band of enhancement within the left parietal lobe is also stable. This tissue, and some areas surrounding the resection cavity, demonstrate elevated rCBV, while the discontiguous nodular foci anterior to the resection cavity are not well assessed due to proximity to bone.A nonenhancing round focus of T2 hyperintensity within the right thalamus is stable. Also stable is mild asymmetric T2 hyperintensity within the left posterior thalamus and the left insula.No new pathologic intracranial enhancement is seen. No new fluid collections are detected. The ventricular system is stable and normal in size.

Output: Stable examination with no convincing evidence of progressive tumor.


Instruction: Generate impression based on findings.

Input: 35 year old with known right breast cancer, whose MRI (6/15/15) demonstrated additional enhancing lesions in both breasts and abnormal right axillary lymph node, for which MR directed ultrasound study is recommended. RIGHT BREAST: Index cancer is present at retroareolar region, slightly medial aspect, measuring 38 x 32 x 39 mm. There is a lobulated hypoechoic mass measuring 13 x 10 mm at 9:00 position, 1 cm from nipple. This mass might correspond to the additional enhancing lesion seen on the MRI. There are additional two small hypoechoic masses near this lobulated mass.RIGHT AXILLA: There is an enlarged lymph node, with cortical thickening of 11 mm at low axilla. In addition, there is smaller, but abnormal lymph node with cortical thickening, measuring 12 x 8 mm.LEFT BREAST: There are multiple intraductal masses at retroareolar region and lower inner quadrant, likely papillomata. These masses are likely corresponding to the multiple enhancing masses seen on MRI. In addition, there is a circumscribed oval hypoechoic mass at 7:00 position, 4 cm from nipple, likely benign fibroadenoma.

Output: 1. Right known cancer with possible satellite lesions posteriorly.2. Abnormal lymph nodes in right axilla.3. Probable multiple papillomata in the left breast, likely corresponding to MR findings. High probability benign mass, likely fibroadenoma, in the left breast at 7:00 position. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, status post seizure with left head deviation and convulsions. Again seen is an area of T2/FLAIR hyperintensity involving the subcortical white matter of the lateral/inferior aspect of the right precentral gyrus. Again noted are small foci of T2 hyperintensity extending medially towards the deep white matter. There is mild prominence of the adjacent perivascular spaces.No significant associated mass effect is detected. No definite associated volume loss. No diffusion restriction or significant susceptibility effect is noted. Elsewhere, brain parenchymal morphology is within normal limits. There are a small number of additional scattered foci of T2 hyperintensity in the cerebral hemispheres which are nonspecific. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology. A cystic foci in the nasopharynx are compatible with mucous retention cysts versus Tornwaldt's cyst. There is mild mucosal thickening involving the paranasal sinuses. Calvarium and extra cranial soft tissues are otherwise unremarkable.

Output: Again seen is an area of T2/FLAIR hyperintensity in the right lateral precentral gyrus which is unchanged from 2/12/2016. No associated enhancement is appreciated. No significant mass effect or volume loss is detected. Differential remains gliosis from prior injury such as ischemia, cortical dysplasia, and less likely low grade neoplasm. If an old MRI is available, it would help narrow the differential. Alternatively would suggest short term follow-up in 1-2 months and longer term follow-ups if the lesion remains stable.


Instruction: Generate impression based on findings.

Input: 47 year old with biopsy proven DCIS grade 3 in the left breast, presents for MRI study. There is scattered fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, limiting the sensitivity of MRI.In the left breast at middle to posterior 2:00 - 3:00 position, there is a segmental non mass enhancement, measuring 84 x 37 x 25 mm (all measurements: AP x LR x CC), corresponding to the proven DCIS. Within the non mass enhancement, there is a lobulated hematoma (25 x 20 x 23 mm), and a marker clip artifact within the hematoma.At the left anterior 12:00 position, there is another suspicious non mass enhancement, measuring 31 x 28 x 21 mm. On the mammogram, there are amorphus calcifications at the corresponding site (superior retroareolar region). Overall AP distance including main non mass enhancement and anterior non mass enhancement is 119 mm.A few normal intramammary lymph nodes are present in the right lateral breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: Large area of non mass enhancement in the left upper outer breast, including the site of proven DCIS.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: Left shoulder pain and decreased strength and motion, evaluate for massive rotator cuff tear. ROTATOR CUFF: The supraspinatus tendon appears normal. There is mild edema-type signal within the supraspinatus muscle belly concentrated along the myotendinous junction which is nonspecific but could represent a strain. The infraspinatus muscle and tendon appear normal. There is fatty atrophy of the teres minor muscle. The teres minor tendon is intact. There is increased signal intensity within the distal subscapularis tendon proximal to its insertion consistent with tendinosis but we see no discrete tear. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Mild/moderate osteoarthritis affects the acromioclavicular joint. There is no fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is no joint effusion. Intermediate signal intensity within the anterior labrum may reflect degeneration or possibly a tear but we see no fluid entering the substance of the labrum.BICEPS TENDON: The tendon of the long biceps is intact.

