Instruction: Generate impression based on findings.

Input: 49-year-old female with biopsy proven right breast IDC with DCIS There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a regional non-mass enhancement at anterior 1:00-2:00 position in the right breast, measuring 31 x 28 x 29 mm (AP x LR x CC), which is proven malignancy. A marker clip artifact is seen at medial aspect of the non-mass enhancement.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy-proven malignancy at anterior 1:00-2:00 position in the right breast2. No MRI evidence for malignancy in the left breast3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 40 years Male (DOB:11/17/1975)Reason: tumor progression, infection History: AMS, weaknessPROVIDER/ATTENDING NAME: THOMAS J. KELLY SERVICES ANCILLARY The patient is status post right frontal craniotomy for known anaplastic oligodendroglioma. There is a CSF filled cavity extending from the tumor resection site to be right lateral ventricle. This resection site appears stable.Since the prior exam a nonenhancing heterogeneous signal intensity lesion crossing from the posterior aspect of the tumor bed into the corpus callosum and into the left frontal lobe has mildly enlarged. On T2 imaging it currently measures approximately 82 x 51 mm axial dimensions and previously measured 75 x 46 mm axial dimensions. It is associated with more vasogenic pattern of edema on the current exam relative to the prior exam. On T1-weighted imaging it has heterogeneous signal with some mixed increased and decreased foci of signal. On susceptibility weighted imaging there are multiple punctate foci of signal loss within the lesion. There is decreased cerebral blood flow to this region.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: The patient is status post treatment for a mass located in the right frontal lobe. Since the previous examination a heterogeneous lesion along the posterior aspect of the tubercle bed which crosses the corpus callosum has enlarged. This is suspicious for tumor progression. Radiation necrosis may have a similar appearance.


Instruction: Generate impression based on findings.

Input: Reason: cuff tear, History: pain Several sequences are limited by patient motion artifact.ROTATOR CUFF: There is thickening and increased signal intensity within the anterior fibers of the supraspinatus tendon indicating mild to moderate tendinosis. There is intermediate signal intensity along the articular and bursal surface fibers which may reflect mild fraying, but we see no fluid-filled tear. There is mild fatty atrophy along the myotendinous junction of the supraspinatus, but otherwise the muscle appears normal. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There are multiple foci of signal void within the superior soft tissues of the shoulder representing metallic susceptibility artifact from prior surgery. There is widening of the acromioclavicular joint with tapering of the acromion process indicating prior surgery. There is mild impression upon the superior fibers of the supraspinatus by the distal end of the clavicle. There is minimal fluid within the subacromial bursa which may not be of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is deformity of the proximal humerus indicating an old healed fracture. We suspect that there is mild osteoarthritis of the glenohumeral joint, although the cartilage is difficult to evaluate due to patient motion artifact. The labrum is difficult to evaluate due to patient motion artifact and lack of intra-articular contrast, however, portions of the labrum are replaced with intermediate signal intensity likely representing degenerative tearing. The superior labrum is attenuated which may represent a combination of degeneration and prior surgery.BICEPS TENDON: The patient has undergone biceps tenodesis.

Output: 1. Supraspinatus tendinosis and surface fraying without fluid-filled tear.2. Surgical changes and other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Kerry is a 40 year old female with a strong family history of breast cancer including mother (diagnosed at the age of 52) and maternal aunt (diagnosed at the age of 48). Patient is BRCA2 positive. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.In the left upper inner breast, mid depth, there is an irregular enhancing mass identified measuring 0.7 x 0.4 x 1.0 cm (AP x ML x SI). This was not seen on multiple prior MRI examinations dating back to 2007. Few enhancing foci are seen in the right breast, all of which are stable when compared to multiple prior examinations. There is no new abnormal enhancement seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) 1.0 cm enhancing mass in the left upper inner breast. An MRI-guided biopsy with clip placement is recommended for further evaluation. (2) No MRI evidence of malignancy in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Right hip pain for one year. Evaluate for labral tear. Severe motion significantly limits the exam. There is a large amount of fluid in the joint may be in part or totally secondary to contrast injection. There are subchondral cysts and severe degenerative changes seen. The exam was terminated by the patient.

Output: Limited study with joint fluid and degenerative changes seen as described above.


Instruction: Generate impression based on findings.

Input: 9 years Female (DOB:3/28/2007)Reason: 9 yo F h/o neuroblastoma now with relapsed disease with paraspinal lesions History: back and leg pain worst on right, no neurologic symptoms PROVIDER/ATTENDING NAME: JILL L. O. DE JONG JILL L. O. DE JONG Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a mottled appearance to the marrow of the cervical spine associated with some foci of signal loss and some vertebrae. Small focus of contrast enhancement is present along the posterior and right aspect of the odontoid of the C2 vertebra. There is an enhancing lesion present between the spinous processes of C7 and T1 measuring 12 x 8 mm sagittal dimensions. It is eccentric to the left side.The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is mild loss of vertebral body height at T6 and T10. There is a heterogeneous signal present within the upper thoracic vertebrae. There is T1 signal hyperintensity throughout the vertebrae. T5, T10, T11 and T12 as well as the upper lumbar spine. There is contrast enhancement within T10 in the T8 centrally.There are enhancing paraspinous lesions present along the thoracic spine. One located to the left of the T2 vertebral body measures 18 x 9 mm axial dimensions. One to the right of the T2 body measures 8 x 13 mm axial dimensions. There are 2 lesions in either side of the T3 spinous process present one on the left measures 18 x 11 mm whereas the one on the right measures 13 x 22 mm there is a 22 x 12 mm axial dimensions. Additional smaller lesions are present between the spinous processes of the T1 and T2 as well as between the spinous processes of T4 and T5. The one at T4-5 is associated with a small soft tissue lesion to the left of the spinous process.There is a lesion to the left of the T4 vertebral body and the smaller one to the right of the T4 vertebral body measuring 12 x 7 mm axial dimensions. The lesion to the left of the T4 vertebral body and is the left T4-5 neural foramen and appears to mildly displace the thecal sac towards the right side. There is a 8 x 12 mm lesion to the right of the T7 vertebra and another one adjacent to the right T7 rib measuring 9 x 18 mm. Another lesion measuring 9 x 8 mm is located adjacent to the T9-10 disc space. There is a pleural-based lesion present measuring 12 x 25 mm axial dimensions located at the T10 vertebral level..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 appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There are contrast enhancing foci present at L4. There is T1 signal hyperintensity throughout the L1 and L2 vertebrae. This is suspected represent radiation effect. There are marrow replacing lesions present within the iliac bones and sacrum.An enhancing lesion is present in the left half of the sacral spinal canal measuring 41 x 12 mm sagittal dimensions. It displaces the adjacent nerve roots in the left temporal canal of the sacral spine. This includes the nerve roots that exit within the left S2 and S3 neural foramen.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a left presacral lesion present measuring 27 x 20 mm axial dimensions.

Output: 1.There are multiple paraspinous lesions present throughout the thoracic spine some which are adjacent to the pleura and some which are detailed above. Some are between vertebral bodies and pleural while others are adjacent to the upper spinous processes and superficial laminae. These are compatible with the recurrence of the patient's known neoplastic process of neuroblastoma.2.One of the thoracic spine lesions extends into the spinal canal through the left T4-5 neural foramen. It displaces this thecal sac towards the right. These are compatible with the recurrence of the patient's known neoplastic process of neuroblastoma.3.There is a lesion within the sacral spinal canal which displaces the left-sided S2 and S3 nerve roots. This is compatible with the recurrence of the patient's known neoplastic process of neuroblastoma.4.There are some enhancing lesions within the cervical and thoracic and lumbar spine which are suspicious for metastatic disease. Additionally there are are multiple foci of marrow replacement throughout the spine and visualized iliac bones which are also suspicious for metastatic disease. 5.There is a left presacral lesion present measuring 27 x 20 mm axial dimensions. This is also suspicious for neoplasm.6.There are mild compression fractures present at T10 and T6 which could be pathologic.


Instruction: Generate impression based on findings.

