Instruction: Generate impression based on findings.

Input: 49-year-old male with hepatic lesion on CT exam. Evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: There are scattered T2 hyperintense foci in both hepatic lobes without evidence of definite enhancement. Some of the lesions are too small to characterize.Evaluation of caudate lobe lesion is limited by motion artifact; however, given T2 hyperintensity and no arterial enhancement, this is considered to be probably benign lesion. Segment 5/8 T2 hyperintense lesion measures approximately 1.2 cm without evidence of enhancement. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Motion artifact limits evaluation.Multiple T2 hyperintense lesions without definite enhancement as detailed above are probably benign.


Instruction: Generate impression based on findings.

Input: CCM yearly surveillance. There are multiple supratentorial and infratentorial cavernous malformations. A cavernous malformation in the left temporo-occipital region has increased in size, now measuring approximately up to 6 mm, previously 1 mm. There is an associated developmental venous anomaly. Otherwise, the other cavernous malformations do not appear to be significantly changed. There is also unchanged extensive encephalomalacia associated with a right cerebellar hemisphere cavernous malformation. There is no evidence of acute infraction. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are unremarkable. The skull and scalp soft tissues are unremarkable.

Output: Interval increase in size of a left temporo-occipital region cavernous malformation. Otherwise, the numerous other cavernous malformations do not appear to be significantly changed. The results were conveyed to Dr. Awad and his team at 11AM on 1/9/15.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with neck pain and radicular symptoms with arm numbness. Mild straightening of the cervical lordosis is seen. Vertebral body alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. No worrisome marrow replacement or evidence of marrow edema is seen.The visualized spinal cord shows normal signal intensity and morphology throughout.C2-3: Mild left facet hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild facet hypertrophy. Minimal posterior disc-osteophyte complex formation with a right paracentral protrusion which barely if at all contacts the ventral surface of the cord. No significant spinal canal or neuroforaminal stenosis. C4-5: Mild facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the right. Mild effacement of the right ventral thecal sac, but no significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. C5-6: Mild facet hypertrophy. Posterior disc-osteophyte complex resulting in effacement of the ventral thecal sac and a mild generalized spinal canal stenosis but no cord impingement. No significant neuroforaminal narrowing. C6-7: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C7-T1: Mild facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild to moderate left foraminal narrowing. The paraspinal soft tissues are unremarkable. A subcentimeter T2 hyperintense lesion is evident within the subcutaneous tissues of the upper back.

Output: Mild degenerative findings are seen without significant spinal canal stenosis or neuroforaminal narrowing. No other specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 2-year-old male with new right facial palsy and new cyst identified on prior head CT, status post multiple resection. There has been interval increase in size of a cystic component within the anterolateral aspect of the patient's right posterior fossa tumor. This exerts new mass effect displacing the pons, medulla, and upper cervical spine leftward with flattening. Redemonstrated is the patient's so residual tumor, which has a more chronic appearance on the current exam. As before there is a left frontal approach ventriculostomy catheter and the ventricles remain decompressed. Fluid is present within bilateral mastoid air cells.

Output: There has been interval increase in size of a cystic component within the anterolateral aspect of the patient's right posterior fossa tumor. This exerts new mass effect displacing the pons, medulla, and upper cervical spine leftward with flattening.


Instruction: Generate impression based on findings.

Input: Burning pain, hyperesthesia of left upper extremity. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive diffuse paranasal sinus mucosal thickening and multiple fluid levels.Cervical Spine: The spinal cord displays normal signal and morphology. There is no evidence of abnormal enhancement in the spine. There is nonspecific lack of the usual lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of cervical spinal cord lesions.3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: 40 year-old female with headache. There is no evidence of intracranial hemorrhage, mass or edema. Minimal nonspecific white matter hypoattenuation is noted and reported on previous MRI of the patient.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The right ethmoid air cells are partially opacified. Otherwise, the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: History of meningioma and CP angle epidermoid cyst. A lobulated, nonenhancing T2 hyperintense mass centered within the right CP angle cistern encasing the right vertebral artery and posterior-inferior cerebellar arteries is unchanged in size and measures 26 x 23 x 20 mm. Mass effect on the right middle cerebellar peduncle and brainstem is again noted. There is no associated diffusion restriction.The pituitary mass is unchanged in size compared to the prior examination measuring 16 mm in coronal series. The lesion encroached on the suprasellar cistern and abuts the undersurface of the optic chiasm, similar to prior.There is no acute intracranial hemorrhage or acute infarction. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. Scattered nonspecific small white matter lesions are unchanged.

Output: 1. Stable mass centered within the right cerebellomedullary angle cistern, possibly representing an epidermoid.2. Stable pituitary mass, which is favored to represent a macroadenoma.


Instruction: Generate impression based on findings.

Input: Stroke workup: right sided weakness. Brain MRI: There is an area of high T2 signal and restricted diffusion as well as faint patchy enhancement in the posterior left basal ganglia and corona radiata. There also a a punctate focus of T2 signal and restricted diffusion as well as intrinsically high T1 signal in the left caudate nucleus. There is no associated susceptibility effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain and Neck MRA: There is no evidence of significant steno-occlusive lesions. There is no evidence of cerebral aneurysms.Brain MRV: The images are markedly degraded by patient motion. However, there is no evidence of venous sinus thrombosis based on the conventional brain MRI sequences.

Output: 1. Findings compatible with subacute left basal ganglia and coronal radiata infarction. A punctate focus of high T1 signal in the left caudate nucleus infarct is nonspecific and does not appear to represent hemorrhage due to the lack of corresponding susceptibility effect. A metastases is also an unlikely consideration. Nevertheless, follow up with a repeat brain MRI in one month or so may be useful.2. No evidence of significant steno-occlusive lesions in the head and neck arteries. 3. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Ataxia, stroke, diabetes type II. 44-year-old female The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hyperdense focus along the lower aspect of the right postcentral gyrus representing a focus of infarction identified and a recent MRI of the brain it measures approximately 3.5 cm by 9 mm in axial dimensions. There is also a small hypodense focus along the left cingulate gyrus extending towards the left paracentral lobule and another smaller one along the left inferior parietal lobule. These are also identified on a recent MRI of the brain . Atherosclerotic calcifications are present along the distal internal carotid arteries.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. The visualized portions of the paranasal sinuses demonstrate partial opacification of right and middle ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate a hyperdense left eyeball probably postoperative. It is unchanged since prior exam.

Output: 1.The patient has a focus of infarction in the right postcentral gyrus. 2.There are small foci of encephalomalacia along the left cingulate gyrus extending towards the left paracentral lobule and along the left inferior parietal lobule. 3.No evidence for acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with altered mental status. The examination is limited due to motion artifact and early termination. Within this limitation, no large areas of restricted diffusion are seen. Encephalomalacia and gliosis are evident affecting the right middle frontal gyrus. No additional large parenchymal defects are seen. There are probably scattered additional foci of nonspecific white matter T2 hyperintensity.

Output: Very limited examination due to motion artifact revealing an area of encephalomalacia and gliosis in the right middle frontal gyrus. No large areas of acute ischemia or large parenchymal lesions are observed.


Instruction: Generate impression based on findings.

