Instruction: Generate impression based on findings.

Input: Redemonstrated is increased T2/FLAIR signal intensity demonstrating a largely periventricular distribution, compatible with small vessel ischemic disease. However, this pattern is asymmetrically prominent adjacent to the right frontal and right anterior temporal horns where it is more confluence. Generalized ex vacuo effect on the right lateral ventricle suggests a chronic etiology for this finding, and the differential diagnosis includes an atypical pattern of small vessel ischemic disease, sequelae of an infectious/inflammatory insult, and demyelinating disease. Given differences in technique (3 Tesla acquisition for the comparison study, 1.5 Tesla acquisition on the current study) there has been no significant interval change.The remaining ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass, mass effect, or midline shift. The pituitary gland is normal in size. There are no foci of increased susceptibility. No diffusion-weighted abnormalities are identified. There are no extra-axial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. The hippocampi are within normal limits.

Output: Stable asymmetric pattern of periventricular T2/FLAIR hyperintensity as described above, with generalized ex vacuo effect on the right lateral ventricle suggesting a chronic etiology. Differential considerations include an atypical pattern of chronic small vessel ischemic disease, prior infection/inflammation, and demyelinating disease among others.


Instruction: Generate impression based on findings.

Input: Reason: hx testicular cancer evaluate for metastasis History: see above ABDOMEN:LIVER, BILIARY TRACT: Scattered T2 hyperintense lesions are unchanged and likely benign. SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease. Subcentimeter retroperitoneal lymph nodes are stable.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate intracranial lesion seen on head CT. Signs and symptoms: As above. Pre- and post enhanced brain MRI:Examination demonstrates a right subfrontal paramedian well-demarcated mass with diffuse enhancement and surrounding vasogenic edema. Mass effect deep to represent a meningioma arising from the right anterior clinoid and right planum sphenoidale region. The mass and its surrounding vasogenic edema results in effacement of adjacent cortical sulci and trace dilatation of midline to the left. There is no evidence of ventriculomegaly. The mass appears to extend to the medial aspect of right middle cranial fossa anteriorly and likely traversing the right superior orbital fissure. There is also apparent involvement of right optic nerve canal and right supraclinoid internal carotid and partially into the right and anterior aspect of sella. The dictated MRI of ORBIT and more precisely assess the extent of the lesion. There is superior growth of tumor which invaginates into the right frontal lobe. The subfrontal and right middle cranial fossa component of tumor measures approximately 45 mm in craniocaudad axis and 36 mm in AP axis along the floor of the anterior cranial fossa.There are mild tiny foci of FLAIR hyperintensity involving the subcortical and periventricular white matter which considering patient's stated age of 76 most likely representing mild chronic small vessel ischemic strokes without evidence of hemorrhage. Unremarkable pre and post enhanced exam otherwise.

Output: 1.Right paraclinoid subfrontal meningioma with surrounding vasogenic edema and resultant trace deviation of midline to the left as detailed/measured above.2.There is extension of tumor into the right middle cranial fossa, suspected right orbital apex, right optic nerve canal, right supraclinoid carotid and right aspect of the sella which requires further evaluation with dedicated MRI of ORBIT and sella to precisely assess the extent of the tumor.3.Negative diffusion-weighted images and mild chronic nonhemorrhagic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: 49-year-old female with history of right knee medial joint line pain. MENISCI: There is increased signal within the posterior horn of a truncated medial meniscus (from prior partial meniscectomy) appearing similar to the prior exam and likely representing degeneration. There is no evidence of new tearing. The anterior horn of the medial meniscus is unremarkable.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is progressive articular cartilage loss about the medial femoral condyle and medial tibial plateau with near bone on bone apposition. There is increased bone marrow edema within the underlying bone. There is marked articular cartilage loss about the medial patellar facet as well as thinning of the cartilage along the medial femoral trochlea. There are tricompartmental osteophytes.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: 1.Increased signal about the remaining posterior horn of the medial meniscus compatible with continued degeneration, but we see no discrete new tear.2.Progressive articular cartilage loss especially at the medial tibiofemoral compartment with near bone-on-bone apposition and adjacent bone marrow edema.3.Small joint effusion.


Instruction: Generate impression based on findings.

Input: Patient with recuring back pain, after kyphoplasty at T8 and T9. There are findings related to kyphoplasty at the T8 and T9 levels, where there is marked loss of vertebral height with exaggeration of the kyphosis. There is no evidence of cement extrusion. There is also endplate deformity at L1 with approximately 40 % loss of height centrally, but no evidence of new compression fractures in the thoracic spine. There is a small disc-osteophyte complex that slightly effaces the intrathecal cerebrospinal fluid space. There is no significant spinal canal stenosis at the other levels. The spinal cord signal is unremarkable.

Output: 1. No evidence of complications related to kyphoplasty at the T8 and T9 levels, where there is marked loss of vertebral height with exaggeration of the kyphosis. 2. Unchanged chronic L1 vertebral compression fracture.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height and mild disc desiccation at this level. There is fluid identified within the facet joints and the facet joints are mildly hypertrophic at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a Schmorl's node present at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There are some mild degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Right hip pain. ACETABULAR LABRUM: There is linear increased signal abnormality which traverses the anterior superior labrum at the 2 o'clock position indicating a tear within the limitations of a non arthrogram study.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified.SOFT TISSUES: The imaged musculature of the pelvis is normal in appearance. ADDITIONAL

Output: Anterior superior acetabular labral tear as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82] / Other specified abnormal immunological findings in serum [R76.8], Reason for Study: ^Reason: 69yo with acute AMS w/+ANA, low complement. Concern for systemic autoimmune dz. Eval with MRI/MRA for comparison, Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Underlying brain shows diffuse minimal brain volume loss which is age appropriate.Multifocal scattered high signal intensities on periventricular white matter on T2-weighted imaging and FLAIR imaging indicate nonspecific small vessel ischemic disease.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, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral PCAs are fetal origin and the left distal vertebral artery is hypoplastic. The right MCA distal M1 shows subtle signal decrease on MIP reconstruction but does not show any significant luminal stenosis on source images.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: 45-year-old man with history of fatty liver ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. Specifically, there is no significant dropout of signal on opposed phase images. A few subcentimeter hepatic cysts are noted.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A few scattered subcentimeter left renal cysts 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: Essentially normal examination without fatty liver or suspicious focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: 39-year-old female with left knee pain. Medial joint line pain after ACL reconstruction. Patient motion artifact limits examination.MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are tricompartmental osteophytes. No full-thickness or near full-thickness articular cartilage defects are identified. There is partial-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft repair. The mid substance and distal fibers of the ACL graft are indistinct suggesting graft disruption. The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The quadriceps tendon appears intact. Note is made of postsurgical changes within the patellar tendon likely reflecting graft harvesting for the aforementioned ACL repair. The patellar tendon appears intact.ADDITIONAL

Output: 1. Disruption of the mid substance and distal fibers of the ACL graft reconstruction.2. Small knee joint effusion.3. Osteoarthritic changes of the knee.


Instruction: Generate impression based on findings.

Input: Migraine with aura, not intractable, without status migrainosus [G43.109], Reason for Study: ^Reason: chronic HA, eval for parenchymal or demyelinating disease History: chronic HA, eval for parenchymal or demyelinating disease No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal signal intensity on FLAIR/T2 weighted image indicating possible demyelinating disease.


Instruction: Generate impression based on findings.

