Instruction: Generate impression based on findings.

Input: Clinical question: New bleed. Signs and symptoms cord status post fall, altered mental status. Non-enhanced CT brain: Images through posterior fossa demonstrate no definitive evidence of abnormality and stable since prior study.There is a focal area of edema involving the anterior tip of right temporal lobe (gray and white matter) with possible minimal hemorrhage which is similar to prior study. This results in effacement of adjacent cortical sulci. There is however no midline shift. This finding is concerning for a foci of contusion. Additional area of low attenuation involving the cortex and subcortical white matter of right frontal pole measuring 30-mm times 20 mm size. There is no detectable parenchymal hemorrhage in this region.Small amount of blood within the subarachnoid space in the right anterior parietal on axial image 21 is noted.There is a CSF density subdural hygroma which extends from approximately the level of the floor of the left anterior and middle cranial fossa superiorly to the vertex. There is interval increase in the size of these finding since prior exam. The thickest segment of this extra-axial CSF collection measures approximately 6 mm. There is resultant mild effacement of adjacent cortical sulci. A very small right sided frontal CSF density extra-axial collection is also suspected. This finding was present on prior exam and shows no change. There is no evidence of new bleed since prior exam. Ventricular size remains within normal and with no midline shift. No evidence of intraventricular hemorrhage. Follow-up with an MRI examination for further detailed evaluation of extent of injury is recommended. Calvarium is intact. Limited view of the orbits are unremarkable. Visualized paranasal sinuses demonstrate minimal soft tissue density within the right maxillary sinus. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.

Output: 1.No evidence of new hemorrhage is prior study.2.Foci of edema in the right anterior temporal with minimal hemorrhage, edema in the right anterior frontal lobe with no hemorrhage or bleed can represent areas of contusion. A small amount of subarachnoid hemorrhage in right parietal region.3.CSF density subdural collections bilaterally as detailed. This finding is more pronounced on the left and the suggestion of interval increase since prior examination of the same date.4.Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: History of renal cell carcinoma status post partial nephrectomy. Pathology/10/15 demonstrated a multilocular cystic renal cell carcinoma grade 2 measuring 2.5 cm. The study was somewhat suboptimal. The patient felt nauseous during the postcontrast image acquisition and no venous or delayed phase images were obtained.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild diffuse thickening of the adrenal glands bilaterally without a focal lesion, unchanged.KIDNEYS, URETERS: Postsurgical changes of a partial nephrectomy of the anterior left renal interpolar cortex. No evidence of residual or recurrent tumor.Unchanged subcentimeter right renal T2-weighted hyperintensities are too small to characterize, likely cysts.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: Postsurgical changes from a left partial nephrectomy without evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: 42-year-old female with left hip pain. Evaluate greater trochanteric bursa. ACETABULAR LABRUM: The acetabular labrum appears intact within the limitations of a non arthrogram study.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. No full-thickness articular cartilage defects are seen.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance ADDITIONAL

Output: No evidence of a bursitis. No findings to account for the patient's left hip pain. Other findings as described.


Instruction: Generate impression based on findings.

Input: Multiple cavernomas seen on outside radiology scan, please evaluate. There is apparent interval increase in size of the left posterior cingular gyrus cavernous malformation as well as formation of a thicker hemosiderin rim, now measuring up to 14 mm, previously 11 mm. There is a small developmental venous anomaly associated with this lesion, as well in the right middle frontal gyrus. There is a punctate focus of susceptibility effect and enhancement in the superior vermis. There is an unchanged lesion with susceptibility effect and diffuse faint enhancement in the right pons that measures up to 11 mm There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Apparent interval increase in size of the left posterior cingular gyrus cavernous malformation with associated developmental venous anomaly.2. A lesion in the right pons likely represent a capillary telangectasia rather than a cavernous malformation.3. A punctate lesion in the superior vermis also likely represents a vascular malformation.


Instruction: Generate impression based on findings.

Input: 82-year-old male with history of colon cancer, status post resection. Presents with abdominal distention and emesis This examination is limited by the absence of intravenous contrast. ABDOMEN: Within the limits of a non-IV contrast enhanced examination of following observations are made. LUNG BASES: No significant abnormality noted LIVER, BILIARY TRACT: No significant abnormality noted SPLEEN: No significant abnormality noted PANCREAS: No significant abnormality noted ADRENAL GLANDS: Low-attenuation right adrenal gland lesion with characteristics typical of benign adenoma seen unchanged dating back to MRI exam of 3/3/2004. KIDNEYS, URETERS: Small kidneys bilaterally with bilateral urinary tract calculi seen. The total burden of calcifications appears relatively unchanged although the location of these calcifications has changed from 2007. No hydronephrosis. Simple cyst seen bilaterally unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: Marked dilatation of colon with redundant colon isvirtually unchanged since CT 1/3/207 and similar to computed radiographs dating back to 2004. Colon is seen with distention and fluid and air through the entire length through to the rectum although collapse of the sigmoid is seen at one location but without surrounding mass. While CT cannot exclude a colonic neoplasm, there is no mass effect around this collapsed colon and this presumably is physiologic. Small bowel is dilated distally while proximally it is of normal caliber. There is no transition point throughout the entire colon to suggest an element of obstruction and this pattern and the chronicity suggests colonic pseudoobstruction. BONES, SOFT TISSUES: No significant abnormality noted OTHER: No significant abnormality noted PELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality noted BLADDER: No significant abnormality noted LYMPH NODES: No significant abnormality noted BOWEL, MESENTERY: See above discussion in the abdomen. BONES, SOFT TISSUES: No significant abnormality noted OTHER: No significant abnormality noted

Output: 1. Marked diffuse dilatation of the colon to maximum diameter 12 cm, without evidence of mass lesion or transition point -- chronic dating back to 2004. Findings are most consistent with colonic pseudoobstruction.2 Right adrenal adenoma is unchanged 3. Bilateral renal calculi with no evidence of urinary obstruction.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: Bilateral lower extremity weakness.. Brain: There are numerous supratentorial and to a lesser degree infratentorial white matter T2 hyperintense lesions, which have overall progressed in size and number since 2013. In addition, there are newly apparent subcentimeter foci of enhancement in the white matter adjacent to the right temporal horn, the subcortical white matter of the inferior temporal gyrus, and in the anterior right lateral periventricular white matter. Otherwise, a focus of enhancement in the inferior right frontal lobe has resolved. Many of the lesions display T1 hypointensity. There is no evidence of intracranial hemorrhage, mass, 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There are a few scattered foci of T2 hyperintensity throughout the cervical spinal cord and imaged upper thoracic spinal cord, but no associated enhancement or expansion. There is lack of the usual cervical lordosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Numerous intracranial demyelinating lesions have overall progressed in size and number since 2013, with several new foci of acute inflammation in the right cerebral hemisphere.2. Multiple demyelinating lesions in the imaged portions of the spinal cord without acute inflammatory manifestations.


Instruction: Generate impression based on findings.

Input: Unknown congenital spinal cord tumor, presenting with severe lumbosacral pain, radiculopathy, inability to ambulate. There is clumping, irregularity, and predominantly posterior displacement of the cauda equina nerve roots at the L5-S1 level, along with what appear to be linear low attenuation bands around the nerve roots. There is a perineural cyst at the S3 level that measures up to approximately 45 mm in width associated with remodeling of the surrounding bone. There are also subcentimeter perineural cysts in the spinal canal at the S2 level. There is mild degenerative spondylosis, including disc bulges and facet hypertrophic changes with trace effusions, in the lower lumbar spine, which result in up to mild bilateral neural foraminal stenosis at L4-5. Otherwise, there is no significant spinal canal stenosis. There are Schmorl nodes at T11-12 level. Otherwise, the vertebral body heights and alignment are intact. There are renal cysts bilaterally. There is a partially-imaged infrarenal aortic aneurysm.

Output: 1. Findings suggestive of arachnoiditis and/or arachnoid cyst and adhesion formation versus inclusion cyst at the L5-S1 level, which may be iatrogenic in nature. Otherwise, evaluation for tumor is limited without contrast.2. Sacral perineural cysts, the largest of which measures 45 mm in width at the S3 level.3. No significant lumbar spinal canal stenosis.4. Partially-imaged infrarenal aortic aneurysm. Dedicated vascular imaging may be useful for further characterization.