Input: Reason: this should be left shoulder W, and not WWO; interestingly I cannot find a ped shoulder W LEFT; please change appropriately; no need to page me; patient does not need IV contrast; ? Labral tear History: pain ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. No intra-articular gadolinium is identified within the bursa to suggest a full-thickness tear. The acromioclavicular joint alignment is anatomic.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is branching linear increased signal abnormality traversing the superior glenoid labrum which fills with intra-articular gadolinium, indicating a SLAP tear. There is no extension of this tear into the biceps anchor. There is a subcentimeter lobulated focus of signal abnormality along the anterior superior aspect of the glenoid labrum which fills with intra-articular gadolinium likely representing paralabral cyst formation (image 15; series 501).BICEPS TENDON: The tendon of the long head of the biceps appears intact ADDITIONAL

Output: SLAP tear of the glenoid labrum with associated paralabral cyst formation.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is unknown susceptibility artifact near the skull base which somewhat limits evaluation of lower intracranial structures, but this appears similar to the previous MRI.There is hypoplastic appearance of the right A1 segment of the anterior cerebral artery which results in asymmetric prominence of the left ICA, likely of no clinical significance. Otherwise, normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Normal MRI of the brain. No evidence of metastatic lesions.


Instruction: Generate impression based on findings.

Input: 16 year old man with history of CP in context of FAS and prematurity of 26 weeks, status post 3rd ventriculostomy. Evaluate ventricle size. Limited sequences of the brain were obtained to follow the ventricular size and assess third ventriculostomy. Dilatation of the lateral ventricles is unchanged when compared to the prior exam from 2013, again measuring 5.5 cm in ML dimension when measured in the coronal plane. The third and fourth ventricles are similarly unchanged in caliber. There is extensive cystic periventricular leukomalacia of the white matter. Diminished supratentorial white matter is also noted. Thinning of the corpus callosum is also unchanged. Mild cerebellar tonsillar ectopia again seen. No new intracranial mass or mass effect.Although the CSF flow study is technically suboptimal, there appears to be biphasic flow across the floor of the third ventricle, consistent with history of third ventriculostomy. Findings appear similar to the prior study.

Output: 1. Unchanged dilatation of the supratentorial ventricular system. 2. CSF flow study is technically suboptimal, but there appears to be biphasic flow across the floor of the third ventricle, consistent with patent third ventriculostomy. 3. Extensive cystic periventricular leukomalacia, unchanged.


Instruction: Generate impression based on findings.

Input: 24 year old woman with history of Ewing's sarcoma and prior adriamycin chemotherapy exposure, referred for cardiac MRI for evaluation of ventricular function. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 60 ml/m2 (normal range: 65+/-11), the LVEDV is 96 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 47 ml (normal range 31+/-10), the LV mass index is 24 g/m2 (normal range 67+/-11), and the LV mass is 38 g (normal range 114+/-24). 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 52%, the RV end diastolic volume index is 57 ml/m2 (normal range 69+/-14), the RVEDV is 92 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 45 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is right lower lung atelectasis vs infiltrate. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%.3. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60 year-old male history of left ureteral reimplant with cholelithiasis and right upper quadrant ultrasound, rising bilirubin and now with epigastric pain ABDOMEN:LIVER, BILIARY TRACT: No focal enhancing hepatic lesion is identified. Cholelithiasis with mild gallbladder wall thickening and trace pericholecystic fluid. No evidence of intra or extrahepatic biliary ductal dilatation. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of pancreatic ductal dilatation. The pancreas is normal in morphology, T1 intrinsic hyperintensity, and enhancement. No abnormal T2 signal to suggest edema or inflammation.ADRENAL GLANDS: The adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Atrophic kidneys. Again noted is mild perinephric T2 hyperintensity consistent with inflammatory changes bilaterally, not changed compared to the CT examination. Mild to moderate left hydroureteronephrosis with partially visualized left nephroureteral stent.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Minimal free air predominantly around the liver is better appreciated on the CT examination. There is mild edema around the second portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis with mild gallbladder wall thickening and small amount of pericholecystic fluid. Findings may represent early cholecystitis in the appropriate clinical setting versus may be related to recently passed stone. No choledocholithiasis.2.Mild edema around the second portion of the duodenum may be related to gallbladder pathology.3.Minimal pneumoperitoneum is better appreciated on the CT examination.Findings text paged to Dr. Aizen at 1100 hours.


Instruction: Generate impression based on findings.

Input: Metastatic head and neck cancer. Head CT:There is no evidence of intracranial hemorrhage or infarction. There is extensive soft tissue abnormality extending from masticator space through the foramen ovale into the right middle cranial fossa and into the right cavernous sinus, better seen on the prior MR study. This appears slightly less prominent. However the subtle interval difference may be secondary to imaging techniques. No new intracranial mass is seen.There is slight prominence of the right superior ophthalmic vein which is unchanged, probably secondary to involvement of mass at the right orbital apex and cavernous sinus, causing impairment of drainage of the vein.Neck CT:Extensive post-treatment changes are again present at the right maxillofacial region. There is extensive enhancing soft tissue abnormality extending from the masticator space, superiorly into the right orbit with involving the right orbital apex, and inferior and medial aspect of the right orbit, along the lamina papyracea. The lesion extends through the skull base, including the foraminal ovale, into the intracranial compartment. Soft tissue abnormalities are also seen in the right ethmoid air cells. There is opacification in the right frontal sinus and frontal sinus ostium, which likely represent trapped secretions. There is involvement of right pterygo-maxillary fissure, pterygopalatine fossa, sphenopalatine foramen, inferior orbital fissure, and foramen rotundum, which is better seen on prior MRI study. Accounting for sampling differences, there is no significant change of the extensive soft tissue abnormality. There is possibly minimal decrease at the right orbit. Opacification of right mastoid air cells is likely secondary to eustachian tube dysfunction.No evidence of adenopathy is seen in the neck.There is degenerative disease of the cervical spine, but no ossenous metastasis is identified.

Output: 1. Status post surgical changes in right maxillofacial region.2. Extensive soft tissue abnormality extending from the right masticator space through the skull base into the right middle cranial fossa, with involvement of the right orbit, cavernous sinus, and right ethmoid air cells. Perineural spread is better seen on prior MRI study. Accounting for sampling differences, there is no significant interval change. There is possibly minimal decrease of the lesion at the medial aspect of the orbit.


Instruction: Generate impression based on findings.

Input: 92-year-old male with diffuse lymphadenopathy, weight loss. Evaluate for mass. The lymph node biopsy with metastatic carcinoma likely renal in origin on pathology. Limited evaluation of the vasculature and solid parenchymal organs due to the lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter T2 hyperintense foci of the left iliac bone (series 3 image 19) are only seen in the coronal series.OTHER: Worsening right lower lobe consolidation and right pleural effusion since the 7/29/2016 PET/CT exam. Septations are noted within the right pleural effusion. Cardiomegaly. Sternotomy wires.

Output: 1.No suspicious renal lesion. Bilateral simple renal cysts.2.Right lower lobe consolidation and right pleural effusion increased in the interval. Dedicated CT chest is recommended for further evaluation.3.The small T2 hyperintense foci of the left iliac bone correspond to the known FDG-avid lesions identified on the 7/29/2016 PET/CT exam.


Instruction: Generate impression based on findings.

Input: Female, 83 years old, with left arm and face weakness. Evaluate for stroke. Brain MRI:No restricted diffusion is seen. However, there is extensive patchy periventricular and subcortical white matter T2 hyperintensity. Several superimposed chronic appearing lacunar lesions are seen within the basal ganglia. No edema or mass effect is detected. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collections. Ventricular size and morphology are within normal limits.Brain MRA:Dolichoectasia of the basilar artery is seen. There may be a moderate segmental stenosis of the distal left A2 segment. The PCAs are not well visualized which is felt to be technical in nature. There may be a few additional scattered mild stenoses in the MCA distributions. No aneurysm or vascular malformation is suspected. Neck MRA:Common origin of the brachiocephalic and left common carotid arteries is seen. No significant stenosis is detected in the carotid vessels of the neck by NASCET criteria. No significant stenosis is detected in the vertebral vessels of the neck.

Output: 1.No acute ischemia is identified. However, there is evidence of extensive chronic small vessel and lacunar ischemic disease.2.Scattered intracranial stenoses are seen, including a moderate segmental stenosis of the distal left A2 segment. No frank vascular occlusion is identified.3.No significant vascular compromise is detected in the neck.