Input: Female; 53 years old. Reason: 53F hx of pancreatitis. MRI/MRCP 12/4/14 large HOP measuring 4.3x3.4cm with narrowing of CBD at head of pancreas. Concern for autoimmune pancreatitis. Now s/p steroid therapy History: Pancreatitis ABDOMEN:LIVER, BILIARY TRACT: No intra-or extrahepatic biliary ductal dilation. Stable mild narrowing of the distal common bile duct near the ampulla. New mild circumferential thickening of the common bile duct with increased enhancement, which is nonspecific and may be related to cholangitis. There is also new geographic increased enhancement of the liver parenchyma near the course of the common bile duct and the gallbladder fossa, which is nonspecific and may be related to reactive hyperemia. No suspicious focal liver lesions. No cholelithiasis or choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Patchy increased T2 signal the uncinate process, most compatible with edema, has slightly decreased since prior study with stable faint enhancement on post contrast images, which is nonspecific and again may be related to focal pancreatitis, particularly in light of the pancreas divisum anatomy. Normal response to secretin augmentation. No definite focal pancreatic mass. No specific evidence of autoimmune pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. New mild common bile duct thickening and enhancement could be due to cholangitis. Findings suggestive of reactive hyperemia in the adjacent liver. Clinical correlation is recommended. 2. Decreased but persistent mild edema in the uncinate process with faint enhancement, which is nonspecific and may be related to focal pancreatitis, particularly in light of pancreas divisum anatomy. Continued follow-up is recommended to ensure resolution.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of renal cell carcinoma with back and leg pain, evaluate for metastases. Recent tumor resection and orthopedic fixation There is been an interval laminectomy of L1 through L4 and posterior fusion of L1 through L5 with posterior stabilization rods, bilateral screws entering the pedicles of L5, L2 and L1 and right-sided screws entering L3 and L4. Artifact limits the evaluation of these levels. There is edema in the paraspinal and posterior soft tissues. Alignment is anatomic. There is subtle nonenhancing soft T1 hypoattenuation along the left posterior aspect of the L3 and L4 vertebral bodies which may represent edema or residual tumor. Vertebral body heights are intact. Mild multilevel disk desiccation. Signal within the distal cord and conus is normal. L1-L2: No central or neuroforaminal stenosis.L2-L3 No central or neuroforaminal stenosis.L3-L4: No central or neuroforaminal stenosis.L4-L5: No central or neuroforaminal stenosis.L5-S1: Mild diffuse disk bulge. No central or neuroforaminal stenosis.Large heterogeneous enhancing left renal mass is partially visualized.

Output: 1.Postsurgical changes tumor resection and posterior spinal fusion.2.Subtle T1 hypoattenuation along the posterior aspects of the L3 and L4 vertebral bodies may represent residual tumor or edema.


Instruction: Generate impression based on findings.

Input: Ms. Denenberg is a 66-year-old female with a personal history of right breast lumpectomy in 2011 for DCIS treated with radiation and tamoxifen therapy. Personal history of bilateral benign breast biopsies (left breast-2004, right breast-2012). Family history of breast cancer in paternal grandmother, diagnosed at the age of 40. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Postsurgical changes are identified in the right upper outer breast, compatible with stated history of prior lumpectomy. Metallic clip artifacts are identified in both breasts, from prior biopsies and surgery. There is no abnormal enhancement seen around these clips.There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: 3T scanner History: s/p epilepsy surgery. There is a rim of susceptibility along the margins of the previously seen post ablation area, corresponding to the prior prominent peripheral enhancement along the mesial left temporal lobe along the left hippocampus and amygdala, with a more conspicuous rounded focus of susceptibility along the anterolateral margin on the left side. Mild heterogeneous T2 signal is seen in the location of previous ablation. There is minimal residual ill-defined peripheral enhancement consistent with expected evolution of postoperative changes. The area of residual peripheral enhancement measures 9 x 24 mm compared to previous 12 x 22 mm. The previous laser fiber tract is also visualized via a left posterior parietal temporal approach with trace susceptibility along its, as well as focal rounded susceptibility in the left periatrial region. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or mass effect. Known new area of abnormal signal is seen. There is no extra axial fluid collection. No diffusion abnormalities appreciated. Faint rounded area of subtle enhancement suggested along the ventral pons likely represents a capillary telangiectasia. Lobulated mucosal retention cyst is present in the left maxillary sinus. Additional left sided trephination holes are also noted.

Output: Interval expected evolution of previously seen postoperative changes from repeat laser ablation of the left hippocampus and portion of the amygdala.


Instruction: Generate impression based on findings.

Input: Reason: 65 year old female with enlarged axillary lymph nodes on ultrasound and prior MRI of LEFT shoulder. Evaluate for LAD in right axilla. History: None. ROTATOR CUFF: Moderate supraspinatus and infraspinatus tendinopathy with full thickness articular surface tear of the insertional subscapularis tendon measuring 6 mm in AP dimension. No retraction. Mild subscapularis tendinopathy without discrete tear. Teres minor is intact. SUPRASPINATUS OUTLET: No significant abnormality. GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is intact. Mild osteoarthritis of the glenohumeral joint.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1.No lymphadenopathy.2.Moderate supraspinatus and infraspinatus tearing with insertional articular surface full thickness tearing as described above.3.Moderate AC joint and mild glenohumeral joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: NF type 1, optic glioma and medullary mass. Brain: There is no significant interval change in the enhancing mass involving the cisternal portion of the left optic nerve, although the tumor has gradually increased in size since 2012, now measuring up to approximately 16 mm. However, there appears to be overall decrease in size of the multiple foci of T2 hyperintensity in the bilateral basal ganglia and cerebellar hemisphere. The non-enhancing expansile lesion in the right posterior medullar has not significantly changed. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. No significant interval change in the left optic nerve glioma, although the tumor has gradually increased in size since 2012.2. Apparent overall decrease in size of the multiple bilateral basal ganglia and cerebellar hemisphere lesions.3. The non-enhancing expansile lesion in the right posterior medullar has not significantly changed.


Instruction: Generate impression based on findings.

Input: Clinical question: SRS planning postop. Signs and symptoms: None. Pre-and post-enhanced treatment planning MRI:Examination demonstrate an enhancing metastatic lesion in the right posterior cerebral measuring at 6.2 mm in transaxial dimensions without significant change since prior exam.A right inferior frontal enhancing metastatic lesion measuring at 14 x 14-mm without significant change.An enhancing metastatic lesion immediately lateral to the trigone upright lateral ventricle measuring at 13 x 10 mm without significant change since prior study. A surgical cavity in the right frontal lobe demonstrate a thick and irregular rim of enhancement with interval progression since prior study. The appearance is concerning for local recurrence of tumor. Right anterior frontal extra-axial collection with a thick hemosiderin laden membrane measures maximum of 21-mm thickness with subtle there interval increased size since prior study measurements. Findings results in mass effect on the adjacent parenchyma and right frontal horn of lateral ventricle without deviation of midline.The intracranial venous sinuses are all well visualized and without evidence of abnormality. The bilateral thalamostriate veins, bilateral internal cerebral veins and straight sinus are well visualized and unremarkable.

Output: 1.Multiple supratentorial and infratentorial metastatic lesions without significant change or mass effect as detailed/measured above.2.A right frontal surgical cavity demonstrate thick irregular rim of enhancement which is new since prior exam and concerning for possible local recurrence of disease.3.Unremarkable intracranial venous sinuses.4.Large right frontal extra-axial collection as detailed.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are a few scattered punctate foci of T2 hyperintensity within the white matter without associated mass effect, restricted diffusion or susceptibility abnormality. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially up the sella. 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. Mucosal thickening is present within bilateral maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are clear. Cervical spine MR:Anterior wedge deformity is noted C5, C6, and C7 with fusion of the C5 and C6 vertebral bodies anteriorly. These changes are chronic given the lack of STIR signal. Associated with this is reversal of normal upper cervical curvature as well as levoscoliosis. 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: Disc bulge, ligamentum flavum thickening, and right facet hypertrophy. There is mild central and mild right neural foraminal stenosis.C3/4: Grade 1 anterolisthesis, osteophyte disc complex, bilateral uncinate hypertrophy, and bilateral facet hypertrophy. There is moderate to severe central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C4/5: Osteophytic disc complex, bilateral facet hypertrophy, and bilateral facet hypertrophy. There is moderate to severe bilateral neural foraminal stenosis.C5/6: Osteophyte disc complex, bilateral facet hypertrophy, and bilateral facet hypertrophy. There is moderate bilateral neural foraminal stenosis.C6/7: Osteophyte disc complex and bilateral uncinate hypertrophy. There is mild bilateral neural foraminal stenosis.C7/T1: Osteophyte disc complex and facet hypertrophy. There is severe left neural foraminal and moderate to severe right neural foraminal stenosis.

Output: 1.Anterior wedge deformity is noted C5, C6, and C7 with fusion of the C5 and C6 vertebral bodies anteriorly. These changes are chronic given the lack of STIR signal. Associated with this is reversal of normal upper cervical curvature as well as levoscoliosis.2.C2/3: Mild central and mild right neural foraminal stenosis.3.C3/4: Moderate to severe central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.4.C4/5: Moderate to severe bilateral neural foraminal stenosis.5.C5/6: Moderate bilateral neural foraminal stenosis.6.C6/7: Mild bilateral neural foraminal stenosis.7.C7/T1: Severe left neural foraminal and moderate to severe right neural foraminal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed, hydrocephalus or mass effect. Clinical question: Progressive dizziness, gait disturbance, urinary symptoms. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci and ventricular system appear slightly prominent however this may be still within normal range for patient's stated age of 87. Prior MRI examination indicates a small vessel disease however on this exam no definitive small vessel disease is detected.