Input: History of pituitary mass resected and now with recurrence. Vision loss and headache appear 60-year-old female. There is redemonstration of a sellar mass which has been described on the recent MRI from yesterday. It is unchanged in appearance since that exam.The patient is status post a nasal septal prosthesis placement.The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated.The frontal sinuses are clear.There is some mucosal thickening present along the maxillary sinuses of a mild degree.Ethmoid air cells are clear . There is partial opacification of the right sphenoid sinus. The patient is apparently status post transsphenoidal surgery.Some atherosclerotic calcifications are present along the distal internal carotid arteries .Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures and demonstrate hypodensity along the right optic tract.

Output: 1.The patient has a sellar and suprasellar mass which is described on a recent MRI.2.Patient is status post nasal septal prosthesis placement.3.Status post transphenoidal surgery.4.Partial opacification of paranasal sinuses as indicated above.5.hypodensity along the right optic tract


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with low back pain and new compression fracture on x-ray. Thoracic:Compression deformities are seen affecting T8 (60% loss of height) and T11 (40% loss of height). The thoracic spine is mildly scoliotic and the thoracic kyphosis is mildly exaggerated.Bone marrow characteristics are diffusely heterogeneous. There are, in addition, superimposed additional areas of marrow replacement with pathologic enhancement involving the vertebral bodies of T8 through T12. Similar lesions are also seen affecting the right T6 pedicle, the T8 spinous process and laminae, the right T9 pedicle and transverse process, and in the soft tissues adjacent to the T11 spinous process.No significant dural or leptomeningeal enhancement is seen. No intracanalicular masses are detected. The spinal cord shows normal signal intensity and morphology.No significant disk herniations or spinal canal stenoses are seen. The neural foramina are patent.Lumbar:Compression deformities of L1 (50% loss of height) and L4 (40% loss of height) are seen. Again, the spine is mildly scoliotic.Bone marrow signal characteristics are diffusely heterogeneous with more focal areas of marrow replacement affecting the left L2 vertebral body, and the left L3 pedicle and transverse process. All the vertebral bodies demonstrate at least patchy enhancement. The sacrum and iliac bones are also diffusely involved.No evidence of any significant epidural or leptomeningeal spread is visualized. The conus and cauda equina are unremarkable except as discussed below. No pathologic leptomeningeal enhancement is seen.T12-L1: Facet hypertrophy. Mild retropulsion of the compressed L1 vertebral body which effaces the ventral thecal sac. No evidence of nerve root impingement is seen. No significant foraminal narrowing.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis or neuroforaminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Moderate left and mild right neuroforaminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Moderate bulging disk. Moderate to severe generalized spinal canal stenosis with crowding of the cauda equina nerve roots. Moderate bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis or foraminal narrowing.

Output: Diffuse marrow infiltration is seen with pathologic compression fractures of T8, T11, L1 and L4. Differential diagnosis would include multiple myeloma as well as metastatic disease. Despite widespread osseous involvement, no significant encroachment upon the epidural space or spinal canal is seen.Multilevel degenerative findings are evident in the lumbar spine, most severely affecting L4-5 where there is a moderate to severe spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: A 21 year old female with history of polymorphic ventricular tachycardia and clinically suspected sarcoidosis. A recent echocardiography showed no abnormal findings. Referred to cardiac MRI for further evaluation.MEDICATIONS: aspirin, pantoprazole First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent "dark rim" artifact was seen. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 43 g/m2, and the LV mass is 77 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 59 ml/m2 (normal range 69+/-14), the RVEDV is 105 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 41 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. The anterior leaflet is elongated, thickened, and bows into the left atrium. Mild eccentric mitral regurgitation is noted. 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 no 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 64%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 61%).5. The anterior mitral leaflet is elongated, thickened, and bows into the left atrium. Mild eccentric mitral regurgitation is noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Assess renal mass History: none Please note that evaluation for renal neoplasms is limited due to lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole simple appearing cyst measures 6.8 x 6.9 cm (3/26), stable in size. No septations or nodular components are identified. Right lower pole lesion is hyperintense on T1-weighted images measuring 2.7 x 2.4 cm (3/44), stable in size.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right upper pole simple-appearing cyst without suspicious features.2.Right lower pole complex cyst which is hyperintense on T1, possibly representing hemorrhagic/proteinaceous contents.


Instruction: Generate impression based on findings.

Input: Breast cancer There is abnormal marrow signal within the proximal humerus extending from the metadiaphysis through the distal diaphysis. Similar abnormal marrow signal within the distal clavicle and possibly involving the glenoid. There is abnormal associated enhancement of the humerus. There is no evidence of fracture or soft tissue mass.Multiple enlarged axillary lymph nodes are noted. There is partial visualization of a right breast implant.

Output: Abnormal marrow signal within the humerus concerning for metastatic disease. Additional areas of abnormal marrow signal may also be present in the glenoid of these could be degenerative in nature.


Instruction: Generate impression based on findings.

Input: Six weeks status post completion proctectomy with pelvic fluid collection status post IR drainage with leukocytosis, evaluate for osteomyelitis of the coccyx PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ostomy. Status post proctectomy. There is a T2 hyperintense tract extending from the base of the penis to the perineum. There is an additional tract posteriorly extending from the presacral soft tissues to the perineum. An enterocutaneous fistula involving a pelvic ileal loop can not be excluded. Small amount of presacral fluid and soft tissue edema without evidence of abscess. A percutaneous drain enters the presacral space.BONES, SOFT TISSUES: No evidence of osteomyelitis.

Output: 1.Postsurgical changes with two fistulous tracts extending from the pelvis to the perineum. An enterocutaneous fistula with a pelvic ileal loop can not be excluded. 2.No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma. Pituitary: There is a pituitary mass with suprasellar extension, which measures up to 22 mm in the craniocaudal dimension and 20 mm in the transverse dimension. The tumor protrudes into the medial compartment of the left cavernous sinus. The tumor also abuts the optic chiasm.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There are mild scattered foci of T2 hyperintensity in the cerebral white matter, which may represent chronic small vessel ischemic disease. There is encephalomalacia in the right inferior cerebellar hemisphere and right pons. The ventricles are unchanged in size and configuration, including cavum septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Gradual increase in size of the pituitary adenoma.2. Chronic infarcts in the right inferior cerebellar hemisphere and right pons.


Instruction: Generate impression based on findings.

Input: 18-year-old male patient with history of sickle cell disease and abnormal knee radiograph. MENISCI AND LIGAMENTS: The medial and lateral menisci are intact. The anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament, and medial collateral ligament complex are intact. The patellar retinacula are intact.BONE AND MARROW: Serpiginous low T1 signal intensity in the distal femoral metadiaphysis with central T2 hyperintensity. A similar appearing area is in the proximal tibial metadiaphysis that extends to the physis and approximately 2 mm into the epiphysis. Both of these areas demonstrate thick peripheral enhancement on postcontrast images.SYNOVIUM: No joint effusion or synovitis.MUSCULATURE: Musculature is normal in appearance.ADDITIONAL

Output: Findings compatible with bone infarcts in the distal femur and proximal tibia.


Instruction: Generate impression based on findings.

Input: 52-year-old female with a history of breast cancer presenting with syncope and new vertigo. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. The left superior ophthalmic vein appears larger than the right, likely a normal variant.Sella and orbits are grossly within normal limits. Mucosal thickening of the left sphenoid sinus. Otherwise, the remaining paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of intracranial metastasis.


Instruction: Generate impression based on findings.