Instruction: Generate impression based on findings.

Input: Altered mental status Patchy areas of low attenuation in the subcortical and periventricular white matter reflect small vessel ischemic disease of indeterminate age. If there is clinical concern for acute ischemia, MRI is recommended. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease of indeterminant age


Instruction: Generate impression based on findings.

Input: 16-week-old male with left septic hip arthritis and abscesses status post incision and drainage. Evaluate for osteomyelitis/septic hip/soft tissue abscess. The left femoral metaphysis is displaced anteriorly and laterally to the femoral epiphysis and acetabulum similar to prior. Moderate-sized intermediate T1 and intermediate T2 signal intensity joint effusion with synovial enhancement decreased in size from prior exam. New small T2 hyperintense/T1 hypointense joint effusion in the right hip with associated synovial enhancement.Focal increased T2 signal in the distal left femoral metaphysis is unchanged from prior study with no associated enhancement or bone destruction. Mild subperiosteal T2 hyperintensity and enhancement along the femoral metaphyses, left greater than right, appear more prominent and well-defined compared to prior exam. The precontrast sequences of this area demonstrate normal marrow T1 signal with no bone destruction. Again seen is moderate T2/STIR signal within the left gluteal and left thigh musculature with associated enhancement. The previously referenced collections/abscesses in the gluteal and proximal thigh musculature are no longer visualized. There are new two linear T2 hyperintensity/T1 hypointense nonenhancing tracts coursing through the left anterior and lateral soft tissues to the hip joint most compatible with tracks related to recent incision and drainage procedure. A drain enters the lateral tract and terminates adjacent to the proximal femur. Also present in the soft tissues/musculature about the right hip and thigh however to a lesser degree compared to the left is T2/STIR hyperintense induration without appreciable enhancement. Similar signal intensity pattern is also present along the fascial planes.

Output: 1. Extensive edema and inflammation in the left gluteal and thigh soft tissue/musculature with interval resolution of the previously identified abscesses. New moderate edema and inflammatory changes in the right gluteal and thigh soft tissues/musculature.2. Decreasing size of moderate left hip joint effusion with associated synovitis and displacement of the left femoral metaphysis. New small right hip joint effusion with associated synovitis. 3. Bilateral subperiosteal edema and enhancement along the femoral metaphyses, left greater than right, with no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Stroke progression: somnolence. Many of the sequences are degraded by patient motion. There is interval evolution of a recent left internal capsule posterior limb infarct, with signs of early Wallerian degeneration along the corticospinal track. There is no evidence of intracranial hemorrhage and there is no evidence of new acute infarcts. There is a background of extensive cerebral white matter T2 hyperintensity. There are also small foci of encephalomalacia in the right cerebellar hemisphere and right corona radiata. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull is grossly unremarkable. There is a right lens implant. There is a 10 mm thick right suboccipital subcutaneous lipoma.

Output: Interval evolution of a recent left internal capsule posterior limb infarct, with signs of early Wallerian degeneration along the corticospinal track, but no evidence of hemorrhagic transformation, superimposed upon a background of chronic small vessel ischemic disease and lacunar infarcts.


Instruction: Generate impression based on findings.

Input: 37-year-old female with history of leiomyoma of the uterus. UTERUS, ADNEXA: Multiple intramural leiomyomas demonstrating T1 and T2 heterogeneous signal and enhancement. The largest measures approximately 7.5 x 7.0 cm. Additionally, the endometrium is not well visualized but appears to be displaced inferiorly by the largest intramural fibroid.Nabothian cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small fat-containing umbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Uterine intramural leiomyomas.


Instruction: Generate impression based on findings.

Input: Short-term memory loss. The brain demonstrates expansion of the CSF-containing spaces reflecting volume loss. This is global though more pronounced in the medial temporal lobes. There are tiny foci of T2 hyperintensity in the frontoparietal white matter that probably reflect minimal microvascular ischemia. There is no space-occupying lesion or midline shift. There is no intracranial hemorrhage. The major intracranial vessels are patentNote is made of a partially empty sella of no clinical significance. Orbits are normal. There is minimal mucosal thickening in the sphenoid and right anterior ethmoid sinuses. The other paranasal sinuses and mastoid air cells are clear.

Output: 1.Brain volume loss, slightly more pronounced in the medial temporal lobes, a pattern which can be seen in the clinical setting of Alzheimer's dementia.2.Minimal microvascular ischemia in the frontoparietal white matter.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of nonalcoholic cirrhosis and breast cancer ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. Mild to moderate intrahepatic biliary ductal dilatation. The common bile duct is normal measuring 5 mm in diameter.No focal liver lesions. The hepatic vasculature is widely patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cysts in the inferior pole of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction. The appendix is well visualized and within normal limits.BONES, SOFT TISSUES: T2 hyperintense, T1 hyperintense lesion demonstrating fat saturation in the T12 vertebra being may represent a hemangioma.Partially imaged T2 hyperintense collection in the soft tissues of the right breast may represent a seroma.OTHER: No significant abnormality noted.

Output: 1.No focal liver lesions. 2.Mild to moderate intrahepatic biliary ductal dilation without evidence of obstructing stone or lesion, appearance may be due in part to mass effect from adjacent mildly distended gallbladder. No CBD dilation. No evidence of acute cholecystitis.3.Partially imaged T2 hyperintense collection in the soft tissues of the right breast may represent a seroma.


Instruction: Generate impression based on findings.

Input: 27 year old female with AV canal defect s/p repair presenting for cardiac evaluation Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 50 ml/m2 (normal range 18+/-5), the LVESV is 87 ml (normal range 31+/-10), the LV mass index is 50 g/m2 (normal range 67+/-11), and the LV mass is 87 g (normal range 114+/-24). There is evidence of a patch repair of the membranous ventricular septum without visible shunt. There is a prominent diverticulum in the basal inferior wall. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Right VentricleThe right ventricle is moderately enlarged with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 113 ml/m2 (normal range 69+/-14), the RVEDV is 197 ml (normal range 110+/-24), the RV end systolic volume index is 60 ml/m2 (normal range 22+/-8), and the RVESV is 104 ml (normal range 35+/-13). AtriaThe left atrium is normal in size. The right atrium is moderately enlarged. There is evidence of a patch repair of the interatrial septum. Qp/Qs is approximately 1. Aortic ValveThe aortic valve is trileaflet opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. Notable abnormal morphology of the mitral valve consistent with history of AV canal defect and surgical repair. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation. Notably the level of the tricuspid and mitral valves is the same, consistent with history of AV canal defect. AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThere is a left sided SVC draining directly into the coronary sinus. Notably no right sided SVC was seen. The IVC is normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are Harrington rods within the cervical spine creating extensive artifact. Sternal wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%. There is a prominent LV diverticulum in the basal inferior wall which may be related to previous surgery. There are no regional wall motion abnormalities present and no LGE. 2. The right ventricle is moderately enlarged with mildly reduced systolic function. The overall RV ejection fraction is 47%3. Evidence of patch repair of ASD and VSD with abnormal morphology of AV valves consistent with known congenital defect with surgical repair. 4. No evidence of clinically significant intracardiac shunt (Qp/Qs is 1). 5. Mild mitral regurgitation. 6. Persistent left-sided SVC draining into coronary sinus. No right-sided SVC noted.


Instruction: Generate impression based on findings.