Output: Essentially unremarkable non-enhanced CT of brain.


Instruction: Generate impression based on findings.

Input: 19-year-old male with a history of lupus and right distal femur and bilateral distal tibial bone infarction No evidence of acute fracture or malalignment. No joint effusion. Previously seen distal femoral AVN on MRI exam is not well visualized on radiographs.

Output: AVN seen on prior MRI is not well visualized on radiographs.


Instruction: Generate impression based on findings.

Input: 77 year-old man with a history of hypertension, coronary artery disease, ischemic cardiomyopathy and recurrent VT with ICD, now presenting for pre-ablation cardiac MRI to evaluate for scar. There is significant artifact related to the patient's indwelling ICD, but the image quality is diagnostic allowing for the following observations to be made:Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function . The overall LV ejection fraction is 35%, the LV end diastolic volume index is 131 ml/m2 (normal range: 74+/-15), the LVEDV is 242 ml (normal range 142+/-34), the LV end systolic volume index is 85 ml/m2 (normal range 25+/-9), the LVESV is 157 ml (normal range 47+/-19). There is akinesis of the mid-distal inferolateral, inferior and inferoseptal wall. There is apical dyskinesis. There is subendocardial late gadolinium enhancement in the mid anteroseptum/anterior wall which involves >50% of the wall thickness, and may be consistent with prior myocardial infarction. Left AtriumThe left atrium is enlarged. Right VentricleRV volumes could not be reliably measured due to artifact. Visually the ventricle appears mildly dilated with normal systolic function. There is a defibrillator lead, the tip of which terminates in the distal right ventricle.Right AtriumThe right atrium is enlarged; there is a device lead present.Aortic ValveThe aortic valve opens widely and there is trivial significant aortic regurgitation.Mitral ValveThe mitral valve opens widely with mild thickening of the leaflet tips. 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. The aortic root is grossly normal in size. The descending aorta is moderately tortuous.Pulmonary VeinsThere appear to be four pulmonary veins which drain into the left atrium.Pulmonary ArteryThe main pulmonary artery is not well visualized.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsProbable exophytic left renal cyst is 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. Severely dilated left ventricle with moderately reduced ejection fraction of 35%. There is evidence of apical thinning and dyskinesis.2. There is subendocardial late gadolinium enhancement in the mid anteroseptum/anterior wall which involves >50% of the wall thickness, consistent with prior myocardial infarction.


Instruction: Generate impression based on findings.

Input: 57-year-old male with elevated PSA, 5.7. PELVIS:PROSTATE:Prostate Size: 3.4 x 4.9 x 4.8 cm.Peripheral Zone: Diffusely striated appearance with T2 hypointensity suggestive prostatitis. Ill-defined areas of T2 hypointensity in the apex and mid gland peripheral zone are nonspecific.Please note that the appearance of prostatitis may mask small foci of malignancy. No specific focal lesion is evident amenable for targeted biopsy.Central Gland: Moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: Nonapplicable.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.Diffusely striated appearance of the peripheral zone suggestive of sequelae of prostatitis. Please note that the appearance of prostatitis may mask small low foci of malignancy. 2.No specific focal lesion is evident. No lesions amenable for targeted biopsy.3.These findings and recommendations were extensively discussed with the patient and his daughter during which all questions were answered.


Instruction: Generate impression based on findings.

Input: There has been significant interval reduction in size of a pineal region mass now measuring 17 mm AP x 14 mm transverse x 14 mm craniocaudal (previously 36 x 28 x 26). There has also been associated decrease in regional mass effect, and previously demonstrated ventricular dilatation is now nearly normalized. Findings of transependymal CSF resorption have decreased. Compared to the recent head CT, again noted is a shunt tract of the right frontal lobe which demonstrates persistent T2 hyperintensity and enhancement, the latter of which is uncertain clinical significance.There is no evidence of intracranial acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The nasal sinuses and mastoid air cells are clear.

Output: 1.There has been significant interval reduction in size of a pineal region mas2.There has also been associated decrease in regional mass effect, and previously demonstrated ventricular dilatation is now nearly normalized. Findings of transependymal CSF resorption have decreased. 3.Again noted is a shunt tract of the right frontal lobe which demonstrates persistent T2 hyperintensity and enhancement, the latter of which is uncertain clinical significance.


Instruction: Generate impression based on findings.

Input: Reason: 81 y/o male with met disease in liver (RCC), evaluate for progression on current chemotherapy regimen. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are approximately 6 hepatic lesions distributed through both lobes. Reference measurements are provided below. Lesions demonstrate a residual thin rim of enhancement with central necrosis in the majority of the lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Complex cystic lesion with dense calcification (correlate with prior CT imaging) in the left upper pole is unchanged. There are several other simple cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 8/30/2016 13:00:00)SEGMENT 8 LESION: 3.7 x 3.0 cm (Image 28, Series 1200); 4.3 x 3.2 cm on prior (6/7/2016) (Image 208, Series 9).SEGMENT 2 LESION: 2.2 x 2.0 cm (Image 28, Series 1200); 2.7 x 2.9 cm on prior (6/7/2016) (Image 209, Series 9).SEGMENT 6 LESION: 2.7 x 3.2 cm (Image 46, Series 1200); 3.4 x 2.5 cm on prior (6/7/2016) (Image 225, Series 9).

Output: Continued decrease in the size of the reference hepatic metastases.


Instruction: Generate impression based on findings.

Input: Diagnosis: Sciatica, right sideClinical question: evaluate for nerve impingementSigns and Symptoms: Rt side sciatica Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, diffuse disc bulge, disc desiccation and bilateral facet hypertrophy associated with effacement of the fat at the lateral recess is somewhat worse on the left versus the right side and a moderate degree of spinal stenosis. The exiting nerve roots within the left neural foramina are mildly encroached. The right-sided exiting nerve roots within the neural foramina are surrounded by fat. These findings have progressed since the 2007 exam.At L4-5 there is mild anterior subluxation of L4 on L5 associated with bilateral facet and ligamentum flavum hypertrophy as well as a diffuse disc bulge. There is complete effacement of the fat at the lateral recesses sees and near obliteration of the thecal sac indicating a severe degree of spinal stenosis at this level. There is narrowing of the neural foramina bilaterally at this level with partial effacement of the fat surrounding the exiting nerve roots. There is loss of disc space height and disc desiccation at this level. These findings have progressed since the 2007 exam.At L3-4 there is bilateral facet hypertrophy associated with a disc bulge. There is loss of disc space height and disc desiccation at this level. There is mild encroachment of the right-sided exiting nerve roots within the neural foramen at this level. Overall there is a mild degree of spinal stenosis present at this level.At L2-3 there is a diffuse disc bulge present associated with disc desiccation and mild facet and ligamentum flavum hypertrophy. There is narrowing of the thecal sac. There is mild narrowing of the neural foramina bilaterally at this level. Overall there is mild spinal stenosis at this level.At L1-2 there is loss of disc space height, disc desiccation, diffuse disc bulge and bilateral facet ligamentum flavum hypertrophy with partial effacement of the fat at the lateral recess on the right side. There is mild narrowing of the neural foramina at this level. Overall there is a mild to moderate degree of spinal stenosis at this level. There are associated endplate reactive changes at this level which are bright on T1. These findings have mildly progressed since the 2007 exam.Some degenerative changes are also observed in the lower thoracic spine.There is a cystic type lesion present in the right kidney which measures 25 x 15 mm in axial dimensions and was also present on the 2007 exam but was smaller at that time.