Output: 1. Moderate fatty atrophy of the teres minor muscle which can be seen in patients with quadrilateral space syndrome although we see no mass in the quadrilateral space.2. Edema within the supraspinatus muscle may represent a strain but we see no rotator cuff tear.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: CNS lymphoma and Omaya now with visual hallucinations. There is increased patchy T2 hyperintensity and mild patchy enhancement in the right basal ganglia region with extension along the margin of the right frontal horn, measuring up to approximately 35 mm, previously approximately 20 mm. There is also persistent infiltrative abnormal enhancement involving the left optic nerve. However, abnormality along the bilateral cerebellar tonsils is no longer discernible. There are unchanged nonspecific foci of T2 hyperintensity without corresponding enhancement in the cerebral white matter. There is no evidence of acute infarction or intracranial hemorrhage. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle, near the right foramen of Monro. There is no midline shift or herniation. There is right maxillary sinus mucosal thickening and an apparent fluid level in the left maxillary sinus. There is also mild fluid signal within the mastoid air cells bilaterally. There are multiple adenoidal mucous retention cysts.

Output: 1. Further increase in size of an infiltrative lesion in the right basal ganglia region with patchy enhancement along the margin of the right frontal horn likely represents involvement by lymphoma. 2. Apparent persistent enhancement of the left optic nerve may also represent involvement by lymphoma, although the images are not optimized for orbital imaging.3. Persistent findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Urothelial cancer with brain metastases. Status post resection and radiation. Evaluate extent of disease. Motion artifact limits the examination particularly the postcontrast images. Redemonstrated postoperative changes from a left frontal craniotomy and left frontal lobe tumor resection. Compared to the MRI from 10/6/2015, the resection cavity now has a more defined cystic appearance. Marked interval reduction in adjacent vasogenic edema is noted. There remains a thin enhancing rim which may represent granulation tissue. No suspicious masslike or nodular enhancement.The previously identified left temporal lobe metastasis has markedly reduced perilesional edema. No residual enhancing lesion is identified, however the postcontrast images are limited by motion artifact. Immediately medial to the resection cavity within the subcortical white matter is a 7 mm focus of increased T2 signal. This appears to have been present previously, but was largely obscured by the extensive vasogenic edema previously present in this region. No enhancement is noted on postcontrast images. This along with other scattered periventricular and subcortical white matter T2 bright foci likely represent small vessel ischemic changes.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Expected evolution of left frontal lobe resection cavity with marked interval reduction in perilesional vasogenic edema. No suspicious residual enhancement to suggest residual tumor.2. Interval reduction in perilesional edema adjacent to the left anterior temporal horn metastatic lesion. No residual enhancement is identified, however motion artifact mildly limits the exam in this region.Artifact from patient motion limits the examination, particularly on the postcontrast images. Performing future imaging with sedation may be useful for improving image quality.


Instruction: Generate impression based on findings.

Input: Shoulder pain. Check for impingement syndrome ROTATOR CUFF: Full-thickness tearing to the supraspinatus along the anterior aspect is observed with associated thickening, abnormal signal and minimal fluid underlying the deltoid and acromion. Undersurface fraying of the infraspinatus and minimal tendinopathy of the subscapularis are also observed. Teres minor appears intactSUPRASPINATUS OUTLET: Mild downward sloping acromion is again observed with associated mild to moderate degenerative changes of the AC joint. Persistent moderate narrowing of the outlet is again observed correlating with plain filmGLENOHUMERAL JOINT AND GLENOID LABRUM: Similar mild to moderate degenerative changes of the glenohumeral articulation is preserved. Marrow signal is intact other than underlying degenerative changes and subchondral cysts. The labrum is grossly intact for techniqueBICEPS TENDON: Grossly intact ADDITIONAL

Output: Associated chronic appearing rotator cuff injury with full thickness tearing of the supraspinatus with more mild changes involving the infraspinatus and subscapularis. See detailed provided


Instruction: Generate impression based on findings.

Input: Seizure like activity, evaluate for focal anomaly. The brain parenchyma appears within normal limits. No focal parenchymal signal abnormality. No evidence of cortical dysplasia or gray matter heterotopia. Myelination is within normal limits. No evidence of acute ischemia or hemorrhage. No mass or mass effect. Bilateral hippocampi are symmetric in size and signal characteristics without evidence of mesial temporal sclerosis. No hydrocephalus. No extra-axial fluid collections. Flow voids of the major intracranial vasculature are preserved. Mild mucosal thickening affects the paranasal sinuses. Fluid is present within the mastoid air cells. The imaged portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.6 x 5.3 x 5.6 cmPeripheral Zone: Diffuse hypointensity, restricted diffusion and early enhancement of the peripheral zone likely represents prostatitis and limits evaluation for underlying malignancy.Central Gland: Mild benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of 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: Findings most suggestive of diffuse prostatitis which limits evaluation for underlying malignancy.


Instruction: Generate impression based on findings.

