Instruction: Generate impression based on findings.

Input: 67-year-old with history of recent infarct presenting with worsening mental status. Evaluate for worsening infarct. Again seen is restricted diffusion in the left parietal, occipital, and temporal lobes. The area of restricted diffusion is slightly decreased in size compared to the prior exam.There is confluent increased T2 signal within the left parieto-occipital, temporal lobes as well as the subcortical white matter of the posterior left frontal lobe, splenium of the corpus callosum, and left occipital lobes. There is some local mass effect in the left parieto-occipital and posterior temporal lobes with effacement of the sulci and the atrium of the left lateral ventricle, but this is also slightly decreased compared to prior.Again seen is gyriform increased T1 signal in the left parieto-occipital and posterior temporal lobes, similar to prior. In addition, there remains enhancement within and around the infarct clear which has become more complete and confluent.There are scattered foci of susceptibility in the right frontal and left parietal lobes at the sites of previously noted metastases. Some the areas of gyriform T1 increased signal in this region also have susceptibility artifact compatible with hemorrhage. No significant extra-axial collection.The postcontrast images are limited by patient motion. Again seen is a focus of enhancement in the right frontal lobe measuring 7 x 6 mm as well as in the right occipital lobe measuring 8 x 6 mm compatible patient's known metastasis. Within the limitations of the study, these are not significantly changed from prior.The orbits are unremarkable. Paranasal sinuses are clear. Trace bilateral mastoid air cell fluid.

Output: 1. Redemonstration of an evolving subacute left parieto-occipital and temporal lobe MCA distribution infarct. The restricted diffusion in the core of the infarct is slightly decreased compared to prior and there is overall less associated mass effect compatible with the expected evolution of a subacute infarct. No new areas of ischemia. 2. Right frontal and occipital enhancing subcortical nodules compatible with previously known metastases are not significantly changed from prior within the limits of this motion degraded exam. The signal abnormality associated with the infarct now obscures the previously noted left parieto-occipital metastases.


Instruction: Generate impression based on findings.

Input: 52 year old female with a history of non-ischemic cardiomyopathy, status post mitral valve and tricuspid valve replacement, atrial fibrillation. She was referred for cardiac MRI to evaluate fibrosis burden. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 184 ml/m2 (normal range: 65+/-11), the LVEDV is 285 ml (normal range 109+/-23), the LV end systolic volume index is 157 ml/m2 (normal range 18+/-5), the LVESV is 247 ml (normal range 31+/-10), the LV mass index is 102 g/m2 (normal range 67+/-11), and the LV mass is 158 g (normal range 114+/-24). There are global hypokinesis present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.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 18%, the RV end diastolic volume index is 155 ml/m2 (normal range 69+/-14), the RVEDV is 240 ml (normal range 110+/-24), the RV end systolic volume index is 128 ml/m2 (normal range 22+/-8), and the RVESV is 198 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveStatus post bioprosthetic mitral valve replacement, and there is mild central mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveStatus post tricuspid valve annuloplasty. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (MPA 34mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is a catheter in SVC.PericardiumThere is no pericardial effusion; however, there is evidence of late gadolinium enhancement of the pericardium suggesting the presence of underlying fibrosis or inflammation.Extracardiac FindingsTrace pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severely reduced biventricular dysfunction (LVEF 14% and RVEF 18%)without evidence of underlying myocardial fibrosing, infiltrative, or inflammatory process.2. Status post mitral valve replacement with there is mild central mitral regurgitation.3. Status post tricuspid valve annuloplasty ring. There is mild to moderate tricuspid regurgitation.4. Severe biatrial dilation.5. There is evidence of late gadolinium enhancement of the pericardium suggesting the presence of underlying fibrosis or inflammation.6. Main pulmonary artery is mildly dilated. 7. 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: MRI Brain:Susceptibility artifact overlying the left anterior frontal lobe slightly limits evaluation for acute ischemia and hemorrhage in this region. There is however no diffusion restriction to suggest acute ischemia. There is also no evidence of acute intracranial hemorrhage or intracranial mass. There is punctate focus of susceptibility consistent with chronic microhemorrhage involving the left inferior lateral cerebellar hemisphere and unchanged. Again seen are postsurgical changes of a left parietal craniectomy. Again demonstrated is extensive encephalomalacia involving the left MCA territory particularly the left lateral frontal, parietal and temporal lobes as well as the insula with associated ex vacuo dilatation of the left lateral ventricle. There is additional underlying mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific unchanged and likely related to mild chronic small vessel ischemic disease. Previously seen diffusion abnormality related to subacute infarct at the right temporal occipital junction has normalized consistent with evolution. No hydrocephalus. 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.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. There is attenuation of the distal left MCA branches coursing near the infarcted territory which may reflect decreased demand. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Left posterior communicating artery is small. The right posterior communicating artery is not definitively visualized. MRA Neck: There is origin of the left common carotid artery from the brachiocephalic artery which is a normal variant. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. There is suggestion of a small atherosclerotic plaque at the left internal carotid artery origin without significant stenosis. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: 1.No evidence of an acute infarct, hemorrhage, or mass effect. 2.Encephalomalacia in the left MCA territory compatible with a chronic infarct again seen. There has been evolution of a small right temporal-occipital infarct which was subacute on prior study from 9/20/2016.3.Diminutive distal left MCA branches in the infarcted territory which may reflect decreased demand. Otherwise, no flow-limiting stenosis involving the intracranial vasculature or the major arteries of the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Knee pain, evaluate for lateral meniscus tear versus patellofemoral pain. MENISCI: Complex multidirectional tearing affects the posterior horn of the medial meniscus. The posterior horn of the medial meniscus is also abnormal small. Abnormal signal extends into the body of the medial meniscus. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the articular cartilage of the lateral facet of the patella with multiple associated subchondral cysts. The articular cartilage and bone marrow signal intensity is otherwise within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: Intermediate signal within the quadriceps tendon may reflect mild mucoid degeneration/tendinosis. ADDITIONAL