Output: There are multilevel degenerative changes present in the lumbar spine with severe spinal stenosis at L4-L5 due to degenerative changes and subluxation as well as a moderate degree of spinal stenosis at L4-5. There is moderate spinal stenosis at L5-S1 predominantly affecting the nerve roots at the left lateral recess. The spinal stenosis at L4-5 and L5-S1 have progressed since the prior exam. There is mild to moderate spinal stenosis at L1-2 which is minimally progressed since the prior exam. There are lesser degrees of spinal stenosis present at L2-3 and L3-4 as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Please evaluate lesion. Concern for CNS lymphoma. Signs and symptoms: Headaches, nausea and vomiting, history of lymphoma. Pre-and postcontrast CT of brain:Examination demonstrate an enhancing mass wave a small area of internal necrosis measuring 25.5-mm x 22 0.2-mm in the inferior right frontal lobe. There is evidence of surrounding vasogenic edema. Very minimal midline shift at the level of floor of anterior cranial fossa.A is a provided clinical date of findings is believed to represent CNS lymphoma. This finding was not present on prior MRI examination from 2007.Small punctate focus of high density measuring approximately 3 mm times 2-mm in deep right frontal periventricular white matter is noted. Finding may represent calcification although its small size makes precise evaluation difficult and the possibility of a small hemorrhage cannot be entirely ruled out although this latter possibility is considered less likely.This examination is otherwise unremarkable.Calvarium, mastoid air cells and limited view of paranasal sinuses are unremarkable.90 cc of Omnipaque 350 is administered for above study.

Output: 1.Enhancing mass in the inferior aspect of right frontal lobe with surrounding vasogenic edema may represent recurrence of CNS lymphoma.2.Small focus of calcification measuring approximately 3 mm in deep periventricular white matter of right frontal lobe of uncertain significance.3.Unremarkable study otherwise.


Instruction: Generate impression based on findings.

Input: There is a focal calvarial defect at the expected location of the confluence of sagittal and lambdoid sutures which is primarily midline with a slight left paramedian extension. This clinically measures 2 x 2 centimeters, with MRI findings supporting that. There does appear to be exposed dura, and flow is maintained in the normal appearing adjacent superior sagittal sinus. The adjacent brain parenchyma appears unremarkable without congenital anomaly.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. Myelination is appropriate for the provided age. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear.

Output: There is a focal calvarial defect at the expected location of the confluence of sagittal and lambdoid sutures which is primarily midline with a slight left paramedian extension. This could be better delineated with CT if further anatomic definition is deemed clinically beneficial. There does appear to be exposed dura, and flow is maintained in the normal appearing adjacent superior sagittal sinus. The adjacent brain parenchyma appears unremarkable without congenital anomaly. There are no MRI findings of atretic cephalocele.


Instruction: Generate impression based on findings.

Input: Diagnosis: DiplopiaClinical question: eval for CNS lymphomaSigns and Symptoms: diplopia, hx of B-Cell lymphoma There is an ill-defined enhancing lesion present which surrounds the frontal horn of the right lateral ventricle and has a patchy spinal extension to the adjacent periventricular white matter extending towards the subcortical white matter of the right inferior frontal gyrus - pars orbitalis. There is a punctate focus of susceptibility effect present along the right inferior frontal gyrus pars orbitalis. The lesion is predominantly hyperintense on FLAIR and hypointense on T1.There is a second focus of contrast enhancement along the medial aspect of the left temporal lobe along the subcortical white matter of the left uncus with some extension posteriorly. The lesion is predominantly hyperintense on FLAIR and hypointense on T1.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: There are at least 2 lesions present within the brain parenchyma. One is centered in the right frontal horn periventricular white matter extending to the subcortical white matter of the right pars orbitalis and one center along the medial aspect of the left temporal lobe. Given the patient's history of lymphoma, CNS lymphoma is a consideration here.


Instruction: Generate impression based on findings.

Input: Chiari, headaches, syrinx, back pain. Brain: Again seen are low-lying cerebellar tonsils measuring up to 6 mm below the foramen magnum. Cerebellar tonsils demonstrate a normal rounded morphology with preserved CSF spaces ventrally and dorsally. CSF flow sequence demonstrates good biphasic CSF flow ventrally and dorsally at the level of the foramina magnum. Remainder of the brain is unremarkable without evidence of ischemia, hemorrhage, mass, or mass effect. No extra-axial collections or hydrocephalus. Major flow-voids are preserved. Again seen is a relatively large mucous retention cyst in the right maxillary sinus, and was present on prior. Paranasal sinuses are otherwise clear. Sella and orbits are grossly unremarkable. Bone marrow signal and extracranial soft tissues are within normal limits. Spine:Cervical: No abnormal signal seen within the cervical cord. No evidence of syrinx. There are mild degenerative changes with loss of normal cervical lordosis. Vertebral body heights are maintained. There are mild disk bulges from C3-C4 to C6-C7 with partial effacement of the ventral thecal sac. Relatively largest of these is at the C6-C7 level and associated with mild bilateral neural foramina stenosis. Disk bulges are minimally worse since prior. No significant spinal canal stenosis at any level is seen.Thoracic: There is trace prominence of the central canal from the T3 to the T10, relatively greater from T6 to T9, and not significantly changed from MRI from 2009. Otherwise no discrete syrinx is appreciated in the spinal cord. Conus is in normal position at the L1-L2 level. Vertebral body heights and alignment are maintained. Bone marrow signal is within normal limits. There is no significant disk disease, spinal canal, or neural foramina stenosis in the thoracic spine.Lumbar: Vertebral body heights and alignment are maintained. Bone marrow signal is within normal limits. There is no significant disk disease, spinal canal, or neural foramina stenosis in the lumbar spine. Unremarkable appearance of the conus, filum, and cauda equina nerve roots.

Output: 1. Mild cerebellar tonsillar ectopia with otherwise preserved CSF spaces and CSF flow at the level of the foramen magnum. 2. Mild prominence of the central canal/tiny syrinx in the thoracic cord remains unchanged. 3. Mild degenerative changes in the cervical spine with multilevel disk bulges and mild bilateral neural foraminal narrowing at C6-C7 level. These appear minimally worse compared to 2009.


Instruction: Generate impression based on findings.

Input: Parkinsonism and cognitive issues. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is blurring of the susceptibility effect in the substantia nigrosomes bilaterally, with loss of the "swallow tail sign". There are a few scattered punctate foci of T2 hyperintensity int eh cerebral white matter. The ventricles and sulci are mildly prominent diffusely due to cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is fluid signal in the mastoid air cells, which may represent an effusion.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Blurring of the susceptibility effect in the substantia nigrosomes bilaterally can be a manifestation of Parkinson's disease.


Instruction: Generate impression based on findings.

Input: MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. There is associated posterior ligamentous hypertrophy present at this level.At C3-4 there is loss of disc space height, disc desiccation and a broad-based right lateral disc protrusion present extending across the midline and encroaching on the right-sided exiting nerve root within the neural foramen and impressing on the thecal sac effacing spinal fluid ventral and posterior the spinal cord crowding and moderate degree of spinal stenosis. There is associated posterior ligamentous hypertrophy present at this level.At C4-5 there is a broad-based right lateral disc protrusion present extending into the right neural foramen and encroaching the right-sided exiting nerve root within the neural foramen which also effaces spinal fluid ventral and posterior the spinal cord creating a mild to moderate degree of spinal stenosis. There is also bilateral uncovertebral osteophyte formation at this level with encroachment of the exiting nerve roots bilaterally.At C5-6 there are endplate and uncovertebral osteophytes present associated with a disc bulge, loss of disc space height and disc desiccation. There is effacement of spinal fluid ventral to the spinal cord at this level with a mild to moderate degree of spinal stenosis. There is narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots bilaterally.At C6-7 there is loss of disc space height, disc desiccation and a left paramedian disc protrusion which extends into the left neural foramen and encroaches on the left-sided exiting nerve root within the neural foramen.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.The patient's nasogastric tube is looped in the hypopharynx. An endotracheal tube is in place. The balloon of the endotracheal tube is larger than the size of the trachea.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. The balloon of the endotracheal tube is larger than the size of the trachea.There are small pleural effusions presentLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal. There is a left far lateral disc protrusion present at this level. There is partial effacement of the fat in the left lateral recess and left neural foramen with mild to moderate encroachment of left exiting nerve roots at L5-S1 and mild encroachment of the nerve roots at the left lateral recess.At L4-5 there is left more than right facet hypertrophy associated with effacement of the fat surrounding the exiting nerve roots within the neural foramen bilaterally. There is effacement of the fat at the left lateral recess at this level with moderate encroachment of the exiting nerve roots bilaterally. There is mild left sided translation of L4 on L5 at this level. At L3-4 there is no significant compromise to spinal canal. There is a broad-based right lateral disc protrusion present at this level associated with mild encroachment of the right-sided exiting nerve roots.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with disc desiccation.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C3-4 and mild to moderate spinal stenosis at C4-5 as well as bilateral encroachment of exiting nerve roots at C3-4, C4-5 and C5-6 and left-sided encroachment of exiting nerve roots at C6-7.2.There are multilevel degenerative changes present in the lumbar spine worse in the lower lumbar spine were there are some encroachment of the exiting nerve roots at the left lateral recess at L4-5 and encroachment of left-sided exiting nerve roots within the neural foramen bilaterally at L4-5 and on the left side at L5-S13.There are small pleural effusions present.4.Stacked axial T2 and non-contrast T1 images of the lumbar spine were not performed.5.No abnormal enhancing lesions are identified within the brain.