Input: 74 year old woman with stable chest pain but progressive shortness of breath. She has a history of known coronary artery disease. First Pass PerfusionDuring hyperemia, the patient has perfusion defects involving the basal anterior, anterolateral, and inferolateral walls, the mid inferoseptal, inferior, and inferolateral wall, and the apical anterior, lateral, inferior, and septal walls which were not present on the resting images. The overall ischemia score is 10 out of a possible 30 and the burden of myocardial ischemia is approximately 33%.Viability/ Myocardial ScarThere is a small transmural myocardial infarction involving the mid inferior wall. This segment is not viable; however, the remainder of the myocardium is free of myocardial infarction and is likely to be viable.Left VentricleThe left ventricle is normal in size with low normal systolic function. There is hypokinesis of the mid inferior wall. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), the LVEDV is 116 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 58 ml (normal range 31+/-10), the LV mass index is 61 g/m2, and the LV mass is 97 g. Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is normal in size and systolic function. The RV ejection fraction is 62%, the RV end diastolic volume index is 50 ml/m2 (normal range 69+/-14), the RVEDV is 80 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.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. Approximately a third of the myocardium is ischemic. The ischemia is distributed in a multivessel pattern (LAD, LCx, and RCA) as described above.2. There is a small transmural myocardial infarction involving the mid inferior wall. This segment is unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and is viable.3. Normal LV size with low normal systolic function (LVEF 50%). There is hypokinesis of the basal inferior wall. 4. Normal RV size and systolic function (RVEF 62%).Findings were conveyed to referring physician.


Instruction: Generate impression based on findings.

Input: 45-year-old woman with chronic left shoulder pain following an injury in January 2010. She has undergone numerous orthopedic surgeries at outside hospitals. Multiple foci of signal void within the shoulder represent metallic susceptibility artifact related to prior orthopedic surgery. Tubular foci of intermediate to low signal intensity in the humeral head presumably represent suture anchor tracks. ROTATOR CUFF: There is moderate severe fatty atrophy of the supraspinatus muscle with severe tendinosis of the distal tendon. We see no definite fluid signal intensity to confirm full thickness tear. There is moderate to severe fatty atrophy of the infraspinatus tendon with tendinosis. There is moderate fatty atrophy of the superior portion of the subscapularis muscle with mild thickening and increased signal of the tendon distally suggesting tendinosis but we see no discrete tear. Teres minor muscle and tendon are intact. SUPRASPINATUS OUTLET: Mild deformity of the acromion presumably postsurgical. There is mild hypertrophy of the capsular structures of the acromioclavicular joint. We see no frank fluid in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. We see no joint effusion. The inferior joint capsule subjectively appears slightly thickened. Increased signal within the superior labrum suggests degeneration/degenerative tearing. BICEPS TENDON: Extra-articular portion of the tendon of the long head of the biceps appears intact. Intra-articular portion of the tendon is not well visualized.ADDITIONAL

Output: 1. Severe tendinosis of the supraspinatus and infraspinatus tendons with moderate to severe muscle atrophy. There is no flow signal suggestive of definite tear.2. Mild osteoarthritis and postsurgical changes of the AC joint and glenohumeral joint.THE PATIENT SHOULD NOT BE CHARGED FOR THIS REPEAT EXAM DUE TO INITIAL POOR QUALITY.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Previous negative biopsy. PELVIS:PROSTATE:Prostate Size: 5.0 x 6.1 x 5.9 cm.Peripheral Zone: No discrete suspicious lesion.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle lesion.Extracapsular Extension: No evidence of extracapsular 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: No suspicious lesion. No 3-D processing was performed given the lack of an identifiable target. The patient should not be charged for 3-D processing.


Instruction: Generate impression based on findings.

Input: NF1 with back pain and paraspinal lesions. There are extensive stigmata of neurofibromatosis type 1, including numerous multilevel cervical, thoracic, lumbar, and sacral foraminal and extraforaminal neurofibromas, which demonstrate a "target appearance" in cross section and appear to have increased in size and number since 2011. Many of the neural foramina are widened, but the spinal cord and cauda equina are otherwise unremarkable. There are also multiple cutaneous, subcutaneous, and paraspinal muscle neurofibromas, which have generally increased in size and number since 2011. A dominant lesion in the right supraclavicular fossa region measures 25 mm in width, for example. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is a small amount of partially imaged fluid within the pelvis, which is likely physiologic.