Output: 1.Complex tearing and degeneration of the posterior horn of the medial meniscus extending into the body.2.Marked thinning of the articular cartilage of the lateral facet of the patella.3.Additional findings as described above.


Instruction: Generate impression based on findings.

Input: Headaches and hypertension. Strong family history of aneurysm. Rule out aneurysm. Left neck pain with radiation and weakness in left arm. MRA brain: No evidence of aneurysms or vascular malformations. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. MRI cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies and intervertebral discs are appropriate in height. There is reversal of normal cervical lordosis with kyphotic angulation centered at the C4-C5 level, at least part of which is positional. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of intracranial aneurysm.2. No significant disc disease or spinal canal or neural foraminal stenosis at any level in the cervical spine.3. Reversal of cervical lordosis which is at least in part positional.


Instruction: Generate impression based on findings.

Input: 79-year-old male patient with prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.5 x 3.8 x 4.6 cm.Peripheral Zone: There is ill-defined signal abnormality with T2 hypointensity, mild ADC hypointensity, and early enhancement extending from the left base to the mid gland with more focal abnormality within the left base measuring approximately 7 x 4 mm (image 17, series 701). Of note, the left peripheral zone is atrophic in comparison to the right peripheral zone.Central Gland: Post-surgical changes of a transurethral resection of the prostate.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No specific evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: There is a small left external iliac lymph node (image 127, series 1501); this is non-specific, however, metastatic disease is not excluded.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Atrophic left peripheral zone with ill-defined signal abnormality within the left base and mid-gland. 2. No evidence of extra-prostatic extension.3. Small left external iliac lymph node is non-specific; metastatic disease is not excluded.


Instruction: Generate impression based on findings.

Input: 92 year-old female with altered mental status, respiratory distress. Rule out CVA. Multiple areas of subcortical and periventricular white matter hypodensity likely represent extensive small vessel ischemic disease, age indeterminate by CT. This appears to have progressed slightly since the prior examination. There is worsening of white matter hypodensity in the left frontal convexity, particularly along the superior frontal gyrus. Abnormal areas of attenuation are also noted in the cerebellar hemispheres appear worse compared to the prior examination. If there is concern for an acute stroke, an MRI is recommended for further evaluation. There is no evidence of intracranial hemorrhage or mass. Prominence of the ventricles and sulci indicate moderate to severe corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Extensive small vessel ischemic disease, age indeterminant, but with slight progression compared to the prior examination. If there is concern for acute stroke on an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Memory loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild patchy bilateral cerebral white matter T2 hyperintensity. There are punctate foci of encephalomalacia in the inferior left cerebellar hemisphere and right middle frontal gyrus cortex. There is diffuse cerebral volume loss, which is most pronounced in the bilateral medial temporal lobes. There is no midline shift or herniation. The distal basilar artery flow void appears to be diminutive. The other major cerebral flow voids are grossly intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant. There is a partially imaged nodule in the subcutaneous tissues of the left upper lateral neck.