Input: Acute midbrain hemorrhage. New vertical gaze palsy.. Many of the images are at least mildly limited by patient motion.MRI: The left midbrain hemorrhage that extends into the posterior medial aspect of the left thalamus has not significantly changed in size since the previous examination. The associated vasogenic edema along T2 hyperintense signal has slightly increased compared to the CT scan, accounting for differences in techniques. There is trace hemorrhage within the occipital horns of the lateral ventricles.There is encephalomalacia in the right basal ganglia and corona radiata, as well as the left corona radiata. In addition, moderate to extensive periventricular confluent T2 hyperintensity, as well as small patches of subcortical T2 hyperintensity are compatible with chronic microvascular ischemia. There is no contrast-enhancing brain lesion. There is no evidence of acute territorial infarct. The pituitary gland appears unremarkable. The ventricles and sulci are enlarged diffusely, reflecting a combination of ex vacuo dilatation from previous infarcts and global cerebral volume loss, but there is no evidence of hydrocephalus otherwise. There is no midline shift or herniation. A left nasal cavity polypoid lesion, a retention cyst in the left maxillary sinus, and secretions in the right posterior ethmoid sinuses are unchanged. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA: The included upper cervical, petrous, cavernous and supraclinoid internal cleft arteries show preserved flow-related signal and caliber with no flow-limiting lesion or aneurysm. The paired anterior and middle cerebral arteries are also unremarkable. An anterior communicating artery is present. The left vertebral artery is small (both its intracranial and included upper extracranial segments). This is associated with small osseous foramina, which is probably developmental/congenital. The basilar artery is predominantly supplied by the right vertebral artery. The right P1 segment is either absent or very small. The right posterior cerebral artery is supplied through an enlarged right posterior communicating artery (fetal origin; normal variation). The left posterior cerebral artery is conventional in anatomy. Both posterior cerebral arteries are otherwise unremarkable.

Output: 1. Left midbrain and thalamic hemorrhage has not significantly changed since the previous CT scan, although the associated vasogenic edema has slightly increased, accounting for differences in technique. Minimal intraventricular extension of the hemorrhage is present as well.2. Extensive chronic small vessel disease and chronic infarcts are unchanged.3. No hemodynamically significant cerebrovascular lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of 4 mm lesion in the uncinate process of pancreas on CT scan. ABDOMEN:LIVER, BILIARY TRACT: There is diffusely decreased parenchymal signal intensity on out of phase images compatible with hepatic steatosis. No suspicious focal hepatic lesions are identified. There is no biliary ductal dilatation. The gallbladder is within normal limits.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal signal intensity and enhancement. The pancreatic duct is nondilated. The previously described 4 mm focus of decreased attenuation within the uncinate process is not well-visualized and is too small to characterize. No pancreatic ductal dilatation. No discrete pancreatic lesions are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Previously described 4 mm hypoattenuation within the uncinate process of the pancreas is not well visualized on this examination and is too small to characterize. No evidence of IPMN or pancreatic ductal dilatation.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Recurrent prostate cancer. EPIC history: prostate cancer s/p RALP 2006. Rising PSA 0.2 (2014), 0.3 (2015). PELVIS: Post-surgical findings of prostatectomy. 11 x 7 mm heterogeneous T2 signal intensity nodule in the left prostatectomy bed with corresponding enhancement is suspicious for local recurrence (series 1501, image 19).BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small nodule in left aspect of the prostatectomy bed suspicious for local recurrence.


Instruction: Generate impression based on findings.

Input: Intra-articular contrast is identified within the radiocarpal joint extending through the expected location of the scapholunate ligament. Please refer to the subsequent MRI report for further information.Exposure time: 4 minutes and 11 seconds.

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


Instruction: Generate impression based on findings.

Input: Provided clinical information states abnormal mammogram. No mammographic studies have been performed here and none are submitted for comparison. A history of breast implants is also provided. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Bilateral retropectoral saline implants are present, symmetric and intact. There are bilateral scattered foci, mostly in the retroareolar regions. These have typically benign kinetic profiles. None of these are uniquely enhancing. A small focus lateral to the left implant is most likely a small lymph node.No abnormal lymph nodes are identified in either axillary region.

Output: No clearly suspicious finding on MRI. Please note that comparison to the reported abnormal mammogram has not been made at this time. It would be highly beneficial to correlate this exam with all prior breast imaging. Also please note that a negative MRI should not prevent abnormal findings on mammogram from being fully evaluated.BIRADS: 1 - Negative.RECOMMENDATION: O - Old Study For Comparison.


Instruction: Generate impression based on findings.

Input: Right knee contracture status post ACLR. Evaluate right knee for chondromalacia of medial femoral condyle 18 month status post microfracture. Scar tissue? Some sequences are limited by patient motion artifact. There are postoperative changes of anterior cruciate ligament reconstruction and microfracture of the medial femoral condyle. Thick bandlike low signal intensity extends from the inferior pole of the patella through Hoffa's fat pad indicating extensive scarring, extending to the anterior horns of both the medial and lateral menisci.MENISCI: As stated above, scar tissue extends to the anterior horn of the medial meniscus. The medial meniscus is otherwise unremarkable. Scar tissue also extends to the anterior horn of the lateral meniscus. There is intermediate to high signal intensity within the anterior horn of the lateral meniscus compatible with intrasubstance degeneration. This signal extends through the peripheral fibers of the anterior horn of the meniscus into the adjacent soft tissues representing extrusion of mucoid material. I do not see definite extension to either the tibial or femoral articular surfaces.ARTICULAR CARTILAGE AND BONE: Multiple small foci of subchondral signal abnormality are seen within the weightbearing portion of the medial femoral condyle, presumably representing the site of prior microfracture. There is edema within the adjacent bone marrow, of questionable significance. Cartilage overlies the microfracture site, and while I see no discrete fluid-filled defect, the cartilage is heterogeneous with foci of increased signal intensity that may reflect degeneration or simply relatively immature cartilage following microfracture. Overall, the thickness of the microfracture cartilage is similar to that of the adjacent native cartilage although it may be slightly thinned along the posterior medial aspect of the microfracture site. I see no fluid-filled defect within the tibial articular cartilage. The articular cartilage of the lateral femoral condyle is within normal limits. Focal increased signal intensity within the articular cartilage of the medial facet of the patella indicates focal degeneration.LIGAMENTS: The anterior cruciate ligament reconstruction graft appears intact although possibly slightly thinned at its femoral entry point. There are small cysts within the medial aspect of the lateral femoral condyle anterior to the graft and I cannot exclude the possibility of graft impingement. There is a laminar appearance of the posterior cruciate ligament that may reflect degeneration or prior injury. The medial collateral ligament appears normal. The lateral collateral complex appears normal. EXTENSOR MECHANISM: The quadriceps tendon appears normal. The patellar tendon appears slightly thickened which may reflect mild tendinosis or prior surgery.ADDITIONAL

Output: 1.Extensive scarring of Hoffa's fat pad with extension to the anterior horns of the medial and lateral menisci.2.Anterior cruciate ligament reconstruction with slight thinning of the ligament at its femoral entry point and small cysts anterior to the graft in the adjacent femur; while these findings may not be of any current clinical significance, I cannot exclude the possibility of graft impingement.3.Surgical changes of medial femoral condyle microfracture with edema in the adjacent bone marrow and heterogeneity of signal of the overlying cartilage that is nonspecific and may reflect degeneration or immaturity of microfracture cartilage.4.Degeneration of the anterior horn of the lateral meniscus and other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: renal cancer and abdominal mass History: as above; please compare with previous MRI ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensities are stable and likely represent cysts. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from partial resection of right moiety and total resection of left moiety of horseshoe kidney. Previously described tumor involving the right midpole and tumor thrombus within the right renal vein is no longer discretely measurable, decreased in size from prior. The right renal vein appears patent. There is mild soft tissue irregularity along the medial margin of the right lower pole (series 10, image 292) which is nonspecific and may reflect treatment changes versus residual disease. Right lower pole cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in size of the tumor involving the right midpole as well as right renal vein tumor thrombus. Mild soft tissue irregularity along the medial margin of the right lower pole may reflect treatment changes or minimal residual disease. Currently, no discretely measurable tumor.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with history of GBM, anemia and check point there is, status post recent fractionated SRS to the basal ganglia lesion. Findings are redemonstrated compatible with prior left occipital lobe resection. The surgical cavity size and morphology, as well as the surrounding T2 hyperintensity, are not significantly changed from prior. No concerning enhancement is seen within or around this cavity.Also redemonstrated is evidence of left anterior temporal resection. The surgical cavity contains heterogeneous T1 and T2 hyperintense material compatible with mixed fluid and blood product. Mild dural enhancement is evident along the craniotomy margin but no convincing pathologic enhancement is seen beyond the intrinsic T1 hyperintense signal.Since the prior examination, T2 hyperintensity involving the left inferior basal ganglia and posterior limb of the internal capsule has expanded and become less well-defined. However, the degree of associated pathologic enhancement has decreased substantially.No additional significant or new areas of parenchymal signal abnormality or pathologic enhancement are identified. A few scattered small foci of white matter T2 signal abnormality in the cerebral hemispheres are unchanged. The ventricular system is stable in size and morphology including ex vacuo dilatation of the left lateral ventricle. The previously seen extradural fluid collection along the left temporal craniotomy flap has decreased in thickness. The right maxillary sinus remains opacified secretions and mucosal thickening.