Output: Stigmata of neurofibromatosis type 1, including numerous multilevel cervical, thoracic, lumbar, and sacral foraminal and extraforaminal neurofibromas, as well as multiple cutaneous, subcutaneous, and paraspinal muscle neurofibromas, which have generally increased in size and number since 2011.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cranial nerves [225.1] / Neurofibromatosis, type 2 (acoustic neurofibromatosis) [237.72] / Neoplasm of unspecified nature of brain [239.6], Reason for Study: ^Reason: please evaluate brainstem tumor vestibular schwannomas Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.The Left frontal meningeal enhancing lesion, left frontal scalp enhancing lesion, left cavernous sinus lesions and right tongue lesion do not show any significant interval change since prior exam in terms of size and MR characteristics. Upper cervical enhancing lesion likely represent spinal astrocytoma or ependymoma do not show any interval change since prior scan in terms of size and enhancement pattern.The right upper pontine enhancing lesion, likely represent right oculomotor schwannoma, does not show interval change since prior scan.There are non specific high signal intensities on bilateral subcortical white matter on FLAIR images, no change since prior scan.The ventricles, cerebral sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on bilateral maxillary sinuses.IAC MRBilateral IACs' enhancing lesions which represent vestibular schwannoma do not show any significant interval change since prior exam in terms of size and MR characteristics.Subtle enhancement of the right facial nerve tympanic segment, no change since prior scan.Bilateral superior carotid space adjacent to extracranial carotid arteries show fusiform enhancing lesions (left bigger than right) indicating schwannoma, again no change in terms of size and MR characteristics since prior scan.Small enhancing lesion on the left hypoglossal canal extending toward left side superior aspect of the carotid space enhancing lesion likely represent schwannoma, no change since prior scan in terms of size and MR characteristics.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multi-focal various sized lesions represent schwannomas, meningioma do not show any interval change in terms of size and MR characteristics.3. Bilateral internal auditory canal lesions and skull base lesions, again do not show any interval change since prior exam. 4. Parenchymal lesion on the upper cervical spinal cord do not show any interval change since prior scan.


Instruction: Generate impression based on findings.

Input: Questionable fracture of C6, please performed thin cut through C5 through C7 per attending. History of fall.IMAGE ACQUISITIONS: Noncontrast examination of the lower cervical spine was performed with thin cut images. Extensive degenerative changes affect the cervical spine with multilevel neural foraminal compromise. Please see cervical spine MRI for additional detail. Alignment of the cervical spine is anatomic. Linear lucencies traversing the bilateral pedicles of the C6 vertebral body are again noted confirming bilateral pedicular fractures (image 27 and 42 of sagittal series). Again, there is no evidence of malalignment of the pedicles at this level. Please see dedicated cervical spine MRI for additional detail regarding soft tissue injury.

Output: 1. Nondisplaced bilateral C6 pedicular fractures. Please see cervical spine MRI report for additional detail regarding soft tissue injury. 2. Extensive degenerative changes of the cervical spine.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord(198.3)Malignant neoplasm of bronchus and lung, unspecified site. Evaluate for response to WBRT The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple ring-enhancing lesions within the brain parenchyma including right and left temporal lobes, right external capsule, left frontal lobe and right cerebellar hemisphere. The largest lesion is centered in the left temporal lobe which has increased in size from 22 x 27 mm axial dimensions to 42 x 39 mm axial dimensions. The one in the right external capsule has increased from 10 x 8 mm to 14 x 10 mm axial dimensions. One adjacent to the right temporal horn of the right lateral ventricle previously measured 15 x 10 mm and now measures 14 x 9 mm axial dimensions. A left superior frontal gyrus lesion previously measured 7 x 10 mm axial dimensions and now measures the same. A left precentral gyrus lesion has a decreased in size. Previously measured 10 x 8 mm axial dimensions and now measures 4 x 3 mm axial dimensions a right cerebellar lesion has also decreased in size. It previously measured 10 x 11 mm and now measures 7 x 5 mm axial dimensions. A left cutaneous lesion has increased in size from 11 x 8 mm to 12 x 9 mm. There is associated midline shift present which was also present on the prior exam. The internal cerebral veins are shifted approximately 7 mm to the right of midline on the current exam and were shifted by approximately this same on the prior exam. There is associated uncal herniation which was also present on the prior exam.The extent of T2 signal change compatible with vasogenic edema as well as periventricular white matter signal change has mildly progressed compared to the prior exam. Brainstem signal changes remain stableOn susceptibility weighted imaging there are are some punctate foci of signal loss in the left insular cortex and left frontal lobe which were not present on the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam some the patient's lesions have decreased in size while others have increased in size as detailed above.2.There is mass effect with subfalcine and mild uncal herniation. This remains stable.3.Extensive white matter signal changes in the brain parenchyma has increased when compared to the prior exam. In part some this may be related to vasogenic edema and in part some this may be related to posttreatment change. 4.There is a microhemorrhage is present on the current exam which are now present on the prior located in the left hemisphere surrounding the left temporal lobe lesion. It is possible that these are treatment related.


Instruction: Generate impression based on findings.

Input: 28 year old male; evaluate for CVA. Subtle area of low attenuation within the brainstem likely represents artifact. A separate subtle area of low attenuation is noted in the right thalamus/posterior limb of the internal capsule; if acute infarct is suspected, recommend MRI or repeat examination to further evaluate.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Subtle areas of low attenuation with the brainstem and right basal ganglia/posterior limb of internal capsule; recommend MRI or repeat CT if acute infarct is suspected.


Instruction: Generate impression based on findings.

Input: Tongue cancer, chronic pain, pain and weakness in upper extremities Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with diffuse T1 shortening which may related to prior radiation therapy.The cervical spinal cord has normal signal characteristics and overall morphology.Mild multilevel degenerative changes are present including mild generalized facet arthropathy. Individual levels 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: No 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.