Output: 1. Mild cerebral white matter small vessel ischemic disease and a punctate inferior left cerebellar chronic and right middle frontal gyrus cortical infarcts, but no evidence of acute intracranial hemorrhage, mass, or acute infarct. 2. Diffuse cerebral volume loss that is most pronounced in the bilateral medial temporal lobes can be a manifestation of Alzheimer dementia.


Instruction: Generate impression based on findings.

Input: History of mycosis fungoides with CNS involvement now s/p 2 cycles of Cytarabine/Etoposide in need of reimaging. CERVICAL SPINE: There is no evidence of mass lesions or abnormal enhancement in the cervical spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is multilevel degenerative cervical spondylosis, with a disc-osteophyte complex at C3-4 that abuts the spinal cord and results in mild bilateral neural foraminal narrowing. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.THORACIC SPINE: There is mild residual enhancement of the thoracic nerve roots and cauda equina, although significantly improved since the prior examination. The thoracic spine is in normal alignment. The vertebral body and disc heights are preserved. There is no abnormal marrow signal abnormality. There are is a small disc bulge at the T1-T2 level, small right paracentral disc protrusion at the T2-3 level, a tiny central disc protrusion at the T5-6 level, but there is no significant spinal canal stenosis or neural foraminal narrowing. There are additional degenerative changes involving the T6-7 posterior T11-12, with variable disc height loss and Schmorl's nodes but no significant spinal canal or neural foraminal stenosis at these levels either. LUMBAR SPINE: There is mild residual enhancement of the thoracic nerve roots and cauda equina, although significantly improved since prior examination. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small disc bulge at L3-4 and L5-S1, with at most mild bilateral neural foraminal stenosis at L5-S1 and no significant spinal canal stenosis at any level in the lumbar spine.

Output: Mild residual enhancement of the thoracic nerve roots and cauda equina related to lymphoma, although significantly improved since September 2016.


Instruction: Generate impression based on findings.

Input: 79 year old male who cannot actively straighten MCP. Evaluate for subluxed extensor tendon versus locked RCL. Evaluation is slightly limited due to the patient's involuntary contracture at the fifth MCP joint.Although the extensor tendon becomes indistinct on the axial images as it courses dorsal to the MCP joint, we suspect this is artifact related to the patient's contracture as it appears intact and in the appropriate position on the sagittal sequences. The collateral ligaments of the fifth MCP joint appear intact, and the remainder of the joint is unremarkable. The central slip of the extensor tendon can be seen inserting on the dorsal aspect of the middle phalanx. Mild osteoarthritis affects the PIP joint of the fifth digit, and there is a small amount of fluid in the joint. The lateral slips of the extensor tendon can be seen inserting along the dorsal aspect of the base of the distal phalanx, although the radial slip is relatively poorly defined which may be due to prior injury. There is edema of the subcutaneous tissues of the finger. The bone marrow signal intensity is within normal limits. There is a slight swan-neck deformity of the fifth finger.

Output: Nonspecific edema of the subcutaneous fat of the fifth finger with osteoarthritis of the PIP joint and other findings as described above. The extensor tendon of the MCP joint appears intact and in the appropriate position. We see no evidence of collateral ligament injury.


Instruction: Generate impression based on findings.

Input: 69-year-old male with dermatomyositis and ongoing CK elevations. Right femur:Musculature: The diffuse muscular edema seen on prior study has improved markedly on the fat saturated T2 imaging, with only mild increased signal visualized within the adductor magnus. There is also mild signal increase in the hamstrings and gluteus maximus, though it is possible that this represents artifact. There is moderate atrophy of the semimembranosus, similar to prior exam. There is perhaps mild fatty atrophy of the remaining thigh musculature on T1-weighted imaging that appears similar to that seen on prior study. Bone marrow: Bone marrow signal of the femur is within normal limits.Additional findings: Small knee joint effusion. There is a small right hydrocele.Left femur:Musculature: The diffuse muscular edema seen on prior study has improved markedly on the fat saturated T2 imaging, with only mild increased signal within the gluteus maximus and hamstring musculature, but this is equivocal and may be artifactual. Small amounts of diffuse fatty atrophy affect the left thigh, with moderate fatty atrophy affecting the semimembranosus and rectus femoris, unchanged.Bone marrow: Bone marrow signal of the femur is within normal limits.Additional findings: Small and knee joint effusion. There is a small left hydrocele.