Output: 1.T2 signal abnormality within the left inferior basal ganglia has increased in geographic extent but appears more ill-defined than on the prior examination with significantly reduced pathologic enhancement. Findings likely reflect response to radiotherapy if indeed this was the targeted lesion.2.Stable appearance of the left anterior temporal resection cavity which contains a heterogeneous mixture of fluid and blood product.3.Stable appearance of the left occipital resection cavity.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of kidney, except pelvis [189.0], Reason for Study: ^Reason: for pre-op planning for tomorrow History: pre-op planning for tomorrow Multiple fiducial markers were seen on the scalp.24 x 36 x 10 mm sized right frontal mass, another 10.8 mm sized lesion on the right frontal lobe metastatic lesion was again demonstrated with minimal midline shift toward left side, no change since prior scan.Small punctate enhancing lesions on bilateral cerebellar hemisphere or so seen, no change since prior scan.The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal intra axial enhancing lesions indicating metastatic lesions were demonstrated, no change since prior scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient is pregnant, known previous HNP assess for new HNP. Signs and symptoms: Pending delivery. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column however the straightening of lumbar lordosis similar to prior study.T12 -- L1 demonstrate minimal degenerative changes and are unremarkable otherwise.L1 -- L2 demonstrate mild disk desiccation and subtle loss of disk height and mild to moderate bilateral ligamentum flavum hypertrophy and minimal facet disease. There is no appreciable interval change. There is no spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease, moderate bilateral ligamentum flavum and mild bilateral facet hypertrophy. There is mild interval progression of disease. There is no spinal stenosis or neural foraminal compromise. Examination at this level mildly degraded due to excessive CSF pulsation artifact which may be related to patient's pregnancy.L3 -- L4 demonstrate mild disk desiccation and mild tube moderate bilateral ligamentum flavum and to lesser degree facet hypertrophic changes. Subtle interval progression of disease. Sagittal images are degraded due to exaggerated CSF pulsation. No convincing evidence of a spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate advanced disk disease with loss of disk height, excessive expectant associated Modic signal changes of the adjacent endplates and moderate (right greater than left) hypertrophy changes of posterior elements. There is interval progression of degenerative changes and including further loss of disk height since prior exam. There is evidence of a right-sided laminectomy at this level. There is a left-sided broad-based disk protrusion which is new since prior exam. The finding results in significant left lateral recess mass effect and to a lesser degree mass effect on the thecal sac. Mild central spinal stenosis and mild right neural foraminal compromise and patent left neural foramina. This finding is best appreciated on axial T2 series 7 image 32 and sagittal T2 series on images 9 and 10.L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum and mild facet hypertrophic changes. Right-sided laminectomy postoperative changes are noted. There is a shallow leftward broad-based disk protrusion which demonstrates subtle interval increased size. There is resultant left lateral recess compromise however without central spinal stenosis normal or neural foraminal compromise.

Output: 1.Advanced degenerative changes at L4 -- L5 with interval progression of disease. New central and left lateral disk protrusion with resultant significant left lateral recess compromise however with patent left neural foramina. Mild right neural foraminal compromise. 2.Left lateral disk protrusion at L5 -- S1 with interval increased size and with resultant left lateral recess compromise as detailed.3.Mild degenerative changes at other levels as detailed per level.


Instruction: Generate impression based on findings.

Input: 59-year-old man with history of lung cancer, evaluate for brain metastases. There is an enhancing nodule in the left occipital cortex which now measures approximately 3 x 3 mm, previously 5 x 5 mm in 9/2016 and 9 x 9 mm in 5/2016. Additionally, there is a small focus of susceptibility corresponding to this lesion. No surrounding edema or significant mass effect.Enhancing, dural based nodule along the right planum sphenoidale is unchanged in size. There are no additional foci of abnormal enhancement. There are a few scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild maxillary sinus mucosal thickening, right greater than left. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1.Continued decrease in size of enhancing lesion in the left occipital cortex compatible with treated metastatic disease.2.Stable enhancing right planum sphenoidale lesion, likely a meningioma.


Instruction: Generate impression based on findings.

Input: 65-year-old female with history of CVA in 5/07 is presents with altered male mental status and decreased LOC x 3 days. There is no evidence of intracranial hemorrhage, mass or edema. Well-defined hypodensity within the left temporal and biparietal regions consistent with chronic ischemia, unchanged from the previous examination. Multiple areas of diffuse hypodensity in a periventricular and subcortical white matter distribution consistent with small vessel ischemic disease, age. indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.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: Stable chronic ischemic changes. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Left upper temporal field cut. There is a somewhat infiltrative heterogeneously enhancing mass with areas of susceptibility effect centered in the right medial temporal lobe, with extension into the cerebral peduncle that measures at least up to 4 cm. There are several adjacent heterogeneously enhancing lesions in the right temporal, inferior parietal, and anterior occipital lobes. There is hazy confluent T2 hyperintensity surrounding all the lesions. There is effacement of portions of the right lateral ventricle, but dilatation of the right temporal horn. There is right uncal herniation and approximately 10 mm of midline shift to the left. There is no evidence of acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A mass centered in the right medial temporal lobe, with extension into the cerebral peduncle that measures at least up to 4 cm, with several satellite lesions likely represents a high-grade glial neoplasm. There is associated entrapment of the right temporal horn and 10 mm of midline shift to the left.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental statusClinical question: rule out new structural lesion, new strokeSigns and Symptoms: pt w/ ho vascular dementia with prior strokes in multiple vascular territories, admitted for AMS,Comments: Pt has severe vascular dementia. Please assess whether pt could be scanned without sedation. If not, study may be cancelled. | The lateral ventricles remain large relative to sulci.There is a mild to moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This was also present on the prior exam.There are small punctate lesions in the cerebellar hemispheres present which are bright on T2 and low signal on T1 and FLAIR which are unchanged since the prior exam. A small lesion in the left thalamus is bright on T2 and FLAIR sequences and also unchanged since the prior exam.There is encephalomalacia along the left superior frontal gyrus and the anterior aspect of the left cingulate gyrus where there was diffusion restriction on the prior exam. There is associated susceptibility effect as well.No foci of diffusion restriction are appreciated.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.There is some narrowing of the spinal canal at C2-3.

Output: 1.No evidence for acute ischemic cerebral infarction.2.No evidence for intracranial mass lesion.3.Encephalomalacia along the left superior frontal gyrus and left cingulate gyrus anteriorly is likely due to prior cerebral infarction.4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Old lacunar infarcts are present in the cerebellar hemispheres and left thalamus.


Instruction: Generate impression based on findings.

Input: Reason: sz History: sz. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Midline structures are intact. The temporal lobes are symmetric without abnormal signal or evidence of volume loss. No heterotopic gray matter. The major cerebral flow voids are intact. Small amount of fluid in the right mastoid air cells.