Output: 1. No significant spinal canal or neural foraminal stenosis at any level.2. No cord signal abnormality.3. No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 74-year-old with bilateral biopsy-proven breast cancer present for second look ultrasound for right breast mass seen medial to the index right breast mass on recent MRI. On physical exam, there is a palpable hard mass in the right upper-outer quadrant, representing the patient's known index right breast cancer.A targeted right ultrasound was performed for the area of concern. There is a 5 x 6 x 9 mm (CC x AP x TV) antiparallel hypoechoic mass with indistinct margins in the right breast 12:30 position 10 cm from nipple, correlating with the findings on MRI. There is associated distortion of the Cooper's ligament. No internal vascularity.

Output: 5 x 6 x 9 mm mass in the right breast 12:30 position 10 cm from nipple, correlating with the findings on MRI. Ultrasound-guided biopsy is recommended. Findings and recommendations were discussed with the patient at the time of the exam.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Female, 52 years old. Finger pain, swelling, bruising. There is soft tissue swelling dorsal to the third metacarpal head. We see no underlying fracture or malalignment. There is bone formation along the volar aspect of the middle phalanx. We suspect that this simply represents prominence at the site of insertion of the flexor digitorum superficialis. However, if this correlates to the site of the patient's pain, MRI can be considered to evaluate for the possibility of Nora's lesion (bizarre parosteal osteochondromatous proliferation).

Output: Soft tissue swelling and other findings as described above. We see no fracture.


Instruction: Generate impression based on findings.

Input: 53-year-old male. Left shoulder pain. History of SLAP debridement 2008 continued pain despite NSAIDs, therapy, and cortisone, evaluate for rotator cuff tear versus recurrent SLAP tear. ROTATOR CUFF: No evidence of a rotator cuff tear. The previously seen supraspinatus partial tear is no longer visualized, presumably healed. No evidence of muscle edema or atrophy.SUPRASPINATUS OUTLET: Mild osteoarthritis of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small paralabral cysts at the posterior labrum raises the possibility of an occult labral tear (series 2, image 10). The glenoid labrum is grossly unremarkable without evidence of a SLAP tear. Small humeral head osteophytes consistent with mild osteoarthritis.BICEPS TENDON: Longitudinal split in the extra-articular long head of the biceps tendon, which is positioned in the intertubercular sulcus, unchanged.ADDITIONAL

Output: 1. Small paralabral cysts at the posterior glenoid raises the possibility of an occult labral tear. The labrum is grossly unremarkable with no evidence of a SLAP tear.2. Longitudinal split within the long head of the biceps, unchanged.3. Previously seen partial tear of the supraspinatus tendon is no longer visualized, presumably healed in.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with neuralgia and neuritis. A reversal of the cervical lordosis is demonstrated. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement is detected. Degenerative endplate edema is seen at C5-6.The visualized spinal cord shows normal signal intensity. No epidural abnormalities are suspected.C2-3: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C3-4: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild right foraminal narrowing. C4-5: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild right foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation with asymmetry in the right paracentral region. No significant generalized spinal canal stenosis. Moderate right foraminal narrowing. C6-7: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant generalized spinal canal or foraminal stenosis.C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Mild cervical spondylosis is seen with no areas of high-grade spinal canal stenosis. Multilevel mild to moderate right-sided foraminal narrowing is demonstrated.


Instruction: Generate impression based on findings.

Input: Meningioma surveillance. There is no significant interval change in the extra-axial enhancing mass overlying the right frontoparietal convexity with extension into the overlying calvarium, although the associated cerebral edema appears to have slightly increased in extent. There is no evidence of acute infarct. There is a background of nonspecific scattered cerebral and brainstem white matter T2 hyperintensity. 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 paranasal sinuses, orbits, and scalp soft tissues are unremarkable.

Output: No significant interval change in size of the mass that may represent a meningioma overlying the right frontoparietal convexity with intraosseous extension, although the associated cerebral edema appears to be slightly increased.


Instruction: Generate impression based on findings.

Input: There is a rotatory subluxation at L1-L2 with 10 mm of rightward subluxation of the L1 vertebral body with respect to the L2 vertebral body. There is also loss of the normal lumbar lordosis. There are multilevel prominent anterior disc-osteophyte complexes. At the T11 level, there is an extradural rounded 9 mm diameter structure with low T2 and low T1 signal adjacent to the left facet joint with an effusion, which causes minimal mass effect upon the spinal cord. There is increased T2 signal intensity within the left-sided facet joint at this level. At T12-L1, there is a left paracentral disc herniation, which causes mild narrowing of the spinal canal, as well as moderate to severe left neural foraminal narrowing, but no significant right neural foraminal narrowing. At L1-L2, there is a disc bulge with considerable narrowing of the central spinal canal with impingement upon the nerve roots. The neural foramina are mildly narrowed bilaterally. At L2-L3, there is a disc bulge and facet hypertrophy with moderate to severe narrowing of the spinal canal. There is also mild left and moderate right neural foraminal narrowing. At L3-L4, there is a disc bulge and facet hypertrophy with severe narrowing of the spinal canal and the neural foramina are moderately narrowed bilaterally. At L4-L5, there is moderate disc bulge without narrowing of the central spinal canal and mild right and moderate left neural foraminal narrowing. At L5-S1, there is facet hypertrophy and a disc bulge with a superimposed left neural foraminal extrusion that results in severe left neural foraminal narrowing, but no significant spinal canal or right neural foraminal narrowing. The vertebral body heights are preserved. The bone marrow signal is unremarkable. There is atrophy of the paraspinal muscles.