Output: Marked improvement of diffuse muscle edema compared to prior study. Bilateral muscular atrophy appears similar to prior study.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with low back pain, prior EMG shows lumbar spine radiculopathy. A trace anterolisthesis of L4 relative to L5 is seen. A trace retrolisthesis of L2 relative to L3 is seen. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement is seen. Mild endplate edema is demonstrated at T12-L1.The visualized distal spinal cord, conus and cauda equina are unremarkable. No epidural abnormalities are suspected.T12-L1: Facet arthropathy. Minimal disc bulging. No spinal canal or foraminal stenosis.L1-2: Facet arthropathy. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. Minimal spinal canal narrowing. Moderate left and mild right foraminal narrowing. L3-4: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Marked facet arthropathy. Ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis. Mild left and minimal right foraminal narrowing. L5-S1: Marked facet arthropathy. Minimal bulging disc. No spinal canal stenosis. Mild right foraminal narrowing.

Output: Multilevel disc disc and posteriorly degeneration is seen. L2-3, L3-4 and L4-5 and the most severely affected levels where there is mild to moderate stenosis of the spinal canal. A moderate narrowing of the left L2-3 neural foramen is seen. Elsewhere foraminal narrowing is mild.


Instruction: Generate impression based on findings.

Input: There are postoperative changes of left temporal craniotomy including skin staples and a subgaleal hematoma. There is heterogeneous T1 and T2 signal, fluid fluid levels and susceptibility artifact within and adjacent to the left temporal lobe corresponding to the heterogeneous density seen on the prior CT. And adjacent extra-axial collection measures up to 10 mm in thickness (series 7, image 16) and extends anteriorly and superiorly along the frontal lobe and falx. Foci of hypointensity within the extra-axial collection are compatible with gas bubbles. Heterogeneous signal within the left temporal lobe measures 29 x 17 mm, slightly increased in size compared to the CT. A 13 mm area of gyriform diffusion restriction and FLAIR abnormality is seen adjacent/posterior to the collection. The ventricles and sulci are within normal limits. The basal cisterns remain patent, particularly the suprasellar cistern on the left is now normal in appearance. There is no midline shift. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Status post left temporal lobe surgery with postoperative changes including temporal lobe blood products and extra-axial collection. Findings suggestive of cytotoxic edema in the left temporal lobe adjacent to the surgical site may be related to acute infarction.


Instruction: Generate impression based on findings.

Input: 22 year old with history of transient LV dysfunction, referred for cardiac MRI to evaluate for possible myocarditis or infiltrative disease. Left VentricleThe left ventricle is mildly dilated in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 94 ml/m2 (normal range: 65+/-11), the LVEDV is 172 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 27 g/m2 (normal range 67+/-11), and the LV mass is 49 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. The native T1 myocardial relaxation time is not significantly abnormal in the basal segments (1020ms). Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 102 ml/m2 (normal range 69+/-14), the RVEDV is 186 ml (normal range 110+/-24), the RV end systolic volume index is 42 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsOblong enhancing lesion in the medial aspect the left breast at anterior depth which may represent an enhancing fibroadenoma or lymph node, likely a low-risk lesion in this young patient unless the patient has strong family history of breast cancer. 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. Mildly dilated left ventricle with normal systolic function (EF 62%). There is no late gadolinium enhancement to suggest an infiltrative, inflammatory or fibrotic process. No definitive evidence of recent active myocarditis.2. Mildly dilated right ventricle with normal systolic function (EF 59%).3. Mild left atrial enlargement.4. Oblong enhancing lesion in the medial aspect the left breast at anterior depth which may represent an enhancing fibroadenoma or lymph node, likely a low-risk lesion in this young patient unless the patient has strong family history of breast cancer. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 21-year-old woman with history of Crohn's disease, diarrhea, terminal ileal stricture. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder appears normal and there is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is nondilated and the parenchyma appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an approximately 7 cm length of terminal ileum (1701/71-35) with circumferential bowel wall thickening and enhancement including some relatively spared areas. Within this area, the terminal 4 cm of ileum is dilated but no definite stricture is seen at the ileocecal valve/junction. Immediately proximal to this dilated terminal ileum, there is a 5 cm area of stricturing (1301/9) with additional proximal dilation.Mild fibrofatty proliferation is noted.The colon appears relatively normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid is likely physiologic.