Instruction: Generate impression based on findings.

Input: Patchy and confluent areas of T2/FLAIR signal hyperintensity and diffusion restriction in the cortex and subcortical white matter in the medial aspect of the right posterior temporal lobe extending to the right occipital lobe have increased compared to prior examination and correlate with the area of hypoattenuation on recent CT head. There is subtle increased sulcal effacement in this area compared to prior MR without evidence of susceptibility to suggest hemorrhage.There are multiple additional foci of cortical and subcortical white matter T2/FLAIR signal hyperintensity in the left precentral gyrus and left frontal lobe, which appear decreased compared to prior MRI examination. There is improved signal abnormality in the right thalamus. There is subtle T2/FLAIR signal hyperintensity in the right greater than left brachium pontis of the cerebellum, decreased compared to prior MRI. No residual abnormality is appreciated in the cerebellar hemispheres.Postcontrast images demonstrate gyriform enhancement of the medial right occipital lobe in the area of increased T2/FLAIR signal. There are additional scattered foci of cortical enhancement overlying the convexity of the right frontal lobe. The ventricles and sulci are within normal limits. The cisterns remain patent. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is complete opacification of the bilateral mastoid air cells and inner ears.

Output: 1.Increased confluence of T2/FLAIR signal abnormality in the medial right posterior temporal lobe extending to the right occipital lobe as well as gyriform enhancement, with interval sulcal effacement. Additional foci of cortical enhancement are also seen over the convexity of the right frontal lobe. These findings are suggestive of evolving now subacute infarcts.2.Interval decrease or resolution of signal abnormality in the infratentorial and anterior white matter.


Instruction: Generate impression based on findings.

Input: Mid lumbar spine tenderness and pain, intermittent left leg weakness and falls. Sickle cell disease/thalassemia Five lumbar type vertebral bodies are presumed to be present. There are central sharply delimited endplate depressions involving the T11, T12, L1, and L2 vertebral bodies which can be seen with sickle cell anemia. There is linear as well as horizontal T2 signal involving the L5 vertebral body which may represent a fluid filled cleft related to prior osteonecrosis. Overall vertebral body height is maintained. Severe endplate degenerative changes are seen at the L5-S1 level with low T1 and low T2 signal likely reflecting sclerosis. There is severe loss of disc height at the L5-S1 level and to a slightly lesser degree from L1-L2 to the L4-L5 levels. There is loss of lumbar lordosis. There is mild retrolisthesis of L2 on L3, L3 on L4, L4 on L5, and L5 on S1. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Disc bulge. No significant spinal canal or neural foraminal stenosis.L2-L3: Disc bulge with superimposed right central disc extrusion resulting in mild central spinal canal stenosis. There is effacement of the right lateral recess. There is mild to moderate right neural foraminal stenosis. No significant left neural foraminal stenosis.L3-L4: There is disc bulge and central protrusion with ligamentum flavum thickening resulting in moderate spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: Diffuse disc bulge, and ligamentum flavum thickening resulting in moderate to severe spinal canal stenosis. Minimal bilateral neural foraminal narrowing.L5-S1: There is disc bulge and ligamentum flavum thickening and prominence of the epidural fat resulting in moderate degree of spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis where there may be impingement of the bilateral L5 nerve roots.There are changes secondary to sickle cell disease involving the bilateral kidneys including evidence of prior infarcts on the left. Left kidney small.

Output: 1. Degenerative changes throughout the lumbar spine as detailed above with moderate to severe spinal canal stenosis at L4-L5 and moderate spinal canal stenosis at L3-L4 and L5-S1. There is also multilevel neural foraminal narrowing, worst at L5-S1 where there is moderate to severe bilateral neural foraminal stenosis and possible impingement of the bilateral L5 nerve roots. 2. Central endplate depressions involving the T11, T12, L1, and L2 vertebral bodies which can be seen with sickle cell anemia related to endplate infarcts. There is linear as well as horizontal T2 signal involving the L5 vertebral body which may represent a fluid filled cleft related to prior osteonecrosis. Overall vertebral body height is maintained. 3. Partially assessed findings of sickle cell nephropathy. Dedicated abdominal imaging can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: 65-year-old male with history of UTI. Evaluate for possible prostatic abscess. PELVIS:PROSTATE/SEMINAL VESICLES: There is a T2 hyperintense collection measuring 1.2 x 1.0 cm in the center of the prostate with thick surrounding contrast enhancement. It is difficult to distinguish this collection from the urethra. No periprostatic fluid collections.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Fluid collection in the center of the prostate with thick surrounding contrast enhancement. It is difficult to distinguish this collection from the urethra. Given that male periurethral diverticulum is a rare entity, this is favored to be an intra-prostatic abscess and less likely an infected periurethral diverticulum.


Instruction: Generate impression based on findings.

Input: 80 years Female (DOB:11/8/1935)Reason: dizziness, ? Basilar circ History: dizzinessPROVIDER/ATTENDING NAME: BRYAN A CAMPBELL BRYAN A CAMPBELL There are subdural effusions present bilaterally and symmetrically which are likely related to atrophy.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening along the left maxillary sinus and left anterior ethmoid air cells.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute cerebral ischemic infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Familial hemophagocytic lymphohistiocytosis that presented with major CNS inflammatory activity; treatment with allo matched sib HSCT June 2008 that engrafted well. Currently spastic quadriparesis, major cognitive deficit, and Increasing frequency of seizures. There is extensive diffuse cerebral, brainstem, and cerebellum volume loss with white matter T2 hyperintensity, which may represent gliosis and is not significantly changed. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: No significant interval change in the extensive chronic sequela of intracranial familial hemophagocytic lymphohistiocytosis.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:7/27/1963) headacheReason: right orbital pain, eye pain History: right orbital pain, eye painPROVIDER/ATTENDING NAME: AUDREY LESLIE SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is a developmental venous anomaly in the pons which drains out towards the right side..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.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.2.No intracranial mass lesions are appreciated which could explain patient's headaches


Instruction: Generate impression based on findings.

Input: Pain MENISCI: There is complex tearing of the posterior horn and body of the medial meniscus which has progressed from the prior examination. The anterior horn of the meniscus is intact. Horizontal tearing the posterior horn of the lateral meniscus is also noted which is also new from the prior exam.ARTICULAR CARTILAGE AND BONE: Bony contusions are noted along the posterolateral tibial plateau and lateral femoral condyle with cortical irregularity of the lateral femoral condyle. There is mild thinning of the articular cartilage of the lateral compartment of the no full-thickness defects are identified within the knee.LIGAMENTS: There are surgical changes relating to prior ACL repair with rupture of the ACL graft. The PCL, MCL, and lateral collateral ligament complex appear intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Ruptured ACL graft.2. Complex tearing of the medial and lateral menisci.3. Bony contusions of the lateral compartment with associated subchondral fracture of the lateral femoral condyle.


Instruction: Generate impression based on findings.

Input: 60-year-old male with left parotid mass, PET avid. Additional information per chart review in EPIC: Patient had an episode in April of left parotid swelling associated with food intake that resolved with conservative measures. He was told that this could be related to a parotid sialolith, however this has not occurred since. He also endorses pin point pain in the region that occurs at regular time periods during the day and lasts for a number of seconds. No constant facial pain. No facial weakness/facial paralysis, history of head and neck cancers. MRI BRAIN: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are scattered T2/FLAIR hyperintense foci within the periventricular and subcortical white matter in an asymmetric distribution predominantly within the left cerebral hemisphere. There is a nonspecific punctate enhancing focus within left anterior parietal bone. There is no diffusion abnormality. There is a retrocerebellar cyst causing mild mass effect on the left paramedian posterior cerebellar hemisphere; otherwise there are no extra-axial collections present.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI SOFT TISSUE NECK: PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: Within the tail of the superficial lobe of the left parotid gland there is an oval-shaped lesion measuring 13 mm x 9 mm (series 901, image 16). The lesion demonstrates well-defined margins only on the T1-weighted sequence but is somewhat difficult to delineate on the other sequences, including the postcontrast sequences. The lesion demonstrates slightly hyperintense but heterogenous signal relative to the background parotid tissue on the T2-weighted images, slightly hypointense signal on the T1-weighted images and mild heterogenous enhancement on the postcontrast sequences. The lesion demonstrates restricted diffusion.Within the right parotid gland there is also a 10 x 8 mm lesion (series 701, image 28) with part of the lesion demonstrating low T1 signal intensity and high signal on T2-weighted sequences relative to the background parotid tissue compatible with a cystic component; the anterolateral component of the lesion demonstrates a different signal intensity pattern (series 901, image 28) and may be more nodular in nature. The cystic component of the lesion appears to demonstrate T2 shine through on the diffusion weighted images with no definite restricted diffusion identified. There was no definite corresponding increased uptake on the previous PET scan.The bilateral submandibular and sublingual glands are unremarkable. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified which are not pathologic by CT size criteria.