Input: 74-year-old male with a history of a right adrenal mass and bilateral renal cysts. Compare with previous examination. ABDOMEN: Limited examination secondary to motion artifact.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Again seen is a heterogeneous, right adrenal mass with foci of internal fat intensity, measuring 3.5 x 2.9 cm, previously measuring 3.3 x 2.7 cm. KIDNEYS, URETERS: Limited evaluation of the previously described renal cysts secondary to motion artifact. Multiple subcentimeter foci of fluid signal intensity are identified within the kidneys bilaterally, which are too small to characterize, but may represent both simple and complex benign cysts. Multiple additional foci of fluid signal intensity are identified within the kidneys bilaterally, however, these are incompletely characterized due to extensive motion artifact which degrades post contrast sequences. 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.No significant interval change in size of the right adrenal mass with foci of internal fat intensity which may represent an adrenal myelolipoma.2.Multiple bilateral renal cysts are incompletely characterized due to limited post contrast images secondary to motion artifact.


Instruction: Generate impression based on findings.

Input: 46 years, Male, left-sided weakness. Evaluate for acute stroke. There is motion degradation on multiple sequences. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. 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. Mild gliosis and subtle volume loss in the right anterior temporal lobe is unchanged. There is also global parenchymal volume loss, which appears advanced for age. No hydrocephalus. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct.2. Mild chronic small vessel ischemic changes.3. Mild global parenchymal volume loss, which is advanced for age, similar to prior. 4. Mild right anterior temporal encephalomalacia is also unchanged, which may be related to remote trauma or other injury.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with upper extremity paresthesias. Assess for worsening of known cervical disc disease at C6-7. Anterior spinal fusion instruments are evident from C4 through C6. Vertebral body morphology is otherwise unremarkable. Spinal alignment is anatomic.The visualized spinal cord is free of significant or convincing signal abnormality. Details of cord morphology will be discussed by level as follows.C2-3: Facet hypertrophy. Right uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing. C3-4: Left facet hypertrophy. Right uncovertebral hypertrophy. Minimal generalized posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: Facet hypertrophy. No significant spinal canal stenosis. No significant foraminal narrowing. C5-6: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. Left uncovertebral hypertrophy. No significant spinal canal stenosis. Mild to moderate left foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Moderate generalized spinal canal stenosis with deformation of cord contour but no definite evidence of cord signal abnormality. Mild to moderate foraminal narrowing.C7-T1: Facet hypertrophy. Right foraminal disc osteophyte formation. No significant generalized spinal canal stenosis. Moderate right foraminal narrowing.

Output: 1.Evidence of anterior cervical spine fusion from C4 through C6.2.At the C6-7 level, disc osteophyte formation posterior element hypertrophy contribute to a moderate spinal canal stenosis with some degree of cord impingement but no definite or convincing evidence of cord edema.3.Mild degenerative findings are seen at additional levels without other areas of significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Planning for radiosurgery, brain mass, anticipating radiosurgery. Limited examination performed for radiosurgery planning again demonstrates a 9 x 9 mm enhancing lesion in the posterior right frontal lobe involving the medial aspect of the precentral gyrus with a moderate amount amount of surrounding 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 (series 2103 image 84), better seen on prior examination. No additional abnormal parenchymal or meningeal enhancement is appreciated. There is mild prominence of the cortical sulci consistent with global volume loss. The ventricles are within normal limits in size and configuration. Patchy areas of T2 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. Small foci of gradient susceptibility along the posterior horns of the lateral ventricles, right greater than left, are nonspecific however appears similar to prior examination and may be related to hemosiderin deposition or mineralization. There is a 1.8 x 1.0 cm area of abnormal signal involving the medial anterior left maxillary sinus consistent with bone on prior CT, and appearing to correlate with an area of increased radiotracer activity seen on prior bone scan (series 5, image 23). There is an approximately 2.1 x 1.8 cm expansile lesion involving the left sphenoid wing (series 5, image 46). There is again a small enhancing lesion involving the left frontal calvarium suspicious for osseous metastatic disease, similar to prior examination.

Output: 1. Stable larger posterior right frontal and punctate left anterior frontal lobe enhancing lesions compatible with metastatic disease. 2. Redemonstration of left frontal calvarial enhancing lesion, suspicious for osseous metastasis.3. Area of intermediate signal along the medial anterior left maxillary sinus correlating to bone on prior CT and an area of increased radiotracer activity seen on prior bone scan. This may relate to fibrous dysplasia, however given patient's history, continued follow-up is recommended.4. An expansile lesion involving the left sphenoid wing is also nonspecific however may also be related to fibrous dysplasia. 5. Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 47-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.0 x 3.0 x 3.9 cmPeripheral Zone: In the right mid gland there is a T2 hypointense lesion with corresponding decreased ADC signal measuring 13 x 10 mm (image 16 of series 1401). There is no appreciable enhancement.Linear and wedge shaped signal abnormality in the left mid gland likely due prostatitis or scarring.Central Gland: Mild BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: There is posterior extracapsular extension in the right mid gland.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Right mid gland peripheral zone tumor with extracapsular extension as above.2. Left peripheral zone findings likely secondary to scarring or prostatitis, however multifocal disease not entirely excluded.


Instruction: Generate impression based on findings.

Input: 67-year-old male with left hip pain in the setting of metastatic prostate cancer. ACETABULAR LABRUM: Although this examination was not protocoled for evaluation of the acetabular labrum, no discrete labral tear is evident.ARTICULAR CARTILAGE AND BONE: Note is made of increased curvilinear/serpentine signal abnormality within the femoral heads bilaterally consistent with avascular necrosis, left greater than right. There is associated increased signal abnormality on fluid sensitive sequences within the left femoral head/neck junction which likely represents the sequela of the aforementioned AVN. There is a small bilateral hip effusions which may be related to the aforementioned AVN. There is curvilinear enhancement in the left femoral head/neck junction on postcontrast sequences in a pattern suggestive of AVN. No additional foci of enhancing signal abnormality are identified to suggest osseous metastatic disease.SOFT TISSUES: No significant abnormality noted. No focal mass lesions are identified.ADDITIONAL

Output: Findings most consistent with bilateral avascular necrosis of the femoral heads, left greater than right.


Instruction: Generate impression based on findings.

Input: 30 year old male with non-ischemic cardiomyopathy referred for further evaluation. Left VentricleThe left ventricle is moderately dilated with severely reduced ejection fraction. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 148 ml/m2 (normal range: 74+/-15), the LVEDV is 380 ml (normal range 142+/-34), the LV end systolic volume index is 102 ml/m2 (normal range 25+/-9), the LVESV is 260 ml (normal range 47+/-19). There is global hypokinesis present. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process however there is artifact that reduces the diagnostic quality of the images. The pre-contrast native myocardial T1 relaxation time is normal (1060 ms of the mid septal wall).Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced ejection fraction. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 241 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 145 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with severely reduced ejection fraction (LVEF 31%).2. The right ventricle is normal in size with mildly reduced ejection fraction (RVEF 40%). 3. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process however there is artifact that reduces the diagnostic quality of the images. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Vilenchik is a 58-year-old female with a personal history of right breast mastectomy in 2007 for invasive tubular carcinoma and benign left breast FNA in 2009 and 2014. Family history of breast cancer in sister, diagnosed at the age of 48. Patient is status post right breast mastectomy. There is heterogeneous amount of fibroglandular tissue in the left breast. No abnormal enhancement is seen in the right chest wall and left breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Of note, there is a subcentimeter progressively enhancing mass seen in the lower sternum, stable in appearance since 2012, and likely represents a benign osseous hemangioma.

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


Instruction: Generate impression based on findings.