Output: Terminal ileum with areas of stricturing and dilation compatible with history of active Crohn's disease.


Instruction: Generate impression based on findings.

Input: Radiculopathy, lumbosacral region 49 years Female (DOB:9/8/1967) PROVIDER/ATTENDING NAME: TARIQ M MALIK TARIQ M MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild to moderate facet hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild to moderate facet hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 68-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 7 cm in transverse, 6 cm in AP, and 9 cm in craniocaudal diameter.Peripheral Zone: Small peripheral zone in comparison to the large transitional zone. No suspicious lesions identified.Central Gland: Enlarged heterogenous appearance compatible with BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious lesions.


Instruction: Generate impression based on findings.

Input: Subjective weakness to right arm. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained, aside from loss of cervical lordosis which may be in part positional. Bone marrow signal is benign with T1 hyperintense lesion involving the C4 vertebral body consistent with hemangioma. The cervical spinal cord has normal signal characteristics and overall morphology.There are multilevel degenerative changes, with disc height loss relatively worse at the C5-C6 and C6-C7 levels. Additional details as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina. C4-5: No significant compromise to spinal canal. Minimal bilateral neural foraminal narrowing related to uncovertebral hypertrophy and mild facet arthropathy.C5-6: Small disc osteophyte complex. No significant compromise to the spinal canal. There is moderate right and mild to moderate left neural foraminal stenosis related to uncovertebral hypertrophy and mild facet arthropathy. C6-7: Small disc osteophyte complex. No significant compromise to the spinal canal. There is minimal narrowing of the neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine, relatively worse at the C5-C6 level where there is moderate right and mild to moderate left neural foraminal stenosis. 2. Minimal neural foraminal narrowing at additional levels as above. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:5/3/1966)Reason: Brain lesion? History: Chronic headache with leiomyosarcoma historyPROVIDER/ATTENDING NAME: DIONNE J BLACKMAN DIONNE J BLACKMAN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is a T2 and FLAIR hyperintense punctate focus located in the right frontal subcortical white matter. In isolation this is of little clinical significance.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The posterior aspects of the sclera of the eyeballs are thin compatible with staphyloma as.

Output: There is no evidence for brain metastasis on the basis of this exam.


Instruction: Generate impression based on findings.

Input: There is no significant change in size of right peri-Rolandic enhancing lesion with susceptibility, which measures 9x14x15 mm (sagittal series 1201 image 20 and axial series 1301 image 138), previously 10 x 14 x 15 mm. There is surrounding FLAIR hyperintensity may represent edema and/or gliosis and similar to prior. No other enhancing lesions to suggest metastatic disease are definitively appreciated. There are subtle punctate focus of enhancement in the left cerebellar hemisphere, axial image 37 and series 1301 which is favored to be vascular in etiology and can be assessed on follow-up studies.Additional scattered foci of T2/FLAIR hyperintensity in the white matter are similar to prior and compatible with chronic small vessel ischemic disease and/or posttreatment changes. No new mass or mass effect. No hydrocephalus. No extra-axial collections. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No significant change in residual enhancing lesion in the right peri-Rolandic region with surrounding post treatment changes. 2. No new lesions or findings to suggest progression of metastatic disease.


Instruction: Generate impression based on findings.

Input: 17 years Male (DOB:9/27/1998)Reason: anatomic causes or acute changes for change in mental status History: change in mental statusPROVIDER/ATTENDING NAME: GRACE CHONG GRACE CHONG The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a very small mucous retention cyst the left maxillary sinus and minor opacities in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for acute ischemic cerebral infarction or intracranial mass lesion and no convincing evidence for MRI findings consistent with hepatic encephalopathy at this time.


Instruction: Generate impression based on findings.