Instruction: Generate impression based on findings.

Input: 52 years Female (DOB:2/24/1964)Reason: left parietal lesion progression History: AphasiaPROVIDER/ATTENDING NAME: AGNIESZKA A ARDELT AGNIESZKA A ARDELT There is diffusion restriction present along the posterior aspect of the left temporal lobe and left parietal lobe. There is a gyriform pattern of diffusion restriction gyriform pattern along the left occipital lobe adjacent to the involved parietal and temporal lobes. There are some additional involvement of the posterior aspect of the left paracentral lobule which is expected to be in the anterior cerebral artery territory as well as the posterior aspect of the left cingulate gyrus. There is associated FLAIR signal abnormality as well as cerebral swelling and sulcal effacement and compression of the left lateral ventricle. The FLAIR signal abnormality appears to be greater than the diffusion-weighted signal abnormality. There is no evidence for associated hemorrhage.There are several foci of the punctate diffusion restriction in the right cerebellar hemisphere inferiorly. This associated with FLAIR signal abnormality.There is a small focus of T2 and FLAIR signal hyperintensity along the posterior aspect of the left thalamus measuring 8 mm in diameter.Postcontrast imaging is significantly degraded due to patient motion. There appears to be leptomeningeal enhancement centered along the left temporal parietal and occipital lobes.There is redemonstration of patchy FLAIR and T2 signal in the pons.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are suggestive of of infarction involving left parietal occipital and temporal lobes. These may represent infarctions in different stages. There is associated mass effect. The pattern of involvement is a bit unusual given the coincidental involvement of 3 adjacent cerebral artery territories and the relative lack of diffusion restriction through much of the abnormality. The possibility of underlying infection, inflammation or other cause is raised.2.There are foci of microinfarction in the inferior aspect of the right cerebellar hemisphere.3.A left thalamic lesion is present. This could represent prior lacunar infarct. However, it is unclear.4.Postcontrast imaging is degraded by patient motion artifact which will obscure more subtle abnormalities.5.Lesions in the pons are suspected be vascular related.


Instruction: Generate impression based on findings.

Input: Chiari, status post decompression, syrinx, worsening head and neck pain. Brain: There are postoperative findings related to Chiari decompression surgery and fourth ventricular stenting. There is kinking of the cervicomedullary junction posteriorly towards the overlying dura, which appears similar as on the prior exam. There is flow of cerebrospinal fluid across the neo-foramen magnum anteriorly, but not posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is a partially empty sella. 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 are grossly unremarkable.Spine: The cervical spine is unremarkable. There are 13 thoracic vertebrae. There is residual trace prominence of the thoracic spinal cord central canal. The conus medullaris is positioned at the lower L1 level. There are postoperative findings related to tethered cord release and partial resection of filar fibrolipoma, with residual punctate T1 hyperintensity at the L1-2 level and linear T1 hyperintensity extending from the L3-L4 level to the distal end of the thecal sac. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild degenerative spondylosis involving the lower lumbar spine, but no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression with kinking of the cervicomedullary junction posteriorly towards the overlying dura, which may secondary to adhesion formation.2. Trace residual thoracic syrinx. 3. Postoperative findings related to tethered cord release and partial resection of filar fibrolipoma, with the conus medullaris positioned at the lower L1 level. 4. Nonspecific partially empty sella.


Instruction: Generate impression based on findings.

Input: Abdominal pain, subacute diarrhea, CT with possible stones. Evaluate for biliary stones. ABDOMEN:LIVER, BILIARY TRACT: There is mild extrahepatic ductal dilatation. No common duct stones are identified. No focal hepatic lesion. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Mild diffuse restricted diffusion of the pancreas is noted, nonspecific. Slight pancreatic ductal dilatation is also seen. No definite pancreatic head lesion is identified within the limitations of a noncontrast exam.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: No focal renal lesion within the limitations of a noncontrast exam.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No definite bowel wall thickening or dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace upper abdominal ascites is noted.

Output: Mild biliary and pancreatic ductal dilatation of unclear etiology. No evidence of choledocholithiasis. No definite pancreatic head lesion identified within the limitations of a noncontrast exam.


Instruction: Generate impression based on findings.

Input: Interval resection of right frontal osseous lesion without evidence of residual enhancing tissue. An additional enhancing dural-based lesion overlying the anterior right frontal lobe and demonstrates susceptibility, which likely representing calcification, measures approximately 7 x 8 mm (image 17, series 1001), and remains unchanged in size and appearance. There is unchanged minimal mass effect of the underlying right frontal lobe without vasogenic edema. Otherwise, there is no abnormal enhancement or mass within the brain elsewhere. A few scattered foci of FLAIR signal are non-specific and unchanged. A small left choroid fissure cyst is incidentally again seen. No diffusion-weighted abnormalities are identified. The ventricles are normal in size and configuration. Flow voids are present within the major vessels indicating patency. There is mild right maxillary sinus mucosal thickening and small left maxillary sinus mucus cyst. There is left greater than right bilateral mastoid opacification.

Output: 1. Postsurgical changes of right frontal calvarial lesion resection without evidence of residual enhancing tissue.2. Unchanged small right frontal dural-based lesion with calcification which likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: Reason: Stage IV NSCLC s/ p SRS to left single occipital brain met History: Follow up imaging There is redemonstration of a small enhancing nodule in the left occipital lobe cortex, which is significantly decreased in size of a now only measuring 5 x 5 mm, previously up to 9 mm. There is again no significant associated FLAIR abnormality. There is also redemonstration of a small enhancing lesion which appears durally based along the right paramedian planum sphenoidale, again measuring 3 x 6 mm on 1201/145.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening within the visualized paranasal sinuses, with patchy opacification of the ethmoid sinuses as well as partial opacification of the right maxillary and sphenoid sinus.

Output: 1.Interval decreased size of enhancing lesion in the left occipital lobe cortex likely relating to treated metastatic disease2.Stable subcentimeter focus of extra-axial enhancement along the right planum sphenoidale which could relate to a small incidental meningioma. Continued attention to this finding on follow-up exams is recommended.3.Extensive paranasal sinus opacification as detailed above, worsened since prior exam. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 44-year-old female with history of pituitary tumor resection, surveillance, annual follow-up. Redemonstrated are postoperative findings related to transphenoidal pituitary resection. There is no significant interval change in the enhancing lesion in the right pituitary, which measures up to 13 mm (in AP dimension). The lesion extends slightly into the right cavernous sinus, without evidence of carotid encasement or narrowing. The mass also extends across the midline and causes slight deviation of the pituitary stalk to the left. Has before, there is no abutment of the optic apparatus.

Output: No significant interval change in the pituitary lesion.


Instruction: Generate impression based on findings.