Output: 1. 13 mm heterogeneously enhancing lesion in the left parotid tail demonstrating restricted diffusion with intermediate T2 and low T1 signal. Findings are suspicious for a primary parotid neoplasm, which given the location may represent a Warthin's tumor; of note on the postcontrast and T2-weighted sequences, the margins are not well-defined raising the possibility of more aggressive malignancy. Differential diagnosis also includes metastatic disease. Correlate with recent biopsy results, note should be made that imaging characteristics may be altered by the preceding biopsy which could result blood products.2. 10 mm superficial right parotid lesion is indeterminate demonstrating a partially cystic component without definite restricted diffusion or uptake on recent PET scan. This may represent a lymph node however an ultrasound is recommended for further characterization, to exclude another primary parotid lesion.3. Likely chronic small vessel ischemic disease, left greater than right.4. Nonspecific punctate enhancing focus within the anterior left parietal bone, although could represent a hemangioma.


Instruction: Generate impression based on findings.

Input: Female 83 years old Reason: Etiology for memory deficit History: memory deficit. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive patchy and confluent scattered T2/FLAIR hyperintensity throughout the periventricular and subcortical white matter most consistent with chronic small vessel ischemic disease. No focal areas of brain parenchymal atrophy. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Extensive T2/FLAIR hyperintensity in the white matter consistent with chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: eval for calcaneal stress fracture vs plantar fascial tear History: heel pain for over a year and abnormal xray We see no stress fracture. There is thickening of and increased signal intensity within the medial band of the plantar at its calcaneal attachment. There is a small amount of edema within the adjacent soft tissues and calcaneus. These findings indicate plantar fasciitis. There is mild edema within the navicular tuberosity, which is nonspecific, but we see no fracture line. There is a small amount of fluid within the tibiotalar and subtalar joints as well as the joints of the midfoot and the MTP joints, but this is not necessarily of any clinical significance. Loss of the normal fatty striations of the deep tibiotalar ligament may reflect prior strain but we see no tear. The tendons and ligaments of the ankle otherwise appear normal. The remaining visualized soft tissue structures appear normal.

Output: MRI findings of plantar fasciitis without evidence of calcaneal stress fracture. Mild nonspecific edema of the navicular tuberosity is not necessarily of any clinical significance.


Instruction: Generate impression based on findings.

Input: The cranium is large but the brain parenchyma is in general atrophic or underdeveloped. Both cerebral hemispheres are affected symmetrically and diffusely, though the frontal and temporal lobes appear to be slightly more affected. As such, the sylvian fissures are quite wide. The cerebellum and brainstem show relatively normal volume.The periventricular white matter of the cerebral hemispheres is symmetrically T2 hyperintense. This affects the deep white matter with sparing of the subcortical U-fibers. The subinsular white matter is questionably T2 hyperintense, as is the junction of the basal ganglia and thalami. The genu and splenium of the corpus callosum are T2 hyperintense, and furthermore, the posterior corpus callosum body and splenium are thinned. Striated T2 hyperintensity is seen in the pons, and there is patchy T2 hyperintensity at the dentate nuclei of the cerebellum.The degree of white matter myelination is difficult to assess on T2 weighted images due to the extensive signal abnormality as above. However, on T1 weighted images, the white matter signal pattern is commensurate with age at least in some areas, for example distally in the cerebral hemispheres. Symmetric bilateral expansion of the subarachnoid spaces is seen along the cerebral hemispheres. In addition, there are bilateral symmetric subdural collections which do not fully suppress on FLAIR images indicating the possibility of proteinaceous debris or old blood product. The ventricular system is mildly prominent, but not to the degree of the subarachnoid spaces.No restricted diffusion is seen. No evidence of acute intracranial hemorrhage is detected. No definite evidence of any migrational anomaly is seen. There is no evidence of an intracranial tumor or mass effect.

Output: Multiple pathologic findings are seen, including symmetric bilateral signal abnormality affecting predominantly the deep cerebral white matter, the corpus callosum, the junction of the basal ganglia and thalami, the pons, and the cerebellum in the area of the dentate nuclei.Brain volume is significantly lower than normal suggesting either atrophy or underdevelopment. The cerebral hemispheres are affected diffusely, with perhaps mild preference for the frontal and temporal lobes. The sylvian fissures in particular are widened.Symmetric bilateral expansion of the subarachnoid spaces is seen. In addition, there are symmetric bilateral subdural collections suggesting prior subdural hemorrhage.The constellation of findings is most suggestive of an inborn error of metabolism or leukodystrophy. Several of the observed findings, including widened sylvian fissures and bilateral subdural collections, can be seen in glutaric aciduria type 1. However, other metabolic conditions must also be considered.


Instruction: Generate impression based on findings.

Input: Thoracic back pain with radiation to the legs. Alignment of the thoracic and lumbar spine is unremarkable. No acute fracture or dislocation is seen. At L5 -- S1 intervertebral level, there is suggestion of an epidural lesion at the central and left central location, causing effacement of the thecal sac and impingement of the left S1 nerve root. This can be seen on series 11, image number 153. It is uncertain whether this represents image artifact, disk extrusion, or other epidural lesions. Further imaging can be obtained with CT myelogram or MRI.The spinal canal and neural foramina at the other levels appear patent.A 12-mm gallstone is noted.

Output: 1. Possible epidural lesion at L5 -- S1 level, effacing the thecal sac and impinging the left S1 nerve root. Further imaging can be obtained with CT myelogram or MRI.2. 12-mm gallstone.Dr. Eileen Wang (page # 2992) was paged at time of reporting of the study, but she was not available. A note to alert the physician of the availability of the final report was left on the paging.


Instruction: Generate impression based on findings.

Input: Ms. Mersch is a 49-year-old female with a family history of breast cancer in her mother (diagnosed in her 60s), sister (diagnosed in her 40s) and maternal grandmother. History of bilateral mastopexy in April 2008 and benign right breast MRI guided biopsy in 2007 for focal mild chronic lobulitis. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Few scattered foci of enhancement are present in both breasts, unchanged from prior examinations. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Preop evaluation of the right parietal brain tumor Scan was performed under pre-operative stealth protocol with fiducial markers attached on scalp.Redemonstration of rim-enhancing right parietal mass, major about 15 x 21 mm, no change since prior scan.Prior surgery related overlying craniotomy site and skull changes do not show any significant interval change.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, 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 change of previously noted right parietal lobe postoperative rim enhancing tumor since prior scan.


Instruction: Generate impression based on findings.