Input: Metastatic prostate cancer. There is redemonstration of findings related to right posterior parietal craniotomy with a small amount of fluid in presumably blood products at the operative site. The cystic mass overlying the right parietal lobe has been grossly resected. A punctate enhancing focus in the right lateral margin of the section cavity may represent granulation tissue or a focally dilated vein. There is otherwise minimal residual edema in the brain parenchyma surrounding to the surgical bed. There is unchanged diffuse dural thickening and enhancement particularly along the bilateral cerebral convexities, measuring up to 10 mm in maximal thickness on the right side. There has been interval decease in the edema adjacent to the left inferior frontal lobe lesion. There is leftward midline shift of approximately 5 mm. The basal cisterns remain patent. There is no evidence of new mass or acute infarct. The major cerebral flow voids are intact. There is persistent fluid in the mastoid air cells bilaterally. There is a small retention cyst in the right maxillary sinus. The orbits and scalp soft tissues are grossly unremarkable.

Output: 1.Postoperative findings related to right posterior parietal craniotomy and resection of an right parietal dural metastasis with markedly decreased surrounding right parietal lobe edema.2. No significant change in size of the extensive remaining bilateral dural based metastatic disease, although left inferior frontal lobe edema has subsided.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with past medical history significant for neuromyelitis optica, myasthenia gravis associated with thymoma, and hypertension with lower extremity weakness. Evaluate for neuromyelitis optica lesions. Motion artifact somewhat degrades image quality.MRI Brain: There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, which likely represent a combination of demyelinating lesions and/or underlying mild to moderate chronic small vessel ischemic changes. Some of these lesions are oval in configuration and oriented perpendicular to the lateral ventricles. Abnormal FLAIR hyperintensity is also seen along the undersurface of the corpus callosum. There is no pathological enhancement.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. A subtle punctate focus of susceptibility artifact in the right parietal white matter, which is less conspicuous compared to the prior study, may represent chronic hemosiderin deposition or calcification.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. An incidental left frontal scalp area of abnormal low signal is again seen, which may represent an exostosis or calcified hematoma. There is mucosal thickening within the bilateral maxillary sinuses.MRI Cervical spine: The cervical spine is in normal alignment, with exaggeration of the normal cervical lordosis. The vertebral body heights are well-maintained. There is minimal loss of disc height at C3-C4 and C4-C5 with disc desiccation throughout the cervical spine. There are scattered foci of T1 hyperintense signal within the cervical spine, which likely represent focal fatty replacement or fat-containing hemangiomas. The spinal cord is of normal caliber and signal. There is no definite pathological enhancement of the cord.At C4-C5 through C6-C7, there are mild disc osteophyte complexes/diffuse disc bulges with central prominence, mostnotably at C4-C5 where it abuts the ventral cord. There is mild ligamentum flavum thickening at C3-C4 and C4-C5. There is no significant central spinal canal or foraminal stenosis. There is an incidental right sided nerve root sleeve cyst at C7-T1. MRI Thoracic spine: There is exaggerated kyphosis of the thoracic spine. There is minimal chronic compression deformity of the superior endplate of the T2 and T5 vertebral bodies again noted. The partially imaged lumbar spine demonstrates abnormal signal and deformity at the superior endplate of the L2 vertebra, suspicious for new compression fracture. Deformity of the superior endplate of the partially imaged L3 vertebra is unchanged and may represent a Schmorl's node and/or chronic compression deformity. There is mild loss of disc space heights. There are scattered foci of T1 hyperintense signal within the thoracic spine, which likely represent focal fatty replacement or fat-containing hemangiomas. There is degenerative spondylosis of the thoracic spine with mild disc bulges throughout. There is no significant spinal canal stenosis. Redemonstrated is increased T2 signal intensity and decreased caliber of the thoracic cord most prominent from the T8-T9 disc level extending inferiorly to the upper T10 level. There is no definite pathological enhancement of thoracic cord.Incidental note is made of an enhancing T2 hyperintense lesion within the left lobe of the thyroid gland measuring at least 2.0 cm in craniocaudal dimension. A left upper lobe opacity is again noted. A right renal T2 hyperintense lesion measuring at least 6.0 cm is partially imaged as well as a 1.1 cm T2 hyperintense lesion, likely representing cysts.

Output: 1.Unchanged abnormal T2 signal in the supratentorial white matter, likely representing a combination of demyelinating lesions and chronic small vessel ischemic changes in a patient of this age. No evidence of enhancement to suggest active demyelinating lesion. 2.Mild spondylotic changes of the cervical and thoracic spine as detailed above, without significant spinal canal or foraminal stenosis. No MR evidence of demyelinating disease within the cervical cord.3.Unchanged mid to distal cord myelomalacia most prominent from the T8-T9 disc level to the upper T10 level which is non-specific at this time but may certainly represent sequela of prior myelitis.4.Mild chronic benign compression deformity of the superior endplates of T2, T5 and L3 again noted. 5.New compression fracture at the superior endplate of the L2 vertebra.6.Incidental left thyroid lesion, which is incompletely evaluated. Please correlate with thyroid ultrasound as clinically indicated.Incidental left upper lobe opacity, also seen in MR thoracic spine dated 8/15/2013. CT may be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: Brain MRI:Thin subdural hematomas are present involving the posterior falx, bilateral temporoparietal regions (left greater than right), and involving the tentorium. Additionally, there is evidence of sporadic foci of subarachnoid as well as intraventricular hemorrhage. Small parenchymal hemorrhages are noted in the medial right cerebellar and lateral right cerebellar hemisphere.The ventricles and sulci are normal in size. The cerebellar tonsils are in appropriate position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. The degree of myelination is appropriate. Flow voids are present within the major vessels indicating patency. Asymmetric scalp swelling is consistent with recent delivery. Fluid is present in the left middle ear cavity as well as within a few right mastoid air cells.Cervical spine MRI:Epidural material is present which is T1 and T2 hyperintense, without suppression on STIR technique, most prominent in the posterior epidural space beginning at the T1 level and extending below the field of view. This does not have associated mass effect, and does not result in thecal sac deformation or cord compression.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 MRI findings of traction-induced meningocele.

Output: 1.Thin subdural hematomas are present involving the posterior falx, bilateral temporoparietal regions (left greater than right), and involving the tentorium. Additionally, there is evidence of sporadic foci of subarachnoid as well as intraventricular hemorrhage. Small parenchymal hemorrhages are noted in the medial right cerebellar and lateral right cerebellar hemisphere.2.Spinal epidural material is present which is T1 and T2 hyperintense, without suppression on STIR technique, most prominent in the posterior epidural space beginning at the T1 level and extending below the field of view. The constellation of these findings are most consistent with a small amount of epidural hemorrhage. This does not have associated mass effect, and does not result in thecal sac deformation or cord compression. Given cervical spine acquisition technique, its inferior extent lies below the field of view and would require additional MR imaging to characterize its entirety.


Instruction: Generate impression based on findings.

Input: Images are significantly degraded by motion artifact. There appears to be restricted diffusion in the corpus callosum, which is incompletely evaluated on this examination. There is probably associated increased T2 signal in this region.Dedicated images through the sella demonstrate a 2.2 x 2 x 2.5 cm (AP x TV x CC) mass in the sella/suprasellar region. The mass predominantly shows mildly increased T1 and T2 signal. Lesional enhancement is moderate along its periphery but fades internally. There is expansion of the sella, invasion into the suprasellar cistern and elevation of the optic chiasm. Mucosal thickening is noted in the sphenoid sinuses. A subcentimeter sebaceous cyst is again noted in the left temporal scalp.

Output: 1. Apparent diffusion restriction in the corpus callosum is incompletely evaluated. Differential considerations would include recent ischemia or perhaps less likely a demyelinating process among other possibilities. MRI of the entire brain is suggested possibly with sedation to control for motion.2. 2.5 cm sellar/suprasellar mass is favored to represent a macroadenoma versus meningioma. Dr. Sorensen discussed the above findings with Dr. Ganjoo on 9/23/2016 at 1545 hours.


Instruction: Generate impression based on findings.