Input: Clinical question: Breast cancer with new brain metastases on CT. Signs and symptoms: These images, difficulty walking, left-sided weakness. Pre and postcontrast enhanced brain MRI:Examination demonstrates multiple supra and infratentorial enhancing tumors consistent with metastatic lesions. The largest lesion is in the cingulate generous of the right posterior frontal lobe. The lesion has a solid as well as multiple loculated cystic component and with evidence of internal hemorrhagic changes with enhancement. This tumor measures approximately at 32 x 46 x 32 mm in three transaxial dimensions. It demonstrate mild surrounding vasogenic edema and mass effect on the corpus callosum. The tumor minimally extends across the midline and likely through the falx to the left.There is a second superficially located left frontal metastatic tumor with enhancement measuring approximately at 12 x 12 x 16 mm. Minimal surrounding edema and regional mass effect is present. A third smaller metastatic lesion abutting the right falx in the left posterior parietal region and measuring 9 x 6 x 8 mm without appreciable surrounding edema or any significant mass effect.Additionally there is a parenchymal metastatic lesion in the right posterior cerebellum measuring 10 x 7.5 mm without surrounding edema or appreciable mass effect.Ventricular system are within normal size and without deviation of midline.The signal void of major intracranial arterial branches are identified.Calvarium and soft tissues of the scalp are unremarkable and without detectable abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses demonstrate a small retention cyst in the dependent portion of right maxillary sinus and unremarkable otherwise.Pre- and post enhanced cervical spine MRI:Examination of cervical spine demonstrate normal signal intensity and alignment of the vertebral column and without evidence of osseous metastatic lesions. Signal intensity and caliber of the cervical cord is also within normal and without abnormal enhancement. No appreciable degenerative changes of cervical spine, no evidence of spinal stenosis or neural foraminal compromise at any level.Pre- and post enhanced thoracic spine MRI:There is normal anatomical alignment of the vertebral column.Examination demonstrates a single focus of marrow signal replacement with enhancement in the posterior left body of T10 vertebrae highly suggestive of a small focus of metastatic lesion. This finding is best appreciated on sagittal T1, sagittal T1 post enhanced on image 14.No convincing evidence of any additional foci of bone marrow signal change or enhancement. Signal intensity and caliber of thoracic cord remains within normal and without abnormal enhancement. There is a large cluster of enhancing pathologic lymph nodes in the mediastinum measuring 27 x 44 x 63 mm.Pre- and post enhanced lumbar MRI:Examination demonstrates normal anatomical alignment of the vertebral column and without intravenous fracture.There is diffuse uniform marrow signal replacement and enhancement of the vertebral body of L2 with involvement of bilateral pedicles and articulating facets consistent with metastatic lesion. Diffuse patchy foci of marrow signal replacement and enhancement is also noted involving vertebral body of L3 as well consistent with metastatic lesion. Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without detectable abnormal enhancement.There are in addition multiple foci of marrow signal changes with enhancement involving the bilateral iliac wings consistent with metastatic lesions. The largest lesion on the left measures approximately at 19 x 11 mm in transaxial dimensions. The visualized lesions demonstrate no evidence of extraosseous spread of tumor.No appreciable degenerative changes of lumbar spine and no evidence of spinal stenosis or neural foraminal compromise.

Output: 1.Pre- and post enhanced brain MRI demonstrate multiple supra and infratentorial metastatic lesions as detailed/measured above. The largest lesion epicentered in the right posterior frontal cingulate gyrus and measuring at 32 x 46 x 32 mm.2.Pre- and post enhanced MRI of cervical spine demonstrate no evidence of metastases. No evidence of spinal stenosis or neural foraminal compromise.3.Pre and post enhanced MRI of thoracic spine demonstrate a single small metastatic lesion in the posterior vertebral body of T10 and unremarkable exam otherwise.4.Pre and post enhanced MRI of the lumbosacral spine demonstrate diffuse metastatic disease involving vertebral body and the posterior elements of L2 and to a lesser degree of L3 as detailed. Multiple osseous metastatic lesions of bilateral iliac wings are also noted. Unremarkable exam otherwise and without evidence of leptomeningeal enhancement, spinal stenosis or neural foraminal compromise.5.Incidental note is made of a large cluster of enhancing nodes in the mediastinum measuring at 27 x 44 x 63 mm as detailed.


Instruction: Generate impression based on findings.

Input: Left-sided thyroid nodule RIGHT LOBE MEASUREMENTS: 2.9 x 1.9 x 0.9 cmLEFT LOBE MEASUREMENTS: 6.8 x 4 x 2.9 cmISTHMUS MEASUREMENTS: 8mmRIGHT LOBE: Multiple small subcentimeter nodules largest measuring 9 x 6 by 8mm. echodensity of the right lobe is again heterogeneous.LEFT LOBE: Dominant nodule