Input: Female, 49 years old. Reason: r/o cord compression History: increased fecal incontinence since fall on 9/24/15. The vertebral bodies are appropriate in the overall alignment and height. No compression fractures are seen. The spinal cord has grossly normal signal characteristics and overall morphology. There are minimal degenerative changes in the cervical spine with mild central canal narrowing and no associated compromise of the spinal cord.There is mild anterolisthesis of L4-5 and L5-S1 and facet degenerative changes without significant compromise of the central canal. There is at least mild bilateral foraminal narrowing at L5-S1.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: There is 4 mm grade 2 anterolisthesis of C4 on C5 and C6 on C7. Grossly this appears similar to prior counting survey from the thoracic spine MRI. The cervical spine is otherwise in normal alignment, with exaggeration of the normal cervical lordosis. There is mild disc narrowing at C3-C4 with mineralization centrally. There is also mild disc narrowing at C4-C5 and moderate-severe disc narrowing at C5-C6. There is diffuse disc desiccation. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.At C2-C3, there is no significant disk pathology or stenosis. There is minimal ligamentum flavum thickeningAt C3-C4, there is no significant disk pathology or central spinal canal stenosis. There is mild bilateral foraminal stenosis due to diminished disc height.At C4-C5, there is uncovering of the disc with a minimal disc bulge and ligamentum flavum thickening resulting in minimal central spinal canal stenosis. There is mild bilateral foraminal narrowing.At C5-C6, there is mild bilateral uncovertebral hypertrophy without stenosis.At C6-C7, there is uncovering of the disc with a moderate disc bulge and ligamentum flavum thickening, without stenosis.At C7-T1, there is a trace disc bulge without stenosis.Punctate T2 hyperintensity within the central pons is nonspecific but may represent small vessel ischemic change. Incidental note is made of medialized course of the common carotid arteries.LUMBAR SPINE

Output: 1.Degenerative grade 2 anterolisthesis of C4 on C5 and C6 on C7, grossly similar to prior counting survey from MRI thoracic spine. Mild to moderate scattered spondylotic changes without high-grade stenosis.2.Stable moderate chronic compression deformity involving L1 and L4. Multilevel spondylotic changes, most conspicuous at L4-L5 where there is up to moderate-severe right foraminal narrowing. Impingement of the exiting right L4 nerve root. No high-grade central spinal canal stenosis.3.Nonspecific T2 hyperintense lesion off the lower pole the right kidney, statistically most likely a cyst. Ultrasound could be obtained for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: Known progression of GBM, evaluate tumor burden Again seen are postoperative changes related to a right parietotemporal craniotomy for partial tumor resection from the right temporal lobe. There is been evolution of the resection cavity with decrease in associated blood products. Compared to prior MRI from 3/30/2015, there is mild interval increase in masslike FLAIR hyperintensity and enhancement surrounding the right temporal resection cavity indicative of tumor progression. Again seen are additional satellite nodules including along the lateral surface of the right inferior temporal lobe. There is increased mass effect compared to prior MRI with midline shift measuring 13 mm, previously 10 mm at the level of the inferior aspect of the foramen of Monro. There is also increased effacement of the right lateral ventricle. Uncal herniation is again noted and slightly progressed in the interval. Again seen is prominent periventricular flair hyperintensity surrounding the left temporal horn which may be related to entrapment. There is restricted diffusion associated with the tumor as seen previously particularly along the right splenium which appears slightly increased and may represent more hypercellular tumor.

Output: 1. Compared to 3/30/2015, there is been evolution of postoperative changes related to partial resection of known GBM and evidence of mild interval tumor progression. 2. There is mild worsening of mass effect including increased midline shift and right uncal herniation. 3. Slight interval enlargement of the left lateral ventricle indicative of entrapment. 4. Worsening mass effect is not significantly changed since more recent CT from 4/28/2015.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 15 seconds.

Output: Successful left hip arthrogram as described above.


Instruction: Generate impression based on findings.

Input: 64 year old woman with history of PVCs and mild LV dysfunction, referred for cardiac MRI for further evaluation of possible underlying cardiomyopathy. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 172 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 29 g/m2 (normal range 67+/-11), and the LV mass is 64 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 181 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 91 ml (normal range 35+/-13). There are no regional or focal right ventricular wall motion abnormalities. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated (Sinus of Valsalva = 40mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%.2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%4. The aortic valve is tri-leaflet and opens widely. There is at least mild aortic regurgitation.5. The aortic root is mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for new bleed. History of altered mental status. Nonenhanced head CT:There is no evidence of any new finding since prior exam. The cortical sulci, ventricular system and all CSF cisterns remain within normal. The gray -- white matter differentiation is also within normal. If patient's condition persist recommend an MRI examination.Calvarium is intact. Visualized mastoid air cells and middle ear cavities as well as paranasal sinuses are unremarkable.

Output: 1.No evidence of acute new findings.2.CT is insensitive for detection of any ischemic process. Recommend MRI if patient's clinical condition persists.


Instruction: Generate impression based on findings.

Input: Meningioma status post laser ablation on 6/30/2016. There is slight interval decrease in size of a nodular component petroclival dural-based mass that projects into the left pons, where laser ablation had been performed. There is resultant mildly diminished mass effect upon the pons. However, there is now more confluent enhancement of the treated portion of the tumor. Nevertheless, there is diffuse vasogenic edema within the brainstem and left cerebellar hemisphere. The rest of the tumor, including the portion that extends into the left cavernous sinus is unchanged. There are postoperative findings related to prior left temporal craniotomy with encephalomalacia in the left anterior temporal lobe and left retrosigmoid craniotomy with left cerebellar hemisphere and left pons encephalomalacia. There is a right transfrontal ventricular catheter. The ventricles are unchanged in size and configuration. There is no evidence of acute territorial infarction.

Output: Slight interval decrease in size of a nodular component petroclival dural-based mass that projects into the left pons, where laser ablation had been performed. However, there is now more confluent enhancement of the treated portion of the tumor. In addition, there is diffuse vasogenic edema within the brainstem and left cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: 62-year-old male with intermediate risk prostate cancer. Evaluate prostate and assess for high risk features.Per pathology report:Prostate, left base lateral; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7.Prostate, left mid medial; needle biopsy: Prostatic adenocarcinoma, Gleason grade 4+3=7.Prostate, left mid lateral; needle biopsy: Prostatic adenocarcinoma, Gleason grade 4+3=7.Prostate, left apex medial; needle biopsy: Prostatic adenocarcinoma, Gleason grade 3+4=7.Prostate, left apex lateral; needle biopsy: Prostatic adenocarcinoma, Gleason grade 4+3=7. PELVIS:PROSTATE:Prostate Size: 4.7 x 3.0 cmPeripheral Zone: There are multiple lesions demonstrating T2 hypointensity with corresponding ADC hypointensity and enhancement as follows:The largest lesion is left mid gland to apex, extending anteriorly and measuring 1.3 x 0.7 cm; the capsule is indistinct in this area and focal extracapsular extension cannot be excluded.Left lateral base lesion measures 1.0 x 0.6 cm.Central Gland: Heterogeneous signal corresponding to benign prostatic hypertrophy. Seminal Vesicles: No evidence of extension into the seminal vesicles.Extracapsular Extension: The capsule is indistinct in the left mid gland to apex at the anterior aspect and extracapsular extension cannot be excluded in this area.BLADDER: No significant abnormality noted.LYMPH NODES: Left external iliac chain lymph node measures 1.1 x 1.1 cm (series 2301, image 84). Left pelvic sidewall lymph node measures 0.8 x 0.4 cm (series 82301, image 113). BONES, SOFT TISSUES: Changes at L5/S1 are better evaluated on the recent lumbar spine MRI 10/9/2015OTHER: No significant abnormality noted.

Output: 1.Multiple prostatic lesions consistent with known adenocarcinoma. 2.Pelvic lymphadenopathy and findings suspicious for extracapsular extension as above.3.Changes at L5/S1 are better evaluated on the recent lumbar spine MRI 10/9/2015


Instruction: Generate impression based on findings.

Input: History of insulinoma status post enucleation. ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of a subcentimeter simple cyst in the right hepatic lobe. No suspicious hepatic lesions are identified. The hepatic vasculature appears patent. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement without focal lesions identified. The pancreatic duct is normal in caliber.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: No evidence of recurrent or residual tumor in the pancreas.


Instruction: Generate impression based on findings.

Input: 43 year-old with history of ALH, LCIS and dense breasts. Family history of breast cancer in her mother at age 54 and sister at age 50. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Multiple cysts are present in both breasts, right greater than left.An enhancing focus at posterior left upper outer quadrant is stable.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 71 year-old female with cirrhosis status post fall with altered mental status. Evaluate for bleed. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse regions of hypodensity throughout the subcortical white matter consistent with advanced small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Advanced small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 9-year-old male with headaches and developmental delay. Evaluate for a structural abnormality, especially the frontal lobe. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right maxillary sinus mucous retention cyst and scattered ethmoid air cell mucosal thickening.