Output: No findings to explain patient's seizures.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapseClinical question: syncopal episode; h/o prior ischemic strokeSigns and Symptoms: passing out episodes x 2 MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal. There is bilateral facet hypertrophy present at this level - right more than left - with encroachment of right-sided exiting nerve roots.At C3-4 there is no significant compromise to the spinal canal. There is bilateral facet hypertrophy present at this level with encroachment of left-sided exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal. There is a left paramedian disc protrusion present at this level as well as bilateral facet hypertrophy and encroachment of the exiting nerve roots bilaterally left worse than rightAt C5-6 there is no significant compromise to the spinal canal. There is a diffuse disc bulge present at this level associated with small uncovertebral osteophytes and narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots. There is partial effacement of spinal fluid ventral to the spinal cord at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are some small endplate and uncovertebral osteophytes present at this level with mild encroachment of the exiting nerve roots within the neural foramina on the right side.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.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.There are T2 and FLAIR hyperintense lesions present in the internal capsules and basal ganglia as well as the brainstem and thalami. On susceptibility weighted imaging there are punctate foci of low signal in the thalami bilaterally as well as the pons and cerebellum and to a lesser degree basal ganglia. This has not changed substantially since the prior exam.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the paranasal sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries identified to the extent of visualization. The origins of the vertebral arteries are partially obscured due to artifacts..

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.There are multiple microhemorrhages present predominantly distributed in the thalami and brainstem and cerebellum which are in a pattern compatible with hypertension. This has not changed substantially since the prior exam.5.There are multilevel degenerative changes present in the cervical spine without evidence for spinal stenosis. There is encroachment of exiting nerve roots within the neural foramina at multiple levels as detailed above


Instruction: Generate impression based on findings.

Input: Redemonstrated is an approximately 28 x 29 mm transaxial dimension solid and cystic mass involving the left parietal lobe. There is associated edema with mild local mass effect yet without midline shift.. No secondary lesions are identified. There are no findings of ventricular dilatation or hydrocephalus.

Output: Redemonstrated is an approximately 28 x 29 mm transaxial dimension solid and cystic mass involving the left parietal lobe.


Instruction: Generate impression based on findings.

Input: 22-year-old woman with history of transaminitis and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: There is a stone in the distal common bile duct (series 801, image 65) measuring approximately 6 mm. Additional gallstones are seen within the gallbladder with similar signal characteristics. There is intra and extrahepatic biliary duct dilatation with the common bile duct measuring up to 14 mm.The liver is normal in signal and morphology.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal. There is no significant pancreatic duct dilatation.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Distal common bile duct stone with intra and extrahepatic biliary duct dilatation. Findings paged to APN service (p6002) at 8:35 on 11/13/2015.


Instruction: Generate impression based on findings.

Input: Male, 27 years old. Shoulder pain with overhead sports for 3 years, unresponsive to PT. ROTATOR CUFF: There is a partial-thickness articular surface tear of the posterior supraspinatus tendon near its insertion. The tear involves approximately 50% of the tendon thickness and measures 5 mm in AP diameter. There is no significant tendon fiber retraction. The remainder of the supraspinous tendon and the muscle appear normal. The infraspinatus, teres minor, and subscapularis tendons and muscles appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is no significant fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears normal. There is a subchondral cyst along the posterior superior aspect of the humeral head.BICEPS TENDON: The tendon of the long head of biceps is normal in course and morphology. ADDITIONAL

Output: 1.Partial-thickness tear of the posterior supraspinatus tendon and a subchondral cyst posteriorly in the humeral head. These two findings in this throwing athlete are consistent with internal impingement.2.Normal appearance of the glenoid labrum.


Instruction: Generate impression based on findings.

Input: 29-year-old female with muscle twitching and elevated creatine kinase and aldolase. Evaluate for myositis. The bilateral thigh musculature is normal, without edema or abnormal enhancement to suggest active inflammation. No skin thickening or inflammatory changes in the subcutaneous fat to suggest overlying cellulitis. No evidence of muscular atrophy. No focal fluid collection. Heterogeneous signal intensity within the bone marrow bilaterally may reflect underlying anemia. The bones are otherwise within normal limits.

Output: No evidence of myositis or other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 34-year-old man with history of left frontal glioblastoma status post craniotomy, resection, radiation therapy completed 10/28/2016, and on chemotherapy. There are postoperative findings from left frontal lobe surgery and resection of recurrent tumor. A slightly lobulated, fluid collection in the surgical cavity appears stable in size. Comparison to prior imaging is limited due to changing order of the post-contrast sequences. There is heterogeneous enhancement posterior to the surgical cavity which crosses the midline via the genu of the corpus callosum. This enhancement has slightly decreased in thickness and appears less confluent compared to the prior examination, particularly along the corpus callosum, although this in part could relate to differences in technique. Surrounding FLAIR and T2 white matter hyperintensity has minimally increased in extent along the left lateral frontal lobe from the prior examination (6/22). There are no additional abnormal remote foci of enhancement. A few, nodular foci of diffusion restriction within the posterior margin of the left frontal lobe resection cavity (3/20) are more conspicuous than the prior examination.Additional right frontal periventricular FLAIR signal is unchanged and nonspecific. Punctate, scattered foci of susceptibility artifact in the bilateral centrum semiovale and right parietal lobe are unchanged. The ventricles and basal cisterns are stable in size and configuration. There is no significant mass effect or midline shift. The major cerebral flow voids are intact. No diffusion abnormality to suggest acute infarct.The sella and orbits are grossly within normal limits. The paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Comparison of postcontrast imaging somewhat limited by acquisition of the series at different times relative to the prior exam. The heterogeneously enhancing tumor appears slightly less thick along the corpus callosum, although nodular diffusion abnormality posterior to the resection cavity appears more conspicuous. Overall, there is no significant progression of tumor but continued close follow-up is warranted.2.Slightly increased extent of surrounding white matter T2 hyperintensity which could represent vasogenic edema, post radiation change, and/or tumor.


Instruction: Generate impression based on findings.

Input: 55-year-old male with a perianal fistula. Evaluate for fluid collection. ABDOMEN:LUNG BASES: No pleural or pericardial effusions.LIVER, BILIARY TRACT: Normal hepatic morphology without biliary ductal dilatation. Normal gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta. No pathologically enlarged retroperitoneal adenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lesion of the T12 or L1 vertebral body (coronal image 27) with mild vertebral body height loss, may represent a hemangioma; other etiologies such as Paget's disease should be considered. If there are symptoms or clinical concern this may be further evaluated with an MRI or bone scan. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No pelvic fluid collection.

Output: No pelvic fluid collection.Lesion of the T12 or L1 vertebral body (coronal image 27) with mild vertebral body height loss, may represent a hemangioma but other entities as noted above could have a similar appearance. If this symptomatic or there is clinical concern this may be further evaluated with an MRI or bone scan.


Instruction: Generate impression based on findings.

Input: 49-year-old female with left thigh swelling and pain. A vitamin E marker was placed along the anterior lateral aspect of the thigh, presumably corresponding to the patient's site of swelling. There is a 7.4 x 2.8 x 17.8 cm intramuscular collection along the anterior aspect of the mid and distal femoral diaphysis which displaces the quadriceps musculature anteriorly and laterally. There is associated increased T1 signal abnormality peripherally and within this collection without evidence of significant enhancement on postcontrast sequences. These findings appear most consistent with hematoma formation although superimposed infection cannot be completely excluded by this examination. There is increased signal abnormality within the rectus femoris and vastus musculature on fluid sensitive sequences which is nonspecific but may represent myositis. There is extensive subcutaneous edema along the anterior and lateral aspect of the thigh which is nonspecific. There is also increased signal abnormality within the gracilis muscle at the level of the myotendinous junction with an associated 13 mm lobulated focus of increased signal abnormality on fluid sensitive sequences with peripheral enhancement which may also represent hematoma formation, however, close attention on follow-up examination is recommended to evaluate for interval change (series 14; image 4).There is a moderate size knee joint effusion. No bone marrow signal abnormality is identified. There are foci of susceptibility artifact within the soft tissues along the anterior aspect of the left hemipelvis presumably postsurgical in etiology. There are prominent inguinal lymph nodes

Output: Large collection within the anterolateral aspect of the distal left thigh with the imaging characteristics most consistent with a hematoma. However, a follow-up examination is recommended to evaluate for interval change. There is an additional focus of signal abnormality within the gracilis muscle, as described above, which may also represent a small hematoma which also should be evaluated on a subsequent contrast-enhanced examination. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Unable to flex knee MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The hyaline cartilage is intact.There is bone marrow edema involving the lateral tibial condyle. In addition on several images, there appears to be a linear vertical component that is highly suspicious for an occult fracture. For example series 901 image 24.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Lateral tibial plateau bone marrow edema and a linear component suspicious for an occult fracture. This could be further evaluated with a CT examination


Instruction: Generate impression based on findings.