Input: 10-year-old female with history of neurofibromatosis type I with large left sacral mass extending into the left leg.EXAMINATION: MRI pelvis and left femur without contrast 10/24/16 Extensive and multifocal T2 hyperintense masses throughout the lumbar spine, predominantly left paraspinal musculature, left lower quadrant, and extending into the left lower extremity, to the level of the mid thigh. These lesions are compatible with plexiform neurofibromata. The masses are relatively confluent, extending superiorly, out of the field of view, to the level of the superior kidneys, (seen on same day MRI lumbar spine). The greatest transverse diameter (in the left lower quadrant) measures greater than 13 cm and greatest AP dimension, also measures 13 cm. The neurofibromata cause significant mass effect in the pelvis, resulting in rightward deviation of the urinary bladder, rectum, as well as the aorta and iliac vasculature. Tumor also surrounds and splays the left internal and external iliac vessels, but flow voids remain patent.There is extensive involvement of the musculature with intramuscular neurofibromas in the left gluteal muscles, paraspinal musculature, psoas, obturator, as well as the majority of the musculature of the left thigh, with relative sparing of the vastus lateralis.Similar to that seen on prior radiographs, the osseous structures in the left pelvis and left femur are markedly abnormal, with heterogeneous marrow signal, thickened cortex, and multifocal areas of thinning.Additionally, there is extensive T2 signal abnormality involving the subcutaneous tissues of the vulva, buttocks, and lower back, compatible with cutaneous neurofibromata. Multiple cutaneous neurofibromata are also present in the posterior and lateral left thigh.Smaller neurofibromata can be seen more distally in the left thigh, which are separate from the confluent masses more proximally.There is extensive dural ectasia of the distal spinal canal with dextroscoliosis of the lumbar spine. Multiple neural foramina in the lower lumbar spine are widened secondary to tumor involvement of the exiting nerve roots.There is asymmetric bladder wall thickening along the anterior/right aspect of the bladder, measuring up to 1 cm in thickness, which may be related to chronic mass effect/obstruction by the massive plexiform neurofibromata.There is a small amount of free fluid in the pelvis, which is likely physiologic.

Output: 1.Extensive plexiform neurofibromata involving the lumbar spine, left hemipelvis, and left thigh which results in extensive mass effect on the pelvic organs and vasculature.2.Multiple intramuscular neurofibromata, particularly in the left gluteal, left psoas, and muscles of the left thigh. 3.Abnormal and bizarre configuration of the bones in the left hemipelvis, which likely reflects a combination of intrinsic bone abnormality as well as mass effect from adjacent and surrounding tumor.4.Extensive sheetlike cutaneous neurofibromata of the lower back, buttocks, vulva, and posterior left thigh. 5.Asymmetric wall thickening along the anterior/right aspect of the bladder, which suggests chronic mass effect/obstruction from adjacent tumor.6.Please refer to same-day MRI of the lumbar spine regarding additional findings including dural ectasia and multifocal neural foraminal widening.


Instruction: Generate impression based on findings.

Input: Renal cell carcinoma with brain metastasis, status post whole brain radiation therapy, surveillance imaging. Allowing for differences in measurement, left parietal lobe (precuneus) lesion measures stable to minimally larger at 6 x 6 x 6 mm, previously 5 x 5 x 4 mm. There is interval decrease in surrounding edema. The enhancing right inferior temporal gyrus lesion measures 4 x 4 x 4 mm previously 3 x 3 x4 mm without significant surrounding edema. The subtle differences in measurement may be related to differences in technique. These lesions are smaller than pretreatment study from 1/14/2015. No new lesions or evidence of intracranial mass effect.There is no evidence of intracranial hemorrhage or acute infarct. 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, and scalp soft tissues are grossly unremarkable. There is minimal fluid in the mastoid air cells and retention cyst formation in the maxillary sinuses.

Output: Stable to minimal increase in size of the residual enhancing left parietal and right temporal lobe metastases. Although the subtle differences in measurement may be related to subtle differences in technique, may consider shorter interval follow-up study. There is continued decrease in mild edema surrounding the left parietal lesion favoring treatment response. No new lesions.


Instruction: Generate impression based on findings.

Input: Unspecified coma [R40.20], Reason for Study: ^Reason: seizure vs syncope, structural brain abnormality History: left sided weakness, loss of consciousness events There is no evidence of acute ischemic or hemorrhagic lesion on scan. There is no evidence of abnormal enhancement.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, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal contrast enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 44 year old female with stroke. Non-infused CT of brain.A focal area of lucency in the white matter of left frontal lobe extends from the level of floor of the anterior cranial fossa superiorly to the high convexity. This produces no definitive evidence of mass effect and is believed to represent an area of encephalomalacia. No definitive evidence of any cortical component is detected. There are no old films available for comparison. The size and distribution of this lesion is unusual for a subcortical stroke. Further evaluation with an MRI is recommended. CT examination of brain is otherwise unremarkable.CTA of the neck.There is good visualization of bilateral common carotid arteries, carotid bifurcations and bilateral internal carotid arteries in the cervical region. No evidence of any stenosis at any of these locations is detected.A dominant right vertebral artery and slightly smaller left vertebral artery is demonstrated and appear normal throughout their course and across the skull base. No pathology is Limited images of the aortic arch and the origins of the great vessels as well as the right brachia cephalic and bilateral subclavian arteries are unremarkable. The basilar artery and its branches are also visualized on reformatted coronal images and are within normal limits. Both supraclinoid internal carotid arteries and bilateral anterior cerebral arteries and middle cerebral arteries are also demonstrate no areas of a stenotic lesion.

Output: 1.Focal area of subcortical left frontal lucency as detailed double. Further evaluation with an MRI is recommended.2.Essentially unremarkable CTA examination of the cervical region and intracranially.3.4.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: grade I meningioma. History: meningioma. There is extensive right frontoparietal temporal occipital craniectomy extending toward left side across the midline and bilateral suboccipital craniectomy.There are significant encephalomalacia involving right temporal, right occipital, left parietal, left occipital and bilateral cerebellar hemispheres.In addition, extra axial T2 intermediate T1 iso signal intensity mass on the right petro-mastoid bone is seen which compresses right temporal lobe and right cerebellar hemisphere as well as right side lower pons.The mass is measured about 56.6mm (RL) x 41.9mm (AP) x 44.6mm (CC) at the level of pontomedullary junction and around the right side inferior cerebellar peduncle. Ventricular system appears to be within normal limits.There is no acute ischemic lesion.Susceptibility artifacts along with the tentorium may indicate surgical clips.Localized fluid collections on the right mastoid air cell is seen likely represent secondary to the mass.Comparing to prior scan performed at out side hospital on Oct 16 2015, there is no interval change since prior scan in terms of extra axial mass size, extent , associated mass effects and edema.The paranasal sinuses are clear.

Output: 1. Post craniectomy status of right frontal, parietal, temporal and occipital bone extended toward left side across the midline as described above.2. Extensive encephalomalacia on surgical site as described above.3. Residual extra axial mass [56.6mm (RL) x 41.9mm (AP) x 44.6mm (CC)] based on the right petro-mastoid region with mass effects toward right temporal lobe, right cerebellum and brain stem, unchanged since Oct 16 2015.


Instruction: Generate impression based on findings.

Input: 66 year old female with history of ovarian cancer and T4 vertebral lesion. Compare to previous studies for interval change. Multilevel degenerative changes present throughout the visualized thoracic spine, lower cervical and upper lumbar segments. The attenuation of the vertebral bodies is within normal limits with exception of T4 which redemonstrates a focal area of sclerosis correlating with the metastatic lesion seen on the previous MRI examination (3/22/2011). No evidence of fracture. No evidence of new lesions.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no significant spinal canal stenosis, with the exception of T11-T12 which demonstrates a small disk protrusion abutting the spinal cord. The neural foramen are patent. The paraspinal soft tissues are unremarkable.Incidental note is made of several surgical clips that are present within the left anterior pararenal space. A large liver lesion is incompletely imaged and appears grossly similar in size to the previous MR examination representing a hemangioma as previously noted on dedicated abdominal MR examination of 4/30/2010. Atherosclerotic calcifications the visualized thoracic and abdominal aorta. Several small lymph nodes are present within the superior mediastinum the largest of which measures 9 mm at the level of the AP window, (series 4, image 41), not pathologically enlarged by CT criteria.Visualized parts of the lungs are grossly clear bilaterally.

Output: 1. Stable T4 vertebral metastasis without evidence of change in size or vertebral body fracture. No additional metastatic lesions are identified.2. Stable appearance of previously noted liver hemangioma.


Instruction: Generate impression based on findings.

Input: 66-year-old man with history of clear cell renal carcinoma status post right nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter cyst in segment 6 of the liver. The liver and gallbladder are otherwise unremarkable. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: The spleen appears normal. PANCREAS: A punctate cystic focus in the body of the pancreas (series 5/25) is unchanged from prior exams and likely an ectatic sidebranch or IPMN. The pancreas is otherwise normal.ADRENAL GLANDS: Bilateral adrenal myelolipomas, right larger than left.KIDNEYS, URETERS: There is a left superior for renal cyst, otherwise the left kidney is normal. The patient is status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post right nephrectomy without evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: Decreased range of motion in knees. History of fracture and osteoarthritis. Four views of the right knee are provided. There is moderate narrowing of the lateral tibiofemoral compartment as well as small tricompartmental osteophytes. There is a moderate valgus deformity of the right knee, particularly noticeable on the skiers view.Four views of the left knee are provided. There are small patellar osteophytes, but the knee joint otherwise appears normal for age. A 1.5-cm soft tissue opacity overlying the anterior aspect of the knee seen on the lateral view may represent a skin lesion or mass in the subcutaneous fat; this could be further evaluated with ultrasonography or MRI if clinically warranted. I see no joint effusion.