Input: Moyamoya disease [I67.5], Reason for Study: ^Reason: hx pial synangiosis: eval revascularization History: surveillance imaging Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.Focal encephalomalacia on the right basal ganglia and thalamus, hemosiderin deposition on the left mesial thalamus and right globus pallidus as well as encephalomalacia on the left inferior parietal lobule are again seen, unchanged since prior scan.Bilateral fronto-temporal craniectomy sites are redemonstrated, unchanged.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate obliteration of bilateral distal ICA supraclinoid segments which are consistent with known Moyamoya disease, unchanged since prior scan. Vertebrobasilar system appears to be normal. Reconstitution of bilateral MCAs and their branches are seen on source images, unchanged since prior scan.Vertebrobasilar system appears to be normal.Brain MR PerfusionAIF was measured from the distal basilar artery.The MTT appears to be delayed symmetrically on bilateral hemispheres comparing to posterior fossa.The rCBV and rCBF maps show approximately symmetric rCBV and rCBF but slightly decreased left hemispheric rCBV and rCBF.There is no focal significant increase or decreased area on either rCBV or rCBF maps. Above findings do not show any significant interval change since prior scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of multifocal chronic ischemic and hemorrhagic lesions.3. No change of Moyamoya disease involving bilateral distal ICA with reconstitution of bilateral MCAs and their branches.4. No significant interval change of MR perfusion study.


Instruction: Generate impression based on findings.

Input: History of uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus is anteverted and mildly retroflexed. The uterus is enlarged with a lobular contour measuring 12.4 x 8.4 cm in the sagittal plane. There are numerous intramural fibroids. The largest intramural fibroid measures 6.1 x 4.8 cm in the sagittal plane at the level of the lower uterine segment. An additional large fibroid measures 5.6 x 4.1 cm in the anterior fundus which distorts and displaces the endometrium, with possibly a small submucosal component. There is a subserosal fibroid measuring 3.5 x 2.9 cm in the dorsal fundus with a broad base.They all demonstrate avid heterogeneous postcontrast enhancement.The endometrium is distorted by the fibroids but demonstrates normal thickness and signal intensity.3.5 cm simple appearing right ovarian cyst. The left ovary is normal morphology and size.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lobular enlarged uterus with numerous, predominantly intramural fibroids demonstrating avid postcontrast enhancement as described above.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils descend below the level of the foramen magnum by at least 5 mm depending on the level of measurement. There is, however, only mild crowding in the posterior fossa and the CSF spaces appear patent. There are no masses, mass effect or midline shift. There is no abnormal enhancement within the brain. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. The ventricles and sulci are normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Cerebellar tonsils descending below the level of the foramen magnum compatible with a Chiari I malformation. Clinical correlation is recommended to determine whether this may be related to the patient's symptoms.2.No additional abnormalities noted to explain the patient's headache.


Instruction: Generate impression based on findings.

Input: Female 51 years old Reason: hx of cholangioCA multiple PTC drains, cholangitis History: as above ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology with patent hepatic and portal vessels. There is thickening of the right and left hepatic bile duct system suggestive of a ongoing cholangitis. There is mild intrahepatic biliary ductal dilatation. The biliary enteric anastomosis is patent. The circumferential thickening of the duct near the anastomosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts some with hemorrhagic or proteinaceous debris.RETROPERITONEUM, LYMPH NODES: Small upper abdominal retroperitoneal and mesenteric lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No drainable fluid collections.

Output: 1.Findings compatible with ongoing cholangitis with mild intrahepatic biliary ductal dilatation.2.Circumferential thickening of the bile duct.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for possible subdural. Signs and symptoms: Poor quality initial CT need to evaluate for subdural. Nonenhanced head CT:There is no evidence of intracranial hemorrhage.There is paucity of cortical sulci, sylvian fissures and a small basal cistern. Findings although may be the normal for patient stated age of 35 possibility of mild diffuse cerebral edema cannot be entirely ruled out. Comment current follow-up with an MRI examination.There is poor differentiation of gray -- white matter however I cannot be certain whether this is due to patient's thicker than normal calvarium and also presence of board under patient's head.

Output: 1.No evidence of parenchymal or subdural hematoma as clinically questioned.2.Paucity of cortical sulci and small size of basal cistern and sylvian fissures and poor differentiation of gray -- white matter as described above. Concern for possible underlying cerebral edema and recommend further follow-up with an MRI exam. Please see above comments.


Instruction: Generate impression based on findings.

Input: 53 yo woman with cardiomyopathy and acute chest pain referred for evaluation of etiology of cardiomyopathy. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 116 ml/m2 (normal range: 65+/-11), the LVEDV is 184 ml (normal range 109+/-23), the LV end systolic volume index is 78 ml/m2 (normal range 18+/-5), the LVESV is 124 ml (normal range 31+/-10), the LV mass index is 82 g/m2 (normal range 67+/-11), and the LV mass is 130 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is a small amount of late gadolinium enhancement (LGE) in the basal anterior wall and mid-wall LGE in the basal anteroseptum to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is not consistent with prior myocardial infarction. There is also a moderate elevation in native myocardial T1 time (1163ms). Theis suggests the presence of diffuse underlying myocardial fibrosis in addition to the focal fibrosis that is represented by the late gadolinium enhancement. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 114 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 46 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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Pericardium isThere is no obvious pericardial disease.Extracardiac FindingsThere is a small hiatal hernia noted. 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. Severe LV dilation with moderately reduced systolic function (LVEF 33%) with evidence of underlying myocardial fibrosis inflammation or infiltration involving the basal anterior and anteroseptal.2. The RV is normal in size with normal systolic function (RVEF 60%)3. Left atrium is severely dilated. The


Instruction: Generate impression based on findings.

Input: Female, 61 years old. Reason: left thyroid nodule seen on MRI of neck. Change in size. History: on synthroid med daily; has had bilateral thyroid nodules seen in ultrasounds in the past RIGHT LOBE MEASUREMENTS: 5.0 x 1.5 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.4 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Predominantly hypoechoic nodule seen in the right superior lobe measures 0.7 x 0.4 x 0.5 cm. This nodule was not definitively seen on the prior study.LEFT LOBE: Predominantly hypoechoic nodule in the left inferior lobe is slightly increased in size compared to prior study and measures 1.2 x 1.0 x 1.2 cm, previously 1.2 x 0.8 x 1.1 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Level 3 cervical lymph node is present with a benign morphology, however, no fatty hilum is visualized. The lymph node measures 2.6 x 1.2 x 0.5. On the previous study, a similar-appearing lymph node measured 2.1 x 0.3 x 0.7 cm.OTHER: No significant abnormality noted.

Output: Hypoechoic nodule in the left inferior thyroid lobe which is not significantly changed. New subcentimeter hypoechoic nodule in the right superior thyroid lobe.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of new hepatic lesion seen on MRI. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, including a stone at the gallbladder neck. No evidence of cholecystitis. Lesions at the porta hepatis and inferior right hepatic lobe are T2 hyperintense without enhancement measuring approximately 1.3 and 1.0 cm respectively.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: Enhancing lesion along right posterior vertebral body of T12 suspicious for metastases.OTHER: No significant abnormality noted.

Output: 1.Lesion seen on prior ultrasound are benign in appearance, likely simple cysts.2.Enhancing lesion in the T12 vertebral body is suspicious for a metastases.


Instruction: Generate impression based on findings.

Input: 28-year-old female with history of Ewing's sarcoma of the right hand. Assess for progression of disease. Markers were placed along the skin dorsal to the base of the second metacarpal and base of the proximal phalanx of the index finger. No underlying lesions or abnormal enhancement is identified. The bone marrow signal is normal throughout. No focal osseous lesion. The extensor and flexor tendons are intact. The structures of the carpal tunnel are normal in appearance.