Output: No evidence of gross intracranial structural anomalies.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Recurrent SCC post-induction protocol 12-1554. Additional history per EMR: Multiple recurrences of H&N SCC s/p multiple partial glossectomies/ND, two courses of EBRT, and brachytherapy, now with biopsy proven right tongue SCC on IRB 121554. There is an ill-defined, heterogeneous posterior left floor of mouth/tongue base region tumor measuring up to approximately 25 mm, with hypermetabolism on the concurrent PET. In addition, there is a small area of nodular enhancement with corresponding hypermetabolism more anteriorly in the left floor of mouth. There is also an enhancing lesion in the right anterior oral tongue that measures up to approximately 9 mm, with hypermetabolism on the concurrent PET. There are several prominent and abnormal appearing left cervical lymph nodes, with hypermetabolism on the concurrent PET. For example, a necrotic left supraclavicular lymph node measures 9 x 11 mm in axial cross-section and a left level 5B lymph node measures 7 x 10 mm. There is no convincing right cervical lymphadenopathy. The right anterior belly of the digastric muscle, submandibular gland, and sternocleidomastoid muscle are surgically absent. The left submandibular gland is atrophic. The right thyroid gland is either atrophic or has been partly resected. There is severe narrowing of the right internal and external carotid artery flow voids at the origins. There is mild degenerative cervical spondylosis. There are also bilateral temporomandibular joint degenerative changes. There is mild esophageal wall edema. The airways are patent. There are bilateral maxillary sinus retention cysts. The imaged intracranial structures are unremarkable.

Output: 1. Post-treatment findings in the oral cavity with an ill-defined, heterogeneous posterior left floor of mouth/tongue base region tumor measuring up to approximately 25 mm, with hypermetabolism on the concurrent PET is compatible with recurrent squamous cell carcinoma. A small area of nodular enhancement with corresponding hypermetabolism more anteriorly in the left floor of mouth may also represent recurrent tumor. 2. A subcentimeter lesion in the right anterior oral tongue, with hypermetabolism on the concurrent PET, is compatible with the known additional squamous cell carcinoma. 3. Multiple left neck lymph nodes with corresponding hypermetabolism on PET are compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: 37-year-old male with rapidly growing left wrist mass on dorsum. Evaluate left wrist cyst. Evaluation of the wrist is limited due to patient motion artifact and inability to use a dedicated wrist coil. The patient refused repeat imaging.A marker was placed along the dorsum of the wrist. There is a dumbbell-shaped mass situated within the soft tissues of the wrist dorsal to the scaphocapitate articulation and situated between the tendons of the second and fourth extensor compartments. It is approximately 14 mm x 11 mm in greatest transverse dimension and approximately 15 mm in longitudinal dimension. It is isointense to skeletal muscle on T1-weighted images and hyperintense to skeletal muscle on T2-weighted images. It is lobulated with internal septations. We see no additional soft tissue masses, although there is prominent vasculature presumably related to the patient's vascular graft not visualized on this study. Given the limitations of the study, the remaining soft tissues appear normal as do the bones.

Output: Limited study as described above showing a lobular mass in the dorsal soft tissues of the wrist. Statistically this is most likely a ganglion, particularly based on its lobulated morphology, however lack of intravenous contrast administration limits further evaluation of the mass.


Instruction: Generate impression based on findings.

Input: 33 year old male with history of CHF, HTN, hypothyroidism, hilar and mediastinal lymphadenopathy. Referred for cardiac MRI to assess for sarcoid. Left VentricleThe left ventricle is severely dilated with global severely reduced systolic function. The overall LV ejection fraction is 18%. The LV myocardium is diffusely thinned out. The LVEDV is 492 ml (normal range 142+/-34), the LV end diastolic volume index is 247 ml/m2 (normal range: 74+/-15), the LVESV is 402 ml (normal range 47+/-19) and the LV end systolic volume index is 202 ml/m2 (normal range 25+/-9). The LV mass is 174 g (normal range 164+/-36) and the LV mass index is 87 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1161 ms in the ventricular septum and 1260 ms in the LV free wall suggestive of the presence of underlying diffuse fibrosis or infiltration.There is no LV thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 19%. The RVEDV is 438 ml (normal range 142+/-31), RV end diastolic volume index is 220 ml/m2 (normal range 82+/-16), the RVESV is 355 ml (normal range 54+/-17), and the RV end systolic volume index is 178 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate right sided pleural effusion. Hilar and mediastinal adenopathy noted. Focal nodular opacity at the right lung base near the right major fissure. Correlation with recent chest CT is suggested. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Severe global left ventricular dilation with severely reduced systolic function (LVEF 18%). No regional wall motion abnormalities.2.Severe right ventricular dilation with severely reduced systolic function (RVEF 19%).3.The native T1 myocardial relaxation time is 1161 ms in the ventricular septum and 1260 ms in the LV free wall suggestive of the presence of underlying diffuse fibrosis or infiltration.4.No late gadolinium enhancement.5.No LV thrombus6.Severe biatrial dilation.7.Moderate right pleural effusion. 8.Hilar and mediastinal adenopathy.


Instruction: Generate impression based on findings.

Input: Male, 91 years old. Altered mental status s/p fall. Assess cervical spine for etiology of fall This exam is significantly limited by motion artifact. Multiple sequences were repeated.The cranial-cervical junction is normal. There is loss of the normal cervical lordosis. Otherwise, the cervical spine alignment is anatomic. The vertebral body height is preserved. There are fatty marrow changes involving multiple cervical vertebral bodies, likely degenerative in etiology. Within the limits of artifact, the signal of the visualized cord is normal. There is no evidence of cord compression or mass. The paraspinal soft tissues are unremarkable. STIR hyperintensity within the subcutaneous fat likely relates to dependent edema.Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is mild disc bulge, facet hypertrophy, and ligamentum flavum thickening with mild spinal canal stenosisC3-C4: There is moderate to severe disc height loss, diffuse posterior disc osteophyte complex formation, uncovertebral and facet joint hypertrophy, and ligamentum flavum hypertrophy with moderate spinal canal narrowing, moderate to severe left neural foraminal narrowing and moderate right neural foraminal narrowing.C4-C5: There is moderate to severe disc height loss, diffuse posterior disc osteophyte complex formation with right paracentral/foraminal prominence, uncovertebral and facet joint hypertrophy, and ligamentum flavum hypertrophy with moderate to severe spinal canal stenosis, moderate to severe right neural foraminal narrowing and moderate left neural foraminal narrowing.C5-C6: There is severe disc height loss with partial fusion of the vertebral bodies, and uncovertebral joint hypertrophy, with mild left neural foraminal narrowing and no significant spinal canal stenosis.C6-C7: There is moderate disc height loss, diffuse posterior disc osteophyte complex formation, and uncovertebral joint hypertrophy, with mild left neural foraminal narrowing.C7-T1: There is minimal 2 mm anterolisthesis of C7 over T1 with disc uncovering and with no significant spinal canal or neuroforaminal narrowing.

Output: 1.Degenerative changes involving the cervical spine including up to moderate-to severe-spinal canal stenosis at the C4-5 level, without associated abnormality of cord signal or morphology.2.No evidence of traumatic abnormality involving the cervical spine.


Instruction: Generate impression based on findings.

Input: Reason: Metastasis to Cerebellum History: Gait instability with known metastatic lung cancer Nonenhanced head CT:There is no detectable abnormality of the cerebellum or the vermis on this non-infused head CT. The fourth ventricle and the cerebellar volume is within normal limits. If concern for metastatic lesion persist recommend contrast MRI.Images through supratentorial space demonstrate no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: Large sacral decubitus ulcer, evaluate for osteomyelitis. There is motion degradation on multiple sequences limiting the study. Five lumbar type vertebral bodies are presumed to be present. Compared to 10/29/2011, there is been development of a compression fracture involving the L3 vertebral body with moderate loss of height with minimal retropulsion. There is edema involving the L3 vertebral body extending into the inferior L2 and upper L4 vertebral bodies as well as the intervening disc spaces. There is focus of linear signal void involving the L3 vertebral body which is suspected to represent a vacuum cleft. There is also a mild compression deformity involving the L5 vertebral body with resolution of edema seen on prior MRI. Alignment is within normal limits. The conus medullaris is normal in position. Mild multilevel degenerative changes are seen including mild disc bulges at the L2-L3, L4-L5, and L5-S1 levels without significant spinal canal or neural foraminal stenosis at any level.There is soft tissue thickening and enhancement involving the partially imaged subcutaneous soft tissues in the left upper gluteal region. There is adjacent T1 hypointensity involving the posterior aspect of the left iliac bone with enhancement. This abnormality is seen on the most inferior slices, series 10 axial images 55 and 56.There is mild deformity involving the sacrum at the S2 level which remains unchanged and may be related to remote trauma.Multiple renal cysts again seen.