Input: There is partial agenesis of the corpus callosum with nonvisualization of the rostrum and hypoplasia of the body and splenium. The genu appears normally formed. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or any abnormal extra-axial fluid collection. No diffusion-weighted abnormalities are identified. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No acute intracranial abnormality.2. Partial agenesis of the corpus callosum.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for cause of UE weakness History: RUE weakness, thenar wasting The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.In general there appears be thickening of the posterior longitudinal ligament which contributes to spinal stenosis.At C2-3 there is narrowing of the AP dimension the spinal canal related to posterior longitudinal ligament thickening and also thickening of the posterior ligaments. Spinal fluid is partially effaced anterior and posterior the spinal cord appeared spinal cord appears atrophic at this level.At C3-4 there is disk desiccation and diffuse disk bulge associated with a new left paramedian disk protrusion and effacement of spinal fluid ventral posterior the spinal cord. Overall there is a mild/moderate degree of spinal stenosis present associated with an atrophic appearance of the spinal cord. There is mild posterior ligament hypertrophy at this level. There are bilateral ritual osteophytes present at this level.At C4-5 there is loss of disk base height disk desiccation, diffuse disk bulge and uncovertebral and to a lesser degree endplate osteophytes. There is effacement of spinal fluid ventral to the spinal cord at this level with a narrowing of the left neural foramen due to disk material and osteophytes. Overall there is moderate spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level associated with some thickening of the posterior longitudinal ligament.At C6-7 there are disk desiccation and disk bulge associated with uncovertebral osteophytes bilaterally and encroachment of the exiting nerve roots within the neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There are small punctate lesions identified in the visualized portions of the lower cerebellar hemispheres left more than right this appearance is unchanged since the prior MRI of the brain from two days ago.There is medial deviation of the right internal carotid artery at the C3 level into the retropharyngeal area.

Output: 1.There are multilevel degenerative changes present in the cervical spine associated with some thickening of the posterior longitudinal ligament. This results in mild/moderate spinal stenosis at C2-3 and C3-4 and moderate spinal stenosis at C4-5 as well as multilevel encroachment of the exiting nerve roots as detailed above.2.Small focus of encephalomalacia is present in the left cerebellar hemisphere


Instruction: Generate impression based on findings.

Input: 64-year-old female with dry gangrene of the left fifth toe. Skin ulceration is noted along the superolateral aspect of the distal fifth digit, with associated enhancement and edema in the soft tissues consistent with inflammation/infection. Low T1 signal within the proximal fifth phalanx with associated enhancement and high T2 signal is consistent with osteomyelitis. No additional areas of osteomyelitis are identified. No drainable fluid collection is seen.

Output: Skin ulceration along the superolateral aspect of the distal fifth digit with findings consistent of underlying osteomyelitis of the proximal phalanx of the fifth digit as described above.


Instruction: Generate impression based on findings.

Input: 82 years, Male, bladder cancer with leg weakness and asymmetric pupils.. There is a 9 x 9 x 9 mm enhancing lesion in the posterior right frontal lobe involving the medial aspect of the precentral gyrus. There is moderate surrounding T2/FLAIR signal abnormality related to vasogenic edema. There is mild local mass effect without midline shift or herniation. There is a faint 2 mm focus of enhancement involving the left anterior frontal lobe seen on post gadolinium axial series 1901 image 16 and post gadolinium 3-D series 2103 axial image 84. No additional abnormal parenchymal or meningeal enhancement is appreciated. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear aside from mild opacification of the anterior ethmoid air cells. There is a small enhancing lesion involving the left frontal calvarium with associated diffusion abnormality suspicious for osseous metastasis.

Output: 1. 9 mm enhancing lesion in the right posterior frontal lobe involving the medial aspect of the precentral gyrus is most consistent with metastasis. There is surrounding vasogenic edema and local mass effect without midline shift or herniation.2. 2 mm focus of enhancement in the left anterior frontal lobe is suspicious for an additional metastasis but is less specific. Suggest attention on follow-up.3. Small focus of enhancement in the left frontal calvarium suspicious for osseous metastasis.4. Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: A 68 year old female with known multiple myeloma and systemic amyloid with echocardiography that showed normal left ventricular function, borderline LVH and diastolic dysfunction. Referred to cardiac MRI to assess possible cardiac amyloid. Left VentricleThe left ventricle is normal in size and systolic function. Based on myocardial tagging, there is normal deformation of the myocardium. The overall LV ejection fraction is 54%, 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 34 ml/m2 (normal range 18+/-5), the LVESV is 53 ml (normal range 31+/-10), the LV mass index is 50 g/m2 (normal range 67+/-11), and the LV mass is 77 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is mild left ventricular hypertrophy (IVSd=11mm). There is a myocardial diverticulum or alternatively a spontaneously healed muscular VSD noted in the interventricular septum.The native myocardial T1 value is 1050ms, which is near the normal range and does not support the diagnosis of cardiac amyloidosis.Based on T2-star imaging, there is no evidence of myocardial iron overload. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 113 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 54 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 mild 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsIron overload was noted in the liver and spleen (T2-star=5msec). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 54%). There are no regional wall motion abnormalities present. The wall thickness is mildly increased. Native T1-mapping and T2-star imaging do not support the diagnosis of cardiac amyloidosis or myocardial iron overload. 2. The right ventricle is normal in size and systolic function (RVEF 52%).3. The left atrium is mildly dilated.4. Mild dilation of the main pulmonary artery. 5. Iron overload was noted in the liver and spleen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of bleeding and ovarian lesion. PELVIS:UTERUS, ADNEXA: Anteverted uterus.The uterus measures 9.7 x 5.4 cm in the sagittal plane. The endometrium is normal in thickness. The inner myometrium/junctional zone measures up to 11 mm. The junctional zone/inner myometrium and outer myometrial junction is poorly defined and heterogeneous. No T1 or T2 weighted focal signal abnormality.Note is made of a 9 mm anterior uterine body fibroid.The cervical and vaginal signal intensity are unremarkable.The left ovary measures approximately 1.6 x 1.0 cm with a small follicle/cyst. The right adnexa measures approximately 7.1 x 5.6 cm (series 401/44) and is predominantly comprised of a 5.9 x 5.2 cm T2 hyperintense cystic lesion demonstrating thin enhancement of the wall without internal mural nodularity, septations or enhancement.BLADDER: Partially collapsed urinary bladder without a focal abnormality.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 5.9 cm right adnexal cystic lesion without internal complexity. Nonspecific mild heterogeneity of the myometrium.


Instruction: Generate impression based on findings.