Output: No evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: Clinical question:? Hemorrhage. Signs and symptoms: Facial droop Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Heavy vascular calcification of intracranial right vertebral. There is also high density of bilateral middle cerebral arteries in the sylvian fissures and basilar artery. Above findings are believed to represent vascular calcification and atherosclerotic disease.There is prominence of the folia of cerebellum and vermis for patient stated age which are concerning for underlying cerebellar parenchymal volume loss. Note should be made that acute early stroke can be missed on CT. If patient's symptoms persist follow-up CT or an MRI is recommended.

Output: 1.No evidence of acute intracranial findings.2.Suspect the parenchymal volume loss of cerebellum.3.If clinical symptoms persist an MRI or follow-up CT is recommended


Instruction: Generate impression based on findings.

Input: 63 year old female with thyroid carcinoma and metastasis to mediastinum. Referred for cardiovascular MRI to evaluate for cardiac metastasis. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 57 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 81 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial tumor infiltration. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 116 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 58 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 trace 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 VeinsThere are 2 right-sided pulmonary veins and a single common left sided pulmonary vein.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. A catheter is noted in the SVCPericardiumThere is mild thickening of the pericardium with evidence of increased T2-signal and late gadolinium enhancement. No significant pericardial effusion. These findings are consistent with acute or subacute pericarditisExtracardiac FindingsThyroid mass and mediastinal lymph nodes are noted. 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. Normal LV size with low normal systolic function (LVEF 53%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 50%).3. Acute or subacute pericarditis noted.4. No evidence of cardiac infiltration by tumor.5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Redemonstrated are remote post-operative findings related to a left parieto-occipital craniotomy for tumor resection. There is unchanged T2/FLAIR hyperintensity surrounding the resection cavity as well as unchanged periventricular T2/FLAIR hyperintensity, left side more than right. There is no pathologic enhancement. There is a thin rim of T1 shortening and susceptibility artifact along the periphery of the surgical cavity, consistent with blood degradation products and/or mineralization. There is an unchanged punctate focus of susceptibility effect within the left frontal white matter, consistent with hemosiderin deposition from chronic microhemorrhage. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, including mild ex vacuo dilatation of the left ventricular atrium. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Stable post-operative findings related to a remote left parieto-occipital craniotomy for tumor resection and surrounding T2/FLAIR hyperintensity consistent with treatment changes. No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with lower extremity weakness and pain, inability to walk. History of lung cancer. Concern for leptomeningeal spread. Patchy leptomeningeal enhancement is seen along a majority of the visualized spinal cord. In addition, more nodular, partially intramedullary enhancing deposits are seen along the left lateral cord at T3 and ventrally at T11 and T12. These nodular lesions produce moderate edema within the cord parenchyma.Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous, but there are no definite focal marrow replacing or enhancing marrow space lesions. The intervertebral discs are preserved. No significant spinal canal or foraminal compromise is seen. Right lung fibrosis and a chronic posterior right pneumothorax are partially visualized. Mediastinal and hilar adenopathy is also partially visualized.

Output: Findings are seen compatible with leptomeningeal spread of disease. In addition, there are several more nodular tumor deposits which appear to be partly intramedullary and which induce moderate edema in the cord parenchyma.


Instruction: Generate impression based on findings.

Input: Nontraumatic subdural hemorrhage, unspecified [I62.00], Reason for Study: ^Reason: view for chronic SDH History: s/p trauma from 8/2016 with tool box on the head s/p repair of skull fracture with plate and history of chronic SD There are interval postoperative findings related to cranioplasty and evacuation of a large left subdural hematoma. A small amount of subgaleal fluid is demonstrated. There is a small amount of persistent left subdural and epidural fluid , significantly decreased since the prior examination. There is mild mass effect on the adjacent left frontal lobe. Small areas of ill-defined T2 signal abnormality in the bilateral centrum semiovale are seen, perhaps representing gliosis or axonal degeneration. There is no diffusion restriction to suggest acute ischemia. The ventricles are nondistended. The craniocervical junction is unremarkable.

Output: Interval postoperative changes of cranioplasty and left subdural evacuation with a small amount of residual left frontal extra-axial fluid.


Instruction: Generate impression based on findings.

Input: There are 2 small foci of T2 hyperintensity in right frontal subcortical white matter, and one in left frontal subcortical white matter, without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. 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 acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There are 2 small foci of T2 hyperintensity in right frontal subcortical white matter, and one in left frontal subcortical white matter, without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. These are nonspecific in appearance and the differential diagnosis would most likely include small vessel disease, migraine sequelae, or residua from past trauma. Given lesional location and morphology, demyelination is to be unlikely.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: 4 days RLE weakness concerning for CVA History: RLE weakness Brain MRIRestricted diffusion lesion seen on the left thalamus indicates acute ischemic infarction.There is no evidence of hemorrhagic conversion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.There is no evidence of intracranial artery aneurysm, no intracranial arterial luminal irregularity or stenosis.

Output: 1. Acute ischemic infarction without hemorrhagic conversion, left thalamus.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Male, 44 years old. Bilateral facial pain There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There are no areas of abnormal signal. There is no abnormal parenchymal or leptomeningeal enhancement. There is no diffusion abnormality. The imaged cranial nerves appear normal. Specifically, the cisternal portions of the trigeminal nerves have normal morphology and signal, without pathologic enhancement. No large vessels approach or impingement on the nerves in this location. There are no focal masses or fluid collections. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal scattered paranasal sinus mucosal thickening. The visualized mastoid air cells are clear. There is mild staphylomatous deformation of the globes. Otherwise, the orbits are unremarkable.

Output: Normal MR images of the brain without specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of tethered cord release, follow-up release. Worsening neck pain. Cervical: The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or right neural foramen. There is mild left neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is a right paramedian disk protrusion associated with mild posterior ligamentous hypertrophy, endplate and uncovertebral osteophytes and effacement of CSF ventral and posterior to the spinal cord. Overall there is mild to moderate spinal stenosis at this level. Moderate right neural foraminal stenosis. No significant left neural foraminal narrowing.At C6-7 there is no significant compromise to the spinal canal. Small disc osteophyte complex, uncovertebral hypertrophy, and facet arthropathy result in moderate to severe left-sided neural foraminal stenosis. No significant right neural foraminal narrowing.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar: For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. There are postsurgical changes of tethered cord release via L4-L5 level with left sided laminoplasty. Conus terminates at the L4-L5 level as before and demonstrates abnormal contour. No new cord signal abnormality, syrinx, or fluid collections within the visualized distal cord or lumbar spinal canal are appreciated. Prone images demonstrate ventral motion of the conus compatible with deep tethering.Vertebral body heights and alignment are maintained. Mild dysplasia/bifid appearance involving the L5 spinous process again seen. Bone marrow signal is benign with scattered foci of T1 hyperintensity compatible with hemangioma. Mild degenerative changes are seen including mild lower lumbar facet arthropathy without significant spinal canal or neural foraminal stenosis at any level. There is minimal epidural fluid at the dorsal L4-L5 level without mass effect. There is edema involving the posterior paraspinous soft tissues also consistent with postsurgical change.

Output: 1. Expected postsurgical changes of tethered cord release. Prone images demonstrate ventral motion of the distal cord compatible with the tethering.2. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at the C5-C6 level. There is also right C5-C6 and left C6-C7 neural foraminal stenosis. These findings are not significantly changed since 7/18/2015.


Instruction: Generate impression based on findings.

Input: 69-year-old female with recurrent urinary tract infections and probable urethral diverticulum with stone. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Nearly circumferential, "saddlebag" urethral diverticulum just below the bladder neck measuring up to 2.6 x 2.6 x 2.4 cm (series 401/31, series 701/20). Somewhat round, low T2 signal material posteriorly within the diverticulum without enhancement, most compatible with calculus. Mild increased mucosal enhancement of the diverticulum is most likely related to inflammation. No definite enhancing soft tissue mural nodularity.Subcentimeter T2 hyperintense right peroneal lesion is most likely due to Bartholin's gland (series 401/23).