Output: Osteoarthritis, right knee valgus deformity, and other findings as above.


Instruction: Generate impression based on findings.

Input: The thoracic spinal cord has a smooth contour and normal signal without focal atrophy, edema, or myelomalacia. There is a mildly exaggerated kyphotic angulation of the thoracic spine at T6/T7; otherwise normal alignment of the thoracic spine is maintained. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout with a small hemangioma within the T2 vertebral body incidentally noted. There is no significant spinal canal stenosis or neural foraminal stenosis. There is prominence of the subcutaneous fat.

Output: No abnormal signal within the thoracic cord to suggest demyelination.


Instruction: Generate impression based on findings.

Input: Diagnosis: Spinal stenosis, lumbar region, with neurogenic claudicationClinical question: spinal stenosis with left thigh radicular pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:1/4/1972) PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The patient status post suboccipital craniectomy for Chiari decompression. Since prior exam postoperative inflammatory changes have resolved. Previously noted extracranial collections have resolved. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable since prior exams and likely of little clinical significance given the small number.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient is status post decompressive posterior fossa craniectomy for Chiari I malformation. CSF flow at the level of the foramen magnum is biphasic. Previously noted extracranial collections have resolved.


Instruction: Generate impression based on findings.

Input: 72-year-old male with history of renal cell carcinoma with new lung lesions ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Numerous lesions in the liver are unchanged. Largest ones are cysts. Some of them are too small to accurately characterize but stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular left adrenal gland is unchanged. Nodular right adrenal gland is also unchanged.KIDNEYS, URETERS: Status post right nephrectomy. Cysts involving the left kidney are unchanged. Punctate, nonobstructing stone in the lower pole of the left kidney is unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes are unchanged. For reference purposes a left para-iliac node measures 1.2 by 0.9 cm on image number 91, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate gland. Enhancement in the posterior peripheral zone is suspicious for prostate cancer. Correlation with PSA level and/or pelvic MRI is recommended.BLADDER: Diffuse wall thickening of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in the abdomen. Enhancement within the posterior peripheral zone although prostate, suspicious for prostate cancer. Correlation with PSA values and/or biopsy results is recommended.


Instruction: Generate impression based on findings.

Input: 81-year-old male with severe low back pain including paresthesias and weakness. For the purpose of labeling, 5 lumbar vertebral bodies are assumed to be present with the lower-most level containing a well-formed disc and numbered as L5/S1. This is the same nomenclature as utilized previously.The conus medullaris is located at level of L1 -- L2 and is normal in appearance.Degenerative disease is seen in the lumbar spine. The degenerative changes at individual levels are as follows:T12-L1: There are disk bulging and facet arthropathic changes, resulting in mild spinal canal stenosis and neural foraminal narrowing, unchanged.L1-L2: There is diffuse disk bulging, severe facet hypertrophy, and ligament flavum thickening, resulting in severe spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. These findings are unchanged.L2-L3: There is diffuse disk bulging, severe facet hypertrophy, and ligament flavum thickening, resulting in severe spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. These findings are unchanged.L3-L4: There is grade 1 anterolisthesis of L3 over L4, diffuse disk bulging, severe facet hypertrophy, and ligament flavum thickening, resulting in severe spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. These findings are unchanged. Bilateral facet effusions appear smaller.L4-L5: There is grade 1 retrolisthesis of L4 over L5, disk bulging with posterior osteophyte, severe facet hypertrophy, and ligament flavum thickening, resulting in moderate to severe spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. These findings are unchanged.L5-S1: There are new T2 hyperintense reactive endplate changes consistent with evolving Modic type I reaction (best seen with sagittal STIR technique). There is disk bulging and posterior osteophyte, severe facet hypertrophy, and ligament flavum thickening, resulting in mild spinal canal stenosis. There is also lateral recess and neuroforaminal stenosis. Other than the new Modic type I reactive endplate changes, the other described findings are unchanged.

Output: Severe degenerative disease of the lumbar spine, with high-grade spinal canal stenosis at multiple levels. There are also lateral recess and neural foraminal stenoses at multiple levels. However, these stenotic changes are stable in appearance.


Instruction: Generate impression based on findings.

Input: Evaluate spondylolisthesis on flexion/extension views. Evaluate L5 on S1 displacement. Based on prior examinations, I will designate 5 lumbar type vertebrae with partial sacralization of L5. There is hyperlordosis of the lumbar spine, as well as a mild scoliosis which limits evaluation of the lower lumbar vertebrae and intervertebral disk spaces. Although there appeared to be an anterolisthesis of L5 relative to S1 on the prior lumbar spine radiograph study, the subsequent CT and MRI studies showed no such anterolisthesis, and therefore the appearance is likely artifactual, perhaps related to the partial sacralization of L5. There is, however, a grade 1 to 2 anterolisthesis of L4 on L5 which measures approximately 12 mm on flexion and 10 mm on extension (not accounting for magnification artifact). Vertebral body heights are preserved.

Output: L4 anterolisthesis as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with dysphagia and a positive is esophagogram. Nonenhanced cervical MRI:There is generalized uniform smaller caliber of the spinal canal which is believed to represent a congenital anatomical variation.There is normal anatomic alignment the vertebral, however with near complete straightening of the cervical lordosis.The signal intensity of vertebral column is unremarkable other than changes related to degenerative disease. Foramen magnum is unremarkable.C2 -- C3 is unremarkable. C3 -- C4 demonstrate mild degenerative disease and mild bilateral neural foraminal and central spinal stenosis. C4 -- C5 demonstrate mild degenerative disease with mild left uncovertebral hypertrophic changes resulting in mild to moderate left neural foraminal compromise and no central spinal stenosis. C5 -- C6 demonstrate mild asymmetric right-sided uncovertebral hypertrophy resulting in mild to moderate right neural foraminal compromise and unremarkable lines.C6 -- C7 is unremarkable.C7 -- T1 is unremarkable.There is normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord.Uppermost visualized thoracic spine and thoracic cord is unremarkable. There is no detectable abnormality in the visualized prevertebral soft tissues.

Output: 1.Generalized uniform smaller caliber of the cervical spinal canal represent a congenital anatomical variation.2.Mild degenerative changes of cervical spine with resultant mild central spinal stenosis at C3 -- C4 and questionably at C4 -- C5.3.Multi-level neural foraminal compromise as detailed per level above.4.No detectable abnormality in the limited view of prevertebral soft tissues.


Instruction: Generate impression based on findings.

Input: Male, 37 years old, with history of metastatic melanoma to the brain, status post SRS. A late subacute parenchymal hematoma is redemonstrated within the left frontal lobe measuring several millimeters smaller than on the prior examination. The surrounding parenchyma is hemosiderin-stained but there is no significant edema.Small foci of chronic hemosiderin staining are seen medial to the left frontal hematoma and within the right parietal lobe, corresponding to prior enhancing foci. On the current examination, no definite residual enhancement is seen at the sites of prior enhancing tumor, and no new enhancing lesions are detected.No evidence of new edema or generalized mass effect is observed. No new intracranial hemorrhage is evident. The ventricles are stable and normal in size.

Output: 1.No definite residual enhancement is seen at the sites of known treated metastatic disease, and no evidence of any new metastases.2.Slight interval decrease in the size of a subacute left frontal hematoma.


Instruction: Generate impression based on findings.