Output: 1. A subcentimeter lesion in the spinal canal at the T11 level, adjacent to the left facet joint with an effusion may represent a synovial cyst or less likely a disc sequestration and causes minimal mass effect upon the spinal cord. 2. Lumbar scoliosis and 10 mm left lateral listhesis at L1-L2. 3. Multilevel degenerative spondylosis affecting the lumbar spine with considerable spinal canal and neural foraminal narrowing at certain levels.


Instruction: Generate impression based on findings.

Input: 3-year-old female patient with right leg pain. There is a 5 x 3.9 x 0.9 cm complex, enhancing collection arising in the soft tissues just superficial to the lateral malleolus and extending proximally. Within this collection, there is a 1.1 x 0.7 cm low signal region compatible with abscess formation with surrounding phlegmonous inflammatory change. This appears to track to a region of eroded fibular cortex and communicates with the medullary bone of the fibula. Low T1, high T2 signal, and enhancement within the entire fibula, excluding the proximal epiphysis, is compatible with osteomyelitis. Extensive edema and enhancement of the musculature of the lower leg is consistent with inflammation. The marrow signal within the tibia is within normal limits. Increased T2 signal within the talus with preservation of T1 signal argues again osteomyelitis and favors reactive osteitis. Multilevel fracturing of the fibular cortex is better evaluated on prior radiographs.

Output: Right fibular osteomyelitis with soft tissue abscess formation.


Instruction: Generate impression based on findings.

Input: Known right breast cancer on I-Spy 2 protocol. MRI #1. No significant change in size of the masses has occurred since the recent prior diagnostic MRI. Index mass in the right retroareolar region again measures 3.9 x 3.7 x 3.8 cm. A Hydromark clip is associated with the mass in the medial aspect. The adjacent medial fluid collection that contains a biopsy clip measures slightly larger, up to 2.6 cm. Associated skin thickening again noted. Satellite masses posterior to the index lesion are similar to prior measurements, up to 1.5 and 0.9 cm respectively. The left breast scattered benign foci and masses are not significantly changed, and were better evaluated on the prior study.No change in the metastatic right axillary node, aside from the fact that a Hydromark clip is now noted within the node. Normal left axillary nodes.Probable hepatic cyst in the dome again noted.

Output: Known right breast malignancy is unchanged, measuring up to 3.9 cm. Other masses and node as above measure similar to the recent prior study.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Metastatic cervical cancer on systemic therapy, evaluate for persistent disease, history of bilateral hydronephrosis status post ureteral stent placement ABDOMEN:LUNG BASES: Bilateral breast prostheses.LIVER, BILIARY TRACT: Gallbladder sludge.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable asymmetrically atrophic right kidney. Moderate left-sided and mild right sided hydronephroureter, increased from earlier study. Left-sided nephroureteral stent and right sided nephroureteral stent, left-sided stent located at level of ureteropelvic junction. Ureteral wall thickening seen bilaterally.RETROPERITONEUM, LYMPH NODES: No pathologically enlarged adenopathy. BOWEL, MESENTERY: Mild to moderate circumferential rectal wall thickening. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. No enhancing soft tissue signal seen at level of postoperative bed. Stable lobulated right adnexal T2 hyperintense lesion encasing the right ureter. Structure essentially unchanged accounting for differences in technique, structure measures approximately 2.6 x 2.4 cm, image 39 series 1301, may represent a lymphocele related to prior nodal dissection.BLADDER: Bilateral nephroureteral stents seen extending into underdistended bladder. BONES, SOFT TISSUES: Scattered foci of susceptibility artifact in pelvis and ventral abdomen, likely postprocedural in etiology.

Output: 1. Mild to moderate rectal wall thickening, may be posttreatment related but correlation with patient's clinical history recommended to exclude proctitis.2. Moderate left-sided and mild right sided hydronephroureter, increased from earlier study. Bilateral ureteral stents present, ureteral wall thickening seen bilaterally.3. Stable lobulated right adnexal T2 hyperintense lesion encasing the right ureter. Structure essentially unchanged accounting for differences in technique, structure measures approximately 2.6 x 2.4 cm, may represent a lymphocele related to prior nodal dissection.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with multiple sclerosis. Brain:Approximately 10 T2 hyperintense lesions are evident in the periventricular and juxtacortical regions of the cerebral hemispheres as well as the genu of the corpus callosum. There may also be a lesion at the midline superior pons but this could also be artifactual.Since the prior examination, three new lesions are identified, one in the right parietal lobe (image 57 series 601), one in the left operculum) image 52 series 601), and one in the left temporal lobe (image 39 series 601). A periventricular lesion along the right lateral ventricular atrium may have slightly increased in size but this is equivocal.No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricles remain normal in size and morphology. Overall brain volume is relatively preserved.C-spine:No focal cervical cord lesions are demonstrated. The spinal cord shows normal morphology throughout. No epidural abnormalities are suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is observed.At C5-6, there is mild posterior disc-osteophyte complex formation with left uncovertebral hypertrophy resulting in mild left foraminal narrowing, without significant interval change. No other significant spinal canal or foraminal compromise is seen.