Input: 49 year old female with BRCA 2 mutation, whose recent mammogram demonstrated benign appearing focal asymmetry in the left breast. Family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal 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: Neurofibromatosis, type 2 [Q85.02] / Dysphagia, unspecified [R13.10], Reason for Study: ^Reason: eval for midbrain disease/infarct History: acute dysphagia, Brain MRIThere is dumbbell shaped extra axial mass appears to be attached to the inferior aspect of the right acoustic schwannoma extends toward right jugular foramen in particular pars nervosa indicating extension of the tumor. Thought it has not been separately reported, there is no interval change since prior scan.There are multiple extra axial enhancing masses involving bilateral acoustic schwannomas, left sylvian fissure enhancing lesion, and multiple dural based enhancing lesions indicating meningiomas, unchanged since prior scan.Multifocal FLAIR high signal intensity lesions of bilateral white matter are again seen, unchanged since prior scan. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Bilateral mastoid air cells show opacifications, unchanged since prior scan.Cervical Spine MRIMore prominent spinal cord T2 high signal intensities are seen at the level of C45 to C56 level especially on the right side. This is likely representing mixed partial volume effects of extradural intraspinal component of residual mass as well as increased extent of spinal cord edema.In addition, at the level of C67, there is T2 high signal intensity lesion on the left side of the spinal cord which is more likely representing spinal cord edema. Again this lesion was seen previously but appears to be more prominent than before. Other findings including prior C3 to C6 laminectomies, scattered intra axial enhancing lesions at medullar and upper cervical spinal cord, right C2 root mass, C45 right neural foraminal and intraspinal mass which still shows some mass effects against spinal cord, right C56 extraforaminal mass, C67 bilateral extraforaminal masses, C7T1 bilateral extraforaminal masses likely representing schwannomas are unchanged since prior scan.Kyphotic deformity of the C spine at the level of C56 with fluid collections on the laminectomy sites are again unchanged since prior scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Multiple schwannomas on bilateral IACs and right jugular foramen as well as dural based enhancing lesions likely representing meningiomas are again seen, unchanged since prior scan.3. C45 to C67 spinal cord T2 high signal intensity lesions on the right side and left side spinal cord at the level of C67 lesion are more prominent on today's scan since prior scan which implies increased extent of spinal cord edema. 4. Multifocal various sized extraforaminal and intraspinal masses on cervical spine as well as intramedullar lesions do not show any significant interval change since prior scan as described above.


Instruction: Generate impression based on findings.

Input: Female 41 years old Reason: New vision changes s/p LV ablation History: vision changes. No evidence of diffusion restriction to suggest an infarct. There is no evidence of intracranial hemorrhage or mass. There are a few scattered nonenhancing foci of T2/FLAIR hyperintensity in subcortical white matter of the frontal lobes, which is nonspecific. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. No specific findings to account for patient's vision changes.


Instruction: Generate impression based on findings.

Input: Parkinsonism, first time diagnosis. There is no evidence of intracranial hemorrhage, mass, or infarct. There is a 4 mm right choroid fissure cyst. The brain brain parenchyma otherwise appears unremarkable with minimal scattered foci of cerebral white matter T2 hyperintensity that may be related to chronic microangiopathy. Aside from possible blurring of the substantia nigrosome susceptibility signal, the brainstem and cerebellum appear to be grossly unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is a small right maxillary sinus retention cyst. There are bilateral lens implants.

Output: Possible blurring of the substantia nigrosome susceptibility signal may be a manifestation of Parkinson disease. Otherwise, no evidence of intracranial mass, acute infract, or hemorrhage.


Instruction: Generate impression based on findings.

Input: 72 years, Female, metastatic lung adenocarcinoma, baseline evaluation for staging. Motion degradation on the postcontrast sequences slightly limits evaluation for small lesions. There is however no evidence of abnormal parenchymal or meningeal enhancement or intracranial mass or mass effect to suggest metastatic disease. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is global parenchymal volume loss commensurate with patient's age. Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Rule out intracranial hemorrhage and airway impingement. Signs and symptoms shortness of breath and anisocoria CT of brain without infusionnotice of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Calvarium remains intact. Examination remains is stable since prior study.Irregular high density material overlapping the cortex of right high convexity frontal -- parietal lobe is nonspecific and was present on the prior exam. There is no evidence of associated edema with this finding. Further evaluation with an MRI is recommended.CT of the soft tissues of the neck.Images through the skull base demonstrate no evidence of destructive lesions. Irregular shape of the left globe with internal calcification is redemonstrated with no interval change since prior exam.Minimal chronic sinus disease.Extensive opacification of left mastoid air cells remains stable since prior study. This finding is not associated with any bony changes.Lack of contrast infusion makes precise evaluation of the soft tissues difficult however within this limitation no definitive evidence of a mass is identified. Three visualization of multiple cervical lymph nodes. Endotracheal tube is identified.Images through the apices of the lungs demonstrate extensive pleural effusion. Please review the dictated report of chest x-ray performed the same date. Bony structures of the area of exam remains unremarkable.

Output: 1.Stable CT examination of brain without infusion. Not a specific cortical calcification in the right parietal with no interval change.2.Endotracheal tube noted on CT of the neck. Extensive pleural effusion.


Instruction: Generate impression based on findings.

Input: Psoriatic arthritis, hip pain The sacroiliac joints appear unremarkable and without evidence of erosion or significant degenerative change. There is no SI joint fluid/effusion. There is no abnormal enhancement following gadolinium administration. The visualized surrounding musculature is normal in signal and caliber.The bone marrow signal of the pelvis is normal.

Output: Normal MRI of the sacroiliac joints with no evidence of sacroiliitis.


Instruction: Generate impression based on findings.

Input: 66 years, Female, history of brain metastases.. Again seen are multiple supra and infratentorial enhancing lesions consistent with known metastatic disease. Most of these lesions demonstrate no significant change in size or appearance allowing for slight differences in technique and measurement. There is however an enhancing lesion along the left central sulcus which measures 12 x 13 mm, previously 9 x 9 mm and also now appears more contiguous with the dural surface and with slightly irregular borders. There is mild associated increase in vasogenic edema in the left posterior frontal and anterior parietal lobe. Small enhancing lesion involving the central sulcus more inferiorly measures 5 mm and not significant changed. Left basal ganglia lesion previously 9 x 8 mm now measures 10 x 9 mm. Multiple bilateral cerebellar enhancing lesions are not significantly changed. Small left-sided subdural collection demonstrates slight evolution and slight decrease in size.Again seen are postoperative changes related to left parieto-occipital craniotomy. Background of confluent T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter is similar to prior and compatible with chronic small vessel ischemic disease and/or posttreatment-related changes. Encephalomalacia in the left cerebellar hemisphere is again seen. Developmental venous anomaly in the brainstem and associated focus of susceptibility compatible with cavernous reformation again seen. Additional foci of susceptibility related to microhemorrhage in the cerebellum are also not significantly changed including few foci which appeared to be associated with the enhancing right cerebellar metastatic lesions but similar to immediate prior. No evidence of acute infarct. Ventricles are stable in size. No midline shift or uncal herniation. Minimal mucosal thickening in the paranasal sinuses and minimal fluid in the bilateral mastoid air cells again seen.

Output: Compared to 1/27/2016, there has been overall no significant change in the size or number of the multiple supra and infratentorial enhancing lesions related to known metastatic disease. There is however a particular left frontoparietal lesion along the left central sulcus which demonstrates slight enlargement, irregular margins, increased contiguity with the overlying dura, and with slightly increased surrounding vasogenic edema. This finding may be related to posttreatment change or perhaps slight progression of this lesion.


Instruction: Generate impression based on findings.

Input: There is a 14 x 14 x 20 mm mass involving the left lateral ventricle including the foramen of Monro with extra ventricular extension to abut the left caudate nucleus. There is mild associated enhancement. There is evidence of prior biopsy of this mass via a left transfrontal approach.Remainder of the brain demonstrates no other intracranial mass. No evidence of infarct or recent hemorrhage. There is a punctate focus of susceptibility effect involving the right cerebellar hemisphere consistent with a chronic microhemorrhage. No extra-axial collections. No hydrocephalus. Major flow-voids are preserved. No abnormal parenchymal or meningeal enhancement is appreciated within the remainder of the brain. Minimal scattered opacification is seen of the paranasal sinuses. Mastoid air cells are clear. Calvarium and extracranial soft tissues are unremarkable.Evaluation of the orbits is slightly motion degraded but demonstrates no abnormal mass or abnormal enhancement. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. Globes appear unremarkable within the limits of MRI. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are also unremarkable.

Output: 1. 14 x 14 x 20 mm mass involving the left lateral ventricle which extends laterally into the basal ganglia is consistent with known tumor. This mass has been previously biopsied. No significant intracranial mass effect associated with this lesion. If prior MRI is available to assess for growth, addendum can be made to this report.2. No orbital mass or findings to suggest inflammatory orbital pseudotumor is appreciated.