Input: Migraine with aura There is a focal relatively well-circumscribed about 5 mm sized high signal intensity lesion on FLAIR and T2 weighted image on the right hippocampal gyrus. The lesion is not enhancing and does not show any evidence of local mass effect or surrounding edema. Comparing to prior scan, considering the difference of imaging acquisition technique, there is no significant interval change in terms of size, and MR characteristics.There is no evidence of acute ischemic or hemorrhagic lesion. There is no evidence of abnormal enhancement.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No interval change of right hippocampal gyrus high signal intensity lesion on FLAIR in terms of size and MR characteristics since prior scan.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness. Diplopia. There is no signal abnormality in the brain to suggest demyelinating disease. Minimal punctate foci of T2/FLAIR hyperintensity such as in the right parietal subcortical white matter are unchanged and nonspecific. There is no intracranial mass or mass effect. There is no abnormal intracranial contrast enhancement. The ventricles and sulci are within normal limits. The deformity of the right orbital floor remains unchanged, likely related to prior inferior blowout fracture. There is moderate mucosal thickening and fluid in the maxillary sinuses and mild mucosal thickening in the ethmoid sinuses.

Output: 1. MRI of the brain is within normal limits. No evidence of demyelinating disease.2. Chronic mild deformity of the right orbital floor likely related to prior trauma.3. Mucosal thickening and fluid in the maxillary sinuses may reflect sinusitis in the appropriate clinical setting.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are post-therapy findings related to right parietal craniotomy and subjacent lesion resection with multiple foci of susceptibility effect and some foci of T1 hyperintensity compatible with old blood products. There is a new 7.4 x 3.4 cm region of heterogenously enhancing tissue within the right parietal lobe resection bed. There is significantly elevated relative cerebral blood volume within the majority of the enhancing tissue, most significantly within the anterior and posterior portions of the mass. There is markedly increased T2 hyperintensity throughout the right cerebral white matter and corpus callosum as well as the right thalamus. New signal abnormality conforming to the corticospinal tract in the right cerebral peduncle and right medullary pyramid is compatible with Wallerian degeneration. There is increased mass effect upon the right lateral ventricle and 8-mm leftward midline shift, previously 5 mm. There is no evidence of acute infarct. The major cerebral flow voids are intact. There is unchanged minimal punctate non-specific enhancement within the left internal auditory canal.

Output: Findings compatible with disease progression.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for ischemia History: altered mental status and known old CVA MRI brain:There is atrophy of the cerebellum and brainstem. Within the pons there is a rounded lesion with peripheral punctate foci of susceptibility measuring approximately 8 mm in diameter which is best seen on the CT scan where it is a hyperdense lesion.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are asymmetric - right larger than left.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.

Output: 1.There is cerebellar and brainstem atrophy present. One possibility is that this represents a spinocerebellar atrophy.2.There is a lesion present within the pons associated with some calcifications (better identified on CT). It does not appear to represent a cerebral cavernous malformation. Perhaps a post contrast CT would be helpful.


Instruction: Generate impression based on findings.

Input: Uterine versus ovarian cancer, evaluate for metastatic disease PELVIS:UTERUS, ADNEXA: Left adnexal cystic mass with peripheral enhancement measures 4.8 x 4.4 cm (series 1301, image 111). Nodular focus of enhancement in the right adnexa measuring 3.9 x 1.9 cm (1301, image 111) may represent a focus of peritoneal carcinomatosis. Submucosal foci of low signal in the endometrium suggestive of leiomyoma.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive ascites in the pelvis.BONES, SOFT TISSUES: Scattered sclerotic osseous in the pelvis suspicious for osseous foci in the bony pelvis.OTHER: Left external iliac, common femoral, and more distal DVTs.

Output: 1.Left adnexal mass with associated ascites and peritoneal soft tissue deposits compatible with peritoneal carcinomatosis.2.Scattered sclerotic osseous in the pelvis suspicious for osseous foci in the bony pelvis.3.Left external iliac, common femoral, and more distal DVTs.


Instruction: Generate impression based on findings.

Input: Reason: metastatic Prostate cancer, right sided lower thoracic spine predominantly sclerotic lesions amenable to biopsy (per Dr Christoforidis) History: Requiered per Protocol 12-0109 Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Incidental note is made of calcific gallstones which have moved to a dependent position on the prone position scan relative to the prior supine position CT of the abdomen from 8/27/13.

Output: 1.T10 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.2.Gallstones


Instruction: Generate impression based on findings.

Input: 28 year old with BRCA1 positive, strong family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Mild patchy parenchymal enhancement is noted bilaterally, similar in distribution to the prior exams.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Left knee pain and swelling. MENISCI: No significant abnormality noted. No meniscal tear is seen.ARTICULAR CARTILAGE AND BONE: There is moderate thinning of the articular cartilage along the medial facet of the patella, with underlying bone marrow reactive changes and cyst formation. Minimally increased signal is noted in the articular cartilage of the lateral patellar facet, without defects or underlying bone marrow reactive changes. The articular cartilage of the tibiofemoral compartments is within normal limits. LIGAMENTS: No significant abnormality noted. The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Cartilage degeneration at the medial facet of the patella, as above.


Instruction: Generate impression based on findings.

Input: Bell's palsy [351.0] / Disturbance of skin sensation [782.0], Reason for Study: ^Reason: right Bell's palsy, right hand numbness History: as above On post enhanced images, there are multifocal asymmetric enhancing lesions on the course of the right facial nerve. The enhancing lesion starts with right facial nerve intracanalicular segment (series 1201, image 42/150), geniculate ganglion (series 1201, image 43/150), tympanic segment (series 1201, image 40/150), mastoid segment (series 1201, image 34/150) and stylomastoid foramen (series 1201, image 24/150). These findings are consistent with Bell's palsy involving peripheral 7th nerve. There is enlarged right middle cerebral vein without associated MR evidence of brain arteriovenous malformation. There is no abnormal parenchymal enhancement.Possibilities of above findings include 1) normal variation of enlarged right middle cerebral vein and 2)arteriovenous shunting such as focal arteriovenous fistulae or small arteriovenous malformation. Since CT angiography and MR angiography do not provide temporal resolution of the lesion, they cannot exclude possibility of arteriovenous shunting. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal right peripheral facial nerve enhancements as described above which is consistent with Bell's palsy.2. Enlarged left middle cerebral vein as described above. The diagnostic possibilities include 1) normal variation of the left middle cerebral vein and 2) arteriovenous shunting. Diagnostic catheter angiography is the only way to exclude the possibility of arteriovenous shunting.Discussed with Dr.Rubeiz at the time of this dictation.


Instruction: Generate impression based on findings.

Input: History of head and neck cancer. Bilateral lower extremity pain and generalized weakness. Brain: There is encephalomalacia with T2/FLAIR hyperientensity and mild volume loss involving the left inferior parietal lobule involving the angular gyrus. Associated T1 hyperintensity compatible with laminar necrosis. There are also multiple small areas of encephalomalacia involving the bilateral cerebellar hemispheres indicative of remote infarcts. No evidence of acute ischemia. No intracranial mass or mass effect. There is mild global parenchymal volume loss. No hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Small left maxillary sinus mucus retention cysts. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine:There is motion degradation, particularly on the axial T2 sequence. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. No suspicious osseous lesions are seen.There is questionable patchy T2 signal abnormality involving the cervical spinal cord from the C4 to C7 level without any evidence of cord swelling. No abnormal enhancement.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild spinal canal narrowing related to small disk osteophyte complex and ligamentum flavum thickening. There is mild to moderate left neural foramina stenosis.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is disk osteophyte complex with mild to moderate spinal canal stenosis including mild indentation of the cord. There is mild bilateral neural foraminal stenosis. C6-7: There is disk osteophyte complex with mild spinal canal stenosis. There is mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy. No significant right neural foramina narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of acute ischemia or intracranial mass effect. 2. Chronic infarcts in the left inferior parietal lobule and bilateral cerebellar hemispheres.3. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at C5-C6 and mild indentation of the ventral cord. There is questionable mild T2 hyperintensity in the cervical cord at the C5-C6 level which may be artifactual. No abnormal enhancement. 4. Mild to moderate neural foramina narrowing at C3-C4, C5-C6, and C6-C7 as detailed above.


Instruction: Generate impression based on findings.

Input: 65-year-old man with pancreatic head mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: The spleen appears normal.PANCREAS: There is a multilobulated cystic mass in the head of the pancreas (series 6, image 33) which measures 34 x 16 mm, previously 38 x 23 mm. There are thin, nonenhancing septations within this lesion. This lesion is again seen communicating with the pancreatic duct.The main pancreatic duct is mildly dilated to 3 mm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 9 mm cyst in the midpole of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: A lobulated gastric body lesion is unchanged. The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable side branch IPMN in the pancreatic head with a stable, mildly dilated pancreatic duct.2.Stable gastric body lesion.