Output: 1. Compared to CT dated 10/2/2015, there has been interval development of a compression fracture involving the L3 vertebral body with linear signal void suggestive of vacuum cleft, which can be seen with avascular necrosis or osteoporotic compression fracture. Signal void can also be seen with cement from vertebroplasty if there is such history, but this seems less likely. There is significant associated edema and enhancement which extends from L2 to L4 which is favored to be reactive to the recent compression fracture. No surrounding paraspinous or epidural fluid collections to suggest infection. If there remains high suspicion for discitis-osteomyelitis at this level, would suggest follow-up imaging.2. Chronic mild compression fracture involving the L5 vertebral body with resolution of edema seen on remote MRI study from 10/29/2011. Chronic fracture/ deformity of the sacrum also again seen.3. Soft tissue thickening and enhancement involving the subcutaneous soft tissues in the left upper gluteal region presumably corresponding to the known decubitus ulcer. There is subtle focus of signal abnormality involving the immediately adjacent left iliac bone which may represent osteomyelitis (axial T1 series 10 image 56). This abnormality is partially imaged with motion degraded sequences and would suggest dedicated MRI pelvis study to more completely image this region for osteomyelitis.


Instruction: Generate impression based on findings.

Input: Male; 81 years old. Reason: Assess for HCC recurrence History: increasing AFP ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Three ablation cavities are stable as detailed below. Stable superior right hepatic lobe cavity measuring 2.4 x 1.9 cm (series 903/358), previously 2.4 x 1.9 cm; no new suspicious enhancement.Stable inferior right hepatic lobe cavity measuring 3.2 x 1.8 cm (series 903/328), previously 3.2 x 1.8 cm; no new suspicious enhancement.Stable left hepatic lobe cavity measuring 2.2 x 1.8 cm (series 903/288), previously 2.2 x 1.8 cm; new mild, ill-defined enhancement is seen in segment 3 just posterior to this ablation cavity without washout or restricted diffusion (series 903/278). This is a nonspecific finding, and attention at follow-up is recommended.Stable small portal-hepatic shunt is in the anterior left hepatic lobe. No new focal hepatic lesions. Stable dilation of the common bile duct again measuring up to 1.3-cm. SPLEEN: No significant abnormality noted.PANCREAS: Stable mild pancreatic ductal dilation with a small side branch intraductal papillary mucinous neoplasm (series 601/16).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered renal subcentimeter T2 hyperintense foci too small to characterize but most likely cysts, not significantly changed.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: Stable size of three ablation cavities as detailed above with no new focal hepatic lesions. There is new mild, ill-defined enhancement in segment 3 just posterior to the left hepatic lobe ablation cavity, which is a nonspecific finding and for which attention at follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Personal history of left breast invasive ductal carcinoma status post chemotherapy, lumpectomy, radiation therapy and sentinel node biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a new 1.3 cm area of linear non-mass enhancement in the central 3:00 position of the left breast. No abnormal enhancement is seen in elsewhere in the left breast or in the right breast. Mild non-suspicious enhancement is present at the left breast lumpectomy bed, with no nodular enhancing component present here. There are scattered enhancing foci bilaterally, some of which are small inflamed cysts, a finding that has been seen on prior MRIs for this patient. No abnormal axillary lymph nodes are identified in either axillary region.

Output: New left breast linear non-mass enhancement is present. Given the appearance, MRI guided biopsy is recommended. Degree of suspicion is relatively low, and a benign diagnosis from biopsy would be accepted. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 72-year-old with back pain Lumbar spine: The bones are demineralized. Slight depression of the superior endplate of the L1 vertebral body may represent a compression fracture although we cannot determine whether this is acute or chronic. The vertebral body height was normal on MRI from 2008. Moderate to severe degenerative disk disease affects L5/S1. There is minimal L3 anterolisthesis. Mild to moderate multilevel facet joint osteoarthritis particularly affects the lower lumbar spine. Clips are noted in the right upper quadrant, presumably from prior cholecystectomy.Hip: The bones are demineralized. Mild to moderate osteoarthritis affects the hip.Pelvis: Mild to moderate osteoarthritis affects the right hip. A left hip hemiarthroplasty is situated in near-anatomic alignment although the distal prosthesis is not visualized. Mature heterotopic ossification is present about the hip. Apparent deformity of the left obturator ring likely is due to rotational artifact.

Output: 1. Slight loss of height of the L1 vertebral body suggesting compression fracture, although we cannot determine whether this is acute or chronic. 2. Degenerative arthritic and postoperative changes as detailed above.


Instruction: Generate impression based on findings.

Input: 68-year-old female with history of carcinoid of the ileum ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter, 1 to 2 mm T2 hyperintense lesions in the right lobe of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts. No hydronephrosis. 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.PELVIS:UTERUS, ADNEXA: Multiple uterine fibroids. Small amount of fluid in the endometrial canal. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the right lower quadrant from bowel resection. BONES, SOFT TISSUES: Perineural cyst versus Tarlov cyst in the sacrum. OTHER: No significant abnormality noted.

Output: 1.No suspicious lesions are evident to suggest metastatic disease.


Instruction: Generate impression based on findings.

Input: Post tumor resection follow-up Previously recognized left frontal lobe opercula intra-axial mass has been resected. Local postoperative changes are seen including resection area high signal intensities on FLAIR imaging and extra axial fluid collections.On gradient echo images, there are nodular and linear signal voids indicate local resection site blood products.High signal intensities on the resection site on FLAIR and T2 images which suggest post resection changes most likely. However, possibilities of residual mass can be completely excluded.Minimal extra cranial fluid collections are seen overlying craniotomy site, again not unusual postoperative changes. 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: 1. Post left frontal opercular tumor resection status. No unusual finding.2. High signal intensities around tumor resection site may indicate postoperative changes but cannot completely exclude possibility of residual tumor.


Instruction: Generate impression based on findings.

Input: 58 year old with strong family history of breast cancer and BRCA 2 mutation carrier. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Please do CT guided bx of left parapharyngeal space mass. Compared to the prior CT scan a ring-enhancing lesion in the left parapharyngeal space measuring 24 x 15 mm on the prior exam is no longer ring-enhancing and currently measures 11 x 6 mm axial dimensions.

Output: 1.Since the prior exam the patient's left parapharyngeal space mass is significantly regressed in size. It's possible that this had represented an infection or a dilated parotid duct. As a result the procedure was aborted. If clinically appropriate a follow-up MRI of this area may be of further benefit to evaluate this.


Instruction: Generate impression based on findings.

Input: 63-year-old female with newly diagnosed right breast cancer, further evaluation with MRI. There is heterogeneous amount of fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast: Spiculated enhancing mass with heterogeneous internal enhancement is identified in the right breast 9:00 position measuring 27 x 25 x 31 mm (AP X ML X CC). A clip artifact is identified along the inferior aspect of this mass. Located adjacent and inferior to it is another spiculated enhancing mass at 8:00 position measuring 27 x 22 x 21 mm (AP X ML X CC). Minimal high signal intensity fluid is identified within the ductal system at 9:00 position. Right breast skin thickening with retraction of the nipple is also noted.Multiple enhancing masses are identified extending inferiorly, medially and anteriorly from the index mass at 9:00 position extending from 5:00 position to 9:00 position making the total extent of 57 x 50 x 59 mm (AP X ML X CC). The anterior most enhancing mass abuts the nipple. The medialmost mass at 5:00 position measures 14 x 10 x 11 mm (AP X ML X CC).No other clip artifact identified in any other part of the breast. Patient will obtain a postprocedure mammogram today.Left breast:No abnormal enhancement is seen in left breast. Axillae:Three small size lymph nodes identified in the right axillary region however given that they had suspicious morphology on outside hospital ultrasound, repeat right axillary ultrasound is recommended for further evaluation. No abnormal axillary lymph nodes are identified in left axillary region.