Output: 1.Multiple T2 hyperintense lesions are evident in the brain compatible with demyelinating disease. Three lesions are new when compared to the prior examination and one pre-existing lesion may be slightly larger.2.No evidence of demyelinating disease is seen in the cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Reason: on 3T Scanner, known paraclinoid ICA aneurysm History: Surveillance MRI of the brainThere is an 8 x 5 mm axial dimension left cerebellar lesion which is heterogeneous but mainly low signal on T2WI and mainly hypointense on T1WI, associated with susceptibility effect and an adjacent developmental venous anomaly. This appears to be stable since the prior exam.There is a punctate focus of susceptibility effect present at the right posterior temporal lobe it is best seen on the susceptibility images and not readily appreciated on the flair or T2 images. It is unchanged since prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No diffusion restriction is appreciated.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 mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is a 3-mm aneurysm along the left internal carotid artery. It is a paraclinoid aneurysm. It is stable compared to the previous exam.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the right posterior cerebral artery with a hypoplastic right P1 segment. The left posterior communicating artery is small. The anterior communicating artery is small. The vertebral arteries are similar in size.

Output: 1.Findings are compatible with a small sporadic cavernous malformation in the left cerebellar hemisphere.2.A left paraclinoid aneurysm along the internal credit artery is stable3.A punctate microhemorrhage in the right temporal lobe and isolation is of unknown clinical significance. It is unchanged since prior exam.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 33-year-old female with benign-appearing 2 cm mass above and right of umbilicus ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Slightly infiltrative right rectus abdominis soft tissue mass measures 2.6 x 6.9 x 4.0 cm (series 1801, image 28; AP x TR x CC). Sigal characteristics include T2 hypointensity and homogeneously avid enhancement. The right inferior epigastric artery courses through the mass.PELVIS:UTERUS, ADNEXA: Fluid within the endometrial canal, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Right rectus abdominis soft tissue mass with signal characteristics most consistent with a desmoid tumor.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, history of meningitis and reported positional nasal dripping, abnormality seen in the superior nasal cavity on prior CT, further evaluation with skull base MRI is requested. Small locules of fluid signal are seen along the cribriform plate in the superior right nasal cavity which do appear to communicate with the intracranial subarachnoid space. This finding correlates with the abnormality noted on recent prior CT.Also noted is the presence of several small cystic spaces within the right greater wing of the sphenoid bone, the largest of which is seen along the right sphenoid sinus. Mild prominence of the CSF space anterior to the right temporal lobe is seen which could reflect a small incidental arachnoid cyst.No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. Numerous scattered foci of white matter T2 hyperintensity are demonstrated in both cerebral hemispheres. No pathologic parenchymal or extra-axial enhancement is observed. No findings are seen to suggest intracranial hemorrhage. The ventricles are normal in size and morphology. Incidental note is made of an expanded and partially empty sella.

Output: 1.Findings are seen which very likely represent a small defect in the right cribriform plate, which may be congenital or acquired, allowing communication between the nasal cavity and the intracranial space. The brain parenchyma does not penetrate through this defect, though a small degree of meningeal penetration is a possibility.2.Small cystic spaces within the greater sphenoid wing component of the floor of the right middle cranial fossa are seen likely representing arachnoid granulations. These would be a less likely source for CSF leakage.3.Numerous scattered foci of white matter T2 hyperintensity are seen without significant edema, mass effect or evidence of active inflammation. Findings are nonspecific and may represent the sequelae of chronic microvascular ischemic disease, prior inflammation or infection, vasculitis or demyelination among other possibilities.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact, especially the postcontrast sequences..ORBITS: There is a 16 x 24 x 20 mm sellar lesion with suprasellar extension that displays intermediate to high signal peripherally and low signal centrally on both T2 and T1-weighted sequences, as well as areas of central and peripheral enhancement. There is mass effect upon the adjacent optic apparatus. There is also mild mass effect upon the bilateral cavernous sinuses. There orbits are unremarkable.BRAIN: There is no evidence of acute cerebral infarction. There are minimal nonspecific scattered punctate foci of T2 hypertensity within the supratentorial white matter that may represent chronic small vessel ischemic disease. There is a small right superior frontal gyrus developmental venous anomaly. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild paranasal sinus mucosal thickening and fluid within the bilateral mastoid air cells.

Output: An acutely hemorrhagic sellar lesion with suprasellar extension that results in compression of the optic apparatus may represent pituitary apoplexy, possibly superimposed on an underlying mass such as a pituitary adenoma or Rathke's cleft cyst. Alternatively, this may represent an internal carotid artery aneurysm or pseudoaneurysm and this is better delineated via CTA.


Instruction: Generate impression based on findings.