Output: Urethral diverticulum containing a calculus, as clinically suspected.


Instruction: Generate impression based on findings.

Input: Reason: Memory deterioration; evaluate for etiology. History of gastrointestinal stromal tumor. The CSF spaces are appropriate for the patient's stated age with no midline shift. There are punctate foci of signal loss present in the hippocampi, left thalamus, left and right cerebellar hemispheres, basal ganglia and the subcortical white matter.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. In addition, T2 and flair hyperintense lesions are present in the brain stem and internal capsules.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate some scattered opacities. The visualized portions of the orbits demonstrate a left ocular prosthesis .

Output: 1.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related though they could be related to nonspecific leukoencephalopathy more be treatment related. Please correlate with the patient's clinical history.2.Lesions in the brainstem and internal capsules are also nonspecific but could be vascular related.3.There is a mild degree of microhemorrhages scattered along the cortex in both hemispheres as well as brainstem and basal ganglia. This is somewhat of a mixed pattern which can be seen with amyloid angiopathy or hypertension.4.There is no evidence for brain metastases.


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.C2/3: UnremarkableC3/4: There is a tiny midline disc protrusion which causes slight anterior midline flattening without intrinsic cord signal abnormality. There are no significant stenoses.C4/5: Posterior osteophyte disc complex as well as ligamentum flavum thickening. There is mild central and mild bilateral neural foraminal stenosis.C5/6: There is a large left paracentral disc extrusion which extends both above and below the disc level, compressing the cord resulting in intrinsic cord T2 hyperintensity and severe leftward central stenosis. There is also uncinate hypertrophy and facet hypertrophy resulting in severe bilateral neural foraminal stenosis.C6/7: Minimal posterior osteophyte disc complex and uncinate hypertrophy without significant stenosis.C7/T1: Right facet hypertrophy causes moderate right neural foraminal stenosis.

Output: 1.C3/4: There is a tiny midline disc protrusion which causes slight anterior midline flattening without intrinsic cord signal abnormality.2.C4/5: Mild central and mild bilateral neural foraminal stenosis.3.C5/6: There is a large left paracentral disc extrusion which extends both above and below the disc level, compressing the cord resulting in intrinsic cord T2 hyperintensity and severe leftward central stenosis. There is also severe bilateral neural foraminal stenosis secondary to spondylitic changes.4.C7/T1: Moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 48-year-old female status post right mastectomy in September 2014 for recurrent breast cancer, status post chemotherapy. Evaluate There is scattered fibroglandular tissue in the left breast. Postsurgical changes, fat necrosis, and a few susceptibility artifacts are seen in the reconstructed right breast.Mild parenchymal enhancement is noted in left breast and post surgical changes are noted in reconstructed right breast.No abnormal enhancement is seen in left breast or reconstructed right breast. No abnormal lymph nodes are identified in either axillary region.Chest port artifact on the left chest wall is identified.

Output: 1.No MRI evidence for malignancy. 2.Postsurgical changes in the right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Meningioma and left sided headache. There is no significant interval change in the extra-axial left paraclinoid tumor, measures up to approximately 13 mm. There is slight mass effect upon the overlying brain parenchyma, but no evidence of edema. There are scattered nonspecific T2 hyperintensities within the subcortical and periventricular cerebral white matter. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No significant change in the left paraclinoid meningioma.


Instruction: Generate impression based on findings.

Input: Male 71 years old Reason: history of left base prostate cancer History: history of left base prostate cancer PELVIS:PROSTATE:Prostate Size: The prostate gland measures 3.8 x 5.5 x 6.3 cm.Peripheral Zone: Three foci of abnormal T2 hypointense signal which demonstrate early enhancement and are dark on the ADC map are identified within the peripheral zone. The dominant focus of signal abnormality is in the right paracentral peripheral zone posteriorly in the base. This measures 1.1 x 0.9 cm. It abuts the posterior capsule but there is no definite extracapsular extension. A second smaller focus of signal abnormality in the left peripheral zone in the mid gland measures 0.6 x 0.6 cm. A third punctate focus measuring 0.4 x 0.4 cm is identified in the left peripheral zone base/mid gland.Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Three foci of signal abnormality within the peripheral zone which are suspicious for foci of prostatic carcinoma. There is no extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: Dizziness. There is no evidence of intracranial hemorrhage or midline shift. An ill-defined region of low density in the right occipital lobe (images 14 and 15/28, series 2) may represent volume averaging. However, an MRI is recommended for further evaluation.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: Area of low-attenuation in the right occipital lobe may represent volume averaging. However, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Unresponsive Non-enhanced CT of brain:Examination demonstrate a left parietal craniectomy. There is a large area of encephalomalacia involving the left posterior frontal -- parietal region under the craniectomy site.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. There is ex vacuo dilatation of left lateral ventricle adjacent to the above described foci of encephalomalacia. The gray -- white matter differentiation is preserved. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. The provided clinical data low follow-up with an MRI is recommended.

Output: 1.No evidence of the acute intracranial process.2.Left parietal craniectomy and underlying parenchymal encephalomalacia of unknown etiology.3.Unremarkable calvarium otherwise and normal visualized paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Hyperreflexia and gait abnormality The sagittal images extend inferiorly through the superior endplate of the T5 vertebral body. There is a 3-4 mm retrolisthesis of C5 on C6. There is mild height loss of the C5 and C6 vertebral bodies. There is no bone marrow edema within the vertebral bodies to suggest acute fracture. Severe degenerative spondylosis affects the cervical spine, worst at C5-6 and C6-7 where there is marked loss of disc height. There is no abnormal cord signal. The prevertebral soft tissues are unremarkable.C2/3: Disc osteophyte complex and posterior element hypertrophy without significant spinal canal stenosis or neural foraminal narrowing.C3/4: Disc osteophyte complex and posterior element hypertrophy with indentation of the ventral thecal sac and perhaps mild flattening of the cord without associated abnormal signal. Moderate to severe spinal canal stenosis and moderate neural foraminal stenosis.C4/5: Disc osteophyte complex and posterior element hypertrophy with indentation of the ventral thecal sac and mild flattening of the cord without associated abnormal signal. Moderate spinal canal stenosis, mild left and moderate right neural foraminal narrowing.C5/6: Disc osteophyte complex and posterior element hypertrophy with indentation of the ventral thecal sac and mild cord deformity without associated abnormal signal. Moderate spinal canal stenosis and moderate neural foraminal narrowing.C6/7: Disc osteophyte complex and posterior element hypertrophy with mild left and moderate right neural foraminal narrowing. No significant spinal canal stenosis.C7/T1: Disc osteophyte complex and posterior hypertrophy without spinal canal stenosis or neural foraminal narrowing. T1/2: Central disc protrusion without spinal canal stenosis or neural foraminal narrowing.Small posterior disc bulges are noted at additional upper thoracic levels on the sagittal images.

Output: 1.Severe degenerative spondylosis of the cervical spine as described above worst at C3-4, C4-5, and C5-6, where there is moderate to severe spinal canal stenosis with cord flattening but without abnormal cord signal.2. Multilevel neuroforaminal narrowing as described above.


Instruction: Generate impression based on findings.

Input: 52-year-old status post left breast lumpectomy in 2012 presents with density/tenderness, no correlate on ultrasound or mammogram, need MRI to evaluate the area.Patient complains of density/tenderness in the far lateral left breast. There is scattered fibroglandular tissue in both breasts. Seroma cavity identified in the left lateral inferior breast.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast especially in the lateral posterior left breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. No suspicious area of enhancement especially in the lateral posterior left breast corresponding to patient's complain of tenderness.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.