Output: 1. Multicentric right breast cancer with clip artifact located along the inferior aspect of the index cancer at 9:00 position. Total extent measures 57 x 50 x 59 mm (AP X ML X CC).Anteriormost satellite abuts the nipple.2. Three small size lymph nodes identified in the right axillary region however given that they had suspicious morphology on outside hospital ultrasound, repeat right axillary ultrasound is recommended for further evaluation. 3. Patient will obtain postprocedure mammogram today. If only one clip is seen within the index mass, additional clips might have to be placed within the anteriormost/medialmost mass to mark the extent of disease.4. No abnormality noted within the left breast or axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 68 year old man with history of PVCs, referred for evaluation of LV dysfunction or underlying fibrosis. Left VentricleThe left ventricle is mildly dilated with low normal systolic function. There is mild concentric left ventricular hypertrophy. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 110 ml/m2 (normal range: 74+/-15), the LVEDV is 209 ml (normal range 142+/-34), the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9), the LVESV is 102 ml (normal range 47+/-19), the LV mass index is 90 g/m2 (normal range 85+/-15), and the LV mass is 171 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a small "patch" of late gadolinium enhancement in the basal inferoseptum. It is patchy and in a pattern atypical for myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 168 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. A trivial pericardial effusion is noted. Extracardiac FindingsThe thyroid is enlarged. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated and mildly hypertrophied with low normal systolic function. The overall LV ejection fraction is 51%. There is a small "patch" of late gadolinium enhancement in the basal inferoseptum. It is patchy and in a pattern atypical for myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%.3. Mild dilation of the main pulmonary artery.4. Mild to moderate mitral regurgitation.5. Mild to moderate left atrial dilation. 6. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Other convulsions [780.39], Reason for Study: ^Reason: concern for PRESS History: new onset seizure There are patch high signal intensities on bilateral parietal lobe including increased signal intensities on the sulci especially right intraparietal sulci and bilateral occipital lobes indicate possibility of PRES.There is a focal round susceptibility artifacts on the right occipital lobe which shows high signal intensity on FLAIR images indicate possible focal hemorrhagic lesion.There is a susceptibility artifacts on the right intraparietal sulcus on gradient echo images, which corresponds to high signal intensity on FLAIR imaging. This finding indicate possible high protein content leakage toward subarachnoid space which again consistent with PRES.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: 1. Multifocal bihemispheric especially bilateral parietal and occipital lobe high signal intensity lesions with high protein content material which is compatible with the diagnosis of PRES as described above.2. Focal hemorrhagic foci on the right occipital lobe as described above.


Instruction: Generate impression based on findings.

Input: 59-year-old with history of cerebral cavernous malformations and prior hemorrhage experiencing headaches. Redemonstrated are innumerable foci of susceptibility effect within the supratentorial and infratentorial brain. As before, the largest lesion measures up to 10 mm in the right inferior frontal gyrus. No lesions demonstrate perilesional edema. A new lesion visible with T2 technique is present within the left cerebellar hemisphere measuring 2-3 mm, without perilesional edema. There is no extra-axial hemorrhage or acute infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The expected intracranial vascular flow voids are present, without evidence of associated developmental venous anomalies. The skull and extracranial soft tissues are unremarkable. There is no abnormal enhancement.

Output: 1.A new cerebral cavernous malformation visible with T2 technique is present within the left cerebellar hemisphere measuring 2-3 mm, without perilesional edema, suggesting interval microhemorrhage, however likely not recent.2.Otherwise stable multiple supratentorial and infratentorial cerebral cavernous malformations.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, status post Rickham removal with headache. Findings are redemonstrated compatible with extensive prior right-sided surgery and right hemispherectomy. The previously seen right parietal approach drainage catheter has been removed. The extra-axial fluid collection within the right-sided craniectomy defect contains air but is otherwise unchanged.Right-sided intracranial fluid involving the hemispherectomy defect and likely contiguous with the ventricular system is unchanged. Multiple left-sided cerebral cysts are redemonstrated. The largest cyst, within the medial left temporal lobe, is not significantly changed. Posterior to this, several smaller cysts are also redemonstrated. One of these, which may have been drained by the previous catheter, seem to have slightly increased in size now measuring up to 18 mm in diameter, previously 14 mm.When compared to the prior MRI, T2 hyperintensity within the left cerebral white matter has increased. In addition, there is new parenchymal hyperintensity involving the left thalamus and cerebral peduncle. No diffusion restriction is seen. No acute hemorrhage is suspected.

Output: 1.Extensive postoperative alterations are redemonstrated including right-sided craniotomy/craniectomy and right hemispherectomy.2.Interval removal of a right parietal approach drainage catheter. One of the left-sided cysts which may have been drained by the catheter has slightly increased in size. Other cysts do not appear to have changed.3.When comparison is made to the prior MRI from 09/29/16, there has been an increase in the extensiveness of T2 signal abnormality involving the left cerebral white matter. New abnormal signal perhaps representing edema is also evident within the left thalamus and cerebral peduncle. The nature of this signal change is uncertain, though it does not appear to be related to acute ischemia as there is no restricted diffusion. Edema related to compression, or perhaps adhesive stretching and traction, would be considerations. An inflammatory or infectious process would also need to be considered.


Instruction: Generate impression based on findings.

Input: 16 year old female with syndromic enchondroma. BONE MARROW: There are numerous intermediate T1 and high T2 lesions especially medially along the proximal left femoral neck that appear similar to recent radiographs and increased when compared to prior MRI. One lesion extends from the femoral neck into the head, crossing the physis. Many similar lesions are noted in the femoral diaphysis, where they become confluent and expand the diaphysis and thin the cortical margin of the bone. These lesions also demonstrate a low T2 rim. No fracture line is identified.These lesions demonstrate peripheral and septal enhancement while centrally intermediate T1 signal remains.SOFT TISSUES: There are a few prominent subcentimeter lymph nodes in the left inguinal region. No soft tissue masses. JOINTS: Joint spaces are well-maintained. No joint effusion present.ADDITIONAL

Output: Multiple areas of marrow replacement by a nonaggressive appearing lesions. There is peripheral and septal enhancement with areas of endosteal scalloping. The differentiation between enchondroma and low-grade chondrosarcoma is difficult by imaging. This is favored to represent enchondroma given lack of radiographic changes from 2011.


Instruction: Generate impression based on findings.

Input: 53-year-old male with right-sided unilateral intraocular pressure increase. Rule out intracranial mass Lucency through the greater wing of the sphenoid bone is seen and may be related to volume averaging. No intraconal abnormalities are identified. No infiltration of the retro-orbital fat. The globes are intact.Subcortical low attenuation regions seen in the right frontal and and right posterior peri-ventricular area areas. These are nonspecific and an MRI is recommended for further evaluation. There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration.The skull base is radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Two subcortical areas of low-attenuation are seen in the right frontal and right posterior periventricular areas. Findings are nonspecific and an MRI is recommended for further evaluation.2. No acute intraconal abnormalities are seen. Small lucency through the greater wing of the sphenoid bone at the inferior orbital surface may be related to volume averaging. Clinical concern remains, a dedicated CT of the orbits may be considered.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right parietal craniotomy for resection of a subjacent tumor. There is unchanged encephalomalacia in the right parietal and temporal lobes with T2 hyperintensity surrounding the resection cavity as well as ex vacuo dilatation of the right atrium. There is no abnormal enhancement surrounding the resection cavity or elsewhere within the brain. There is a right parietal approach ventriculostomy catheter that courses through the right atrium and terminates immediately adjacent to and with mass effect upon the right hippocampal body. The hippocampi are otherwise symmetric and normal in appearance. There are multiple punctate foci of susceptibility effect in the region of the surgical bed compatible with blood products as well as multiple additional punctate foci of susceptibility effect within the bilateral hemispheric white matter. There are also additional punctate foci of susceptibility effect within the left frontal horn and the 4th ventricle that correspond to calcification on prior CT. Stability of some of these foci is difficult to determine due to differences in technique. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is sphenoid sinus mucosal thickening and bilateral maxillary sinus retention cyst.