Input: Chiari decompression, evaluate decompression and syrinx change. Patient had difficulty tolerating the study, and examination is technically degraded. There are interval postsurgical changes of Chiari decompression including suboccipital craniectomy, resection of posterior arch of C1, and reduction in cerebellar tonsillar tissue. There is interval increase in CSF spaces ventrally and dorsally at the foramen magnum as well as at the C1-C2 level. Cervical syrinx which extends throughout the cervical cord and into the partially imaged thoracic cord is again seen with interval decrease in size. For example at the C6-C7 level syrinx measures 5 x 8 mm in the AP and transverse dimensions, previously 7 x 12 mm, measured similarly. Residual syrinx in the cervical cord more superiorly is noted to predominantly occupy the right aspect of the cord.Vertebral body heights and alignment are maintained. There is no significant spinal canal stenosis or neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures are grossly unremarkable.

Output: Interval postsurgical changes of Chiari decompression with increase in CSF spaces at the foramen magnum and C1-C2 level. There is also interval decrease in size of the visualized portion of the syrinx.Please note patient could not tolerate the study. Cervical spine study is technically degraded, and thoracic spine MRI has been rescheduled.


Instruction: Generate impression based on findings.

Input: 27-year-old female with left knee pain MENISCI: The menisci are intact bilaterally.ARTICULAR CARTILAGE AND BONE: No abnormal marrow signal. The articular cartilage is intactLIGAMENTS: The ACL and PCL are intact. The medial and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal MRI knee.


Instruction: Generate impression based on findings.

Input: Medial ankle joint pain TENDONS: There is a split tear of the posterior tibialis tendon, with a transverse component. Thickening of the proximal aspect of the tendon is suggestive of some retraction.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Split tear of the posterior tibialis tendon, as above.


Instruction: Generate impression based on findings.

Input: Reason: CVA? 72F AML DM HTN c/o new slurred speech, worsening weakness L arm/leg x 3 wk. Also h/o L rotator cuff injury History: transient slurred speech, limp L hand, weakness L arm/leg There are punctate foci of diffusion restriction scattered in the right middle cerebral artery territory located in the right frontal lobe and parietal lobe and to a lesser degree right temporal lobe as well as periventricular white matter. There are several punctate foci of diffusion restriction in the right posterior cerebral artery territory located in the right occipital lobe and periventricular white matterThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 left eyeball lens is thin.

Output: 1.There are multiple punctate foci of cerebral infarction scattered in the right middle and posterior cerebral artery territories2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: s/p excision/xrt of left wrist soft tissue sarcoma, evaluate for local recurrence3 History: above The field-of-view was increased to include the distal forearm. Foci of metallic susceptibility artifact are noted along the ulnar aspect of the wrist, compatible with prior synovial sarcoma resection.We see no mass lesion to suggest tumor recurrence. Again seen is reticulation of the subcutaneous fat along the ulnar aspect of the forearm and wrist which appears similar to the prior examination. There is mild edema and enhancement of the pronator quadratus muscle and extensor digitorum muscle which may reflect post therapy changes, appearing similar to the prior study. The extensor and flexor tendons appear intact. There is a small amount of fluid within the radiocarpal joint with foci of nodular enhancement likely representing a mild synovitis.

Output: Posttreatment changes following synovial sarcoma resection without evidence of tumor recurrence. Other findings as described above.


Instruction: Generate impression based on findings.

Input: For numbering purposes, there are total of 5 lumbar type vertebral bodies. Alignment is anatomic. There are no fractures or subluxations. Well-defined T1 hypointense area near the inferior endplate of L3 vertebral body may represent a Schmorl node. No cord signal abnormalities identified. Intervertebral disc spaces are preserved. The conus is normal in signal and morphology and terminates at the L1-L2 level. The visualized intra-abdominal and paraspinal contents are unremarkable. There is chronic mild anterior wedging of the T11 vertebral body, otherwise the vertebral body heights are preserved.T12/L1: No evidence of spinal canal or neural foraminal stenoses.L1/2: No evidence of spinal canal or neural foraminal stenosis.L2/3: There are small left and minimal right paracentral disc protrusions, as well as superimposed disc bulge and minimal bilateral facet joint arthropathy, resulting in mild left neural foraminal stenosis. The spinal canal and the right neural foramina are unremarkable.L3/4: There is diffuse annular disc bulge with bilateral facet joint arthropathy resulting in minimal bilateral neural foraminal stenosis without significant spinal canal stenosis.L4/5: Diffuse disc bulge and ligamentum flavum thickening results in mild bilateral neural foraminal stenosis without spinal canal stenosis.L5/S1:There is right greater than left facet joint hypertrophy resulting in mild right neural foraminal stenosis. No significant spinal canal stenosis.

Output: 1.L2/3: There are small left and minimal right paracentral disc protrusions, as well as superimposed disc bulge and minimal bilateral facet joint arthropathy, resulting in mild left neural foraminal stenosis.2.L3/4: Minimal bilateral neural foraminal stenosis.3.L4/5: Mild bilateral neural foraminal stenosis.4.L5/S1:Mild right neural foraminal stenosis.