Instruction: Generate impression based on findings.

Input: Female, 15 years old, with headache. Artifact presumably arising from orthodontic braces degrades image quality particularly on the diffusion-weighted, susceptibility weighted, and FLAIR images. Given this limitation, the following observations are made.Brain parenchymal morphology is within normal limits. No definite evidence of restricted diffusion or other significant parenchymal signal abnormality is seen. No edema or mass effect is detected. No intracranial hemorrhage or abnormal extra-axial fluid is observed. The ventricular system is normal in size and morphology.On MRA imaging of the head, an apparent 4 mm outpouching is seen along the anterior genu of the left ICA. While it is possible that this represents artifact or vascular tortuosity, it is observed again on the MRV sequence. The intracranial arterial structures are otherwise within normal limits. No significant stenosis or vascular occlusion is identified.On MRV imaging of the head, again a small vascular outpouching is suspected at the level of the anterior genu of the left ICA. The dural venous sinuses and deep venous structures of the brain are well visualized and patent.On MRA imaging of the neck, no significant vascular abnormalities are detected.

Output: 1. Allowing for artifact induced by orthodontic braces, no significant brain parenchymal abnormalities are detected.2. On MRA imaging of the head, a 4 mm vascular outpouching is suspected at the level of the anterior genu of the left ICA, also confirmed on MRV imaging. While this could reflect an artifact or vascular tortuosity, the possibility that this may represent a small aneurysm must be considered. Confirmation of this finding with CTA of the head is recommended.3. On MRV imaging of the head, no dural venous or deep venous thrombosis is suspected.4. On MRA imaging of the neck, no significant vascular abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate posterior fossa. Signs and symptoms: Dizziness. Nonenhanced brain MRI:Unremarkable diffusion weighted series and without evidence of acute ischemic stroke. The and T2-weighted images demonstrate few punctate foci of periventricular subcortical hyperintensity. The findings are nonspecific however in the proper clinical setting and the risk factors possibility of minimal chronic small vessel ischemic strokes should be considered.There is mild degradation of images secondary to motion artifact. Within this limitation however there is no convincing evidence of any additional foci of parenchymal signal abnormality. The cortical sulci, ventricular system, CSF spaces and myelination the brain is otherwise within normal.Signal void of major intracranial arterial branches are identified.There is a tiny well-demarcated extra axial dural based lesion with T2 hypointensity signal in the right posterior parietal high convexity. Review of prior head CT exam demonstrate heavy calcification of this lesion. The finding is highly suggestive of a burned out calcific meningioma measuring at approximately 6 mm in size.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. There is normal anatomical variation of partially empty sella.Nonenhanced brain MRA:There are normal appearing bilateral vertebral arteries, basilar artery, bilateral pica and aica branches and bilateral superior cerebellar and posterior cerebral arteries.Unremarkable bilateral internal carotid arteries, bilateral middle and anterior cerebral arteries and their branches. No abnormality of the anterior communicating artery is detected. A tiny right posterior communicating artery is present and there is normal anatomical variation of absent left posterior communicating artery.Enhanced neck MRA:The visualized aortic arch and the origins of major vessels are unremarkable.Right brachial cephalic vein and bilateral subclavian arteries are unremarkable.Unremarkable bilateral common, external and internal carotid arteries.Unremarkable bilateral vertebral arteries.

Output: 1.Nonenhanced brain MRI demonstrates no acute ischemic process. Few subcortical and periventricular punctate foci of flair hyperintensity are a nonspecific finding. In proper clinical setting this appearance could represent mild chronic small vessel ischemic strokes. A tiny 6 mm right posterior parietal extra-axial meningioma is detected as detailed above.2.Unremarkable nonenhanced brain MRA. 3.Unremarkable enhanced neck MRA.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal carcinoma, status post treatment. Neck: There has been marked interval decrease in size of the left nasopharyngeal mass, which now measures up to approximately 7 mm, previously approximately 40 mm. The remaining tumor also appears necrotic. There is no evidence of intracranial extension or skull base erosion. There are secretions in the right lateral nasopharyngeal recess. A cystic or necrotic right level 2B lymph node measures 5 x 10 mm in axial cross-section, previously 20 x 30 mm. Other cervical lymph nodes are unchanged. The salivary glands and thyroid are unremarkable. There is no evidence of acute infarction. The orbits are unremarkable. The cervical spine is intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: Marked interval decrease in size necrosis of the left nasopharyngeal tumor and right level 2B lymphadenopathy with necrosis, consistent with treatment response.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, left thalamic stimulator, and altered mental status. The images are degraded by patient motion. There is a left transfrontal approach brain stimulator tip in the left thalamus. There is diffuse prominence of the ventricles and sulci due to cerebral volume loss. There are extensive non-enhancing lesions in the bilateral subcortical and periventricular white matter.

Output: Left thalamic stimulator and extensive demyelinating disease with diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes or stenoses.

Output: Negative noncontrast cervical spine MRI. Specifically, there are no MRI findings of spinal cord cavernous malformation.


Instruction: Generate impression based on findings.

Input: 53-year-old female with right shoulder pain x1 month, positive impingement and scratch test. Evaluate for tear. ROTATOR CUFF: There is abnormal high signal intensity along the distal aspect of the supraspinatus tendon near its insertion on the greater tuberosity compatible with a full-thickness tear. There is associated fluid in the subdeltoid bursa. There is an intramuscular ganglion within the infraspinatus muscle suggestive of a laminar tear. The subscapularis and teres minor muscles and tendons are preserved.SUPRASPINATUS OUTLET: As above there is a full-thickness tear of the supraspinatus tendon with associated fluid in the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint and labrum are preserved with no significant narrowing or findings to suggest a labral tear.BICEPS TENDON: There is normal joint fluid communicating with the long head of the biceps tendon within the bicipital groove.ADDITIONAL

Output: 1. Findings compatible with full-thickness supraspinatus tendon tear with associated fluid in the subdeltoid bursa.2. Intramuscular ganglion within the infraspinatus muscle suggestive of a laminar tear.


Instruction: Generate impression based on findings.

Input: 41-year-old female with left shoulder pain and anterior swelling ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact. There is no fluid within the subacromial-subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. The labrum is grossly intact. There are small cysts in the lateral humeral head.BICEPS TENDON: The long head of the biceps tendon is normally situated within the bicipital groove. ADDITIONAL

Output: Small degenerative cysts in the humeral head without other specific findings to account for the patient's symptoms. The rotator cuff is intact.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post pericardial window POD #1. Now with new facial droop. Evaluate for acute stroke, intracranial hemorrhage. Signs and symptoms: Left facial droop, right pronator drift. CT of brain without infusion:Images through posterior fossa demonstrate minimal prominence of the fourth of the cerebellum and vermis and are otherwise unremarkable.Images through supratentorial space demonstrate an area of low attenuation involving the subcortical white matter of right frontal lobe. This appears to apply mass effect on the adjacent cortical sulci and is highly suspected for an acute stroke. If clinically is desired an MRI can further evaluate this area of stroke. There is no evidence of hemorrhage, ventriculomegaly or midline shift. Calvarium, limited view of paranasal sinuses and mastoid air cells are also unremarkable.

Output: 1.Focal area of edema in subcortical right frontal lobe suspected for an acute/subacute stroke considering patients provided clinical data.2.No evidence of hemorrhage, hydrocephalus or midline shift.


Instruction: Generate impression based on findings.

Input: MRI brain: Again seen is a stable pineal gland cyst which measures 12 x 10 mm, previously 12 x 10 mm. There are a few punctate foci of susceptibility effect in the cerebral hemispheres, unchanged. There is a single very small focus of T2 signal abnormality in the right frontal white matter, unchanged and nonspecific. There is no diffusion abnormality. There are no areas of abnormal signal or pathological enhancement.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. MRA brain: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. Bilateral posterior communicating arteries are seen. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. Stable pineal gland cyst. No new findings on brain MRI to account for patient's symptoms.2. No evidence of cerebrovascular occlusion or aneurysm.