Output: 1.Unchanged postoperative findings related to right parietal tumor resection without evidence of recurrence.2.A right parietal approach ventriculostomy catheter terminates immediately adjacent to and with mass effect upon the right hippocampal body. The shunted ventricles are unchanged in size and the hippocampi otherwise normal in appearance.3.Multiple bilateral supratentorial punctate foci of susceptibility effect may represent chronic microhemorrhages, cavernous malformations, or calcification. Stability is difficult to determine due to differences in technique. Additional intraventricular foci of susceptibility effect corresponding to calcification on prior CT and are of uncertain etiology.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with speech changes and and abnormality noted on prior imaging. Evaluate for changes in lesion status. An ill-defined region of T2 hyperintensity is redemonstrated involving the medial superior left temporal lobe, left periatrial white matter and left lateral thalamus. The extent of this abnormality is stable or at most very slightly increased when compared to prior examinations. However, there remains no evidence of significant mass effect. Ill-defined enhancement is again seen in this region, but the enhancement is stable to slightly reduced when compared to the prior study. Single voxel spectroscopy of this region shows markedly diminished NAA. The choline peak, however, has increased from that seen on the prior exam, and is now slightly higher than that observed in the contralateral normal hemisphere. A small doublet peak is evident at 1.15 ppm which may be artifactual, though propylene glycol, a common pharmaceutical and food additive, produces just such a peak in this location of the spectrum.A subcentimeter focus of enhancement and minimal diffusion restriction in the left centrum semiovale is unchanged. Likewise, a similarly sized T2 hyperintense non-enhancing lesion in the right parietal white matter is unchanged. Streaky perivenular enhancement in the right parietal lobe is still present though less distinct than on the prior exam.

Output: Overall, there has been little if any significant change in the appearance of scattered lesions as demonstrated on the conventional MRI sequences. MR spectroscopy of the dominant left temporal/periatrial lesion does, however, shows an interval increase in the choline peak, which is a marker for cell membrane turnover. Such a finding can be seen in gliosis or post-inflammatory repair, but also in neoplastic processes.As before, the differential diagnosis would include granulomatous disease, lupus, vasculitis, a post-inflammatory autoimmune phenomenon, and atypical demyelinating disease. Atypical neoplastic processes, such as intravascular (angiocentric) lymphoma, can also present with similar findings. While the overall stability of the lesion is somewhat reassuring, the MR spectroscopic evidence for increased membrane turnover warrants at least one additional follow up exam, perhaps at 6 months.


Instruction: Generate impression based on findings.

Input: 53 year old patient with a lytic lesion in the T10 vertebral body. History of transitional cell urothelial carcinoma . Now with T10 lytic lesion. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the right pedicle and transverse process vertebral lytic lesion.

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


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are prominent, consistent with moderate-severe age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular white matter, consistent with relatively mild chronic small vessel ischemic changes. There is additional focal and cephalization along the posterior right frontal lobe laterally. There is no 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 minimal grade 1 anterolisthesis of C7 on T1 which appears degenerative in nature. The cervical spine is in otherwise normal overall alignment, although with mild reversal of the normal cervical lordosis. The vertebral body heights are well-maintained, while there is mild multilevel disc narrowing, although there is also moderate-severe disc narrowing with prominent endplate degenerative marrow changes at T1-T2. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is diminutive in caliber, with focal T2 hyperintensity along the right lateral aspect of the cord at the upper C6 level as seen on 7/33 suggesting myelomalacia. There is prominent developmental narrowing of the cervical spinal canal due to shortened pedicles.At C2-C3, there is right-sided uncovertebral hypertrophy as well as left facet arthropathy. There is overall mild to moderate central spinal canal stenosis, with moderate left and minimal right foraminal narrowing.At C3-C4, there is a mild posterior osteophyte disc complex superimposed by a shallow central disc protrusion. There is overall moderate central spinal canal stenosis. There is moderate-severe right and moderate left foraminal narrowing and bilateral uncovertebral hypertrophy.At C4-C5, there is mild diffuse posterior osteophyte disk complex with moderate central spinal canal stenosis. Bilateral uncovertebral hypertrophy contributing to moderate bilateral foraminal narrowing. There is also ligamentum flavum thickening.At C5-C6, there is a diffuse posterior osteophyte disk complex with superimposed right paracentral disc protrusion. There is moderate-severe central spinal canal stenosis with bilateral ligamentum flavum thickening. There is resultant severe right greater than left foraminal narrowing.At C6-C7, there is mild diffuse posterior osteophyte disk complex with overall moderate central spinal canal stenosis. There is mild bilateral uncovertebral hypertrophy and prominent ligamentum flavum thickening. There is also mild to moderate bilateral foraminal narrowing.At C7-T1, there is minimal uncovering the disc with superimposed mild disc bulge. There is mild bilateral facet arthropathy and ligamentum flavum thickening, as well as moderate bilateral foraminal narrowing.At T1-T2, sagittal images suggest a diffuse posterior osteophyte disk complex which indents the ventral thecal sac and results in mild bilateral foraminal narrowing.There is trace fluid in bilateral mastoid air cells. Incidental note is made of a prominent lobulated area of fat signal intensity along the anterior aspect of the left parotid gland which may represent a lipoma.

Output: 1. No acute abnormality. Minimal chronic small vessel ischemic changes with small area of peripheral right frontal lobe encephalomalacia.2. Developmentally slender cervical spinal canal with superimposed moderate spondylosis, resulting in up to moderate-severe central spinal canal stenosis at C5-C6 with complete effacement of CSF within the thecal sac, as well as severe bilateral foraminal narrowing at this level.3. Focal area of myelomalacia along the right cord at the upper C6 level. Overall, the cord appears thinned in caliber, likely a chronic finding.3. Trace degenerative grade 1 anterolisthesis of C7 on T1.


Instruction: Generate impression based on findings.

Input: Reason: 38yo woman with known grade 1 endometrial cancer s/p levonorgestrel IUD to decide between surgery and additional medical therapy. PELVIS:UTERUS, ADNEXA: The uterus is anteverted related and retroflexed in position and measures 9 x 5 x 7 cm (CC by AP by TR). The endometrial stripe appears homogeneous and measures up to 8 mm in thickness. The posterior junctional zone is mildly thickened measuring up to 14 mm.An intrauterine device is noted.There is a polypoid lesion arising from the posterior uterine body endometrium with reference measurements below. There is no associated gross invasion of the myometrium.The ovaries are normal in size and morphology and contain small cysts or follicles. The right ovary measures 2.4 x 2.8 x 2.3 cm. The left ovary measures 3.1 x 2.0 x 2.4 cm. No abnormal adnexal masses are identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Symmetric, mildly heterogeneous bone marrow signal intensity may reflect red marrow.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/20/2016 10:00:00)ENDOMETRIAL LESION: 1.1 x 0.8 cm (Image 15, Series 8).

Output: 1.Small endometrial polypoid lesion which may reflect polyp or endometrial hyperplasia/carcinoma without of gross myometrial invasion. No pelvic lymphadenopathy.2.Mild thickening of the posterior junctional zone which is nonspecific but can be seen with adenomyosis.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis follow up. There are numerous supratentorial and infratentorial T2 hyperintense white matter lesions, which are generally T1 hypointense as well. Accounting for differences in technique, the lesions appear to be similar in size and extent compared to 2014. There is an unchanged globular T2 hypointense lesions along the right posterior frontal convexity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Numerous supratentorial and infratentorial demyelinating lesions. Accounting for differences in technique, the lesions appear to be similar in size and extent compared to 2014.2. Unchanged globular T2 hypointense lesions along the right posterior frontal convexity, which is otherwise incompletely characterized without intravenous contrast.


Instruction: Generate impression based on findings.

Input: Lump on left neck RIGHT LOBE MEASUREMENTS: The right lobe measures 5.6 x 1.5 x 1.6 cmLEFT LOBE MEASUREMENTS: The left lobe measures 5.9 x 2.8 x 2.4 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: There is a complex, partly cystic and partly solid well-defined nodule in the inferior left lobe measuring 3.7 x 2.2 x 2.6 cm. No microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Complex dominant nodule in the inferior left lobe of thyroid as described


Instruction: Generate impression based on findings.

Input: 30 year-old female with hypertension, coronary artery disease and history of falls. Question bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse periventricular hypodensity consistent with small vessel disease common age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Ventricles are prominent but may be within normal limits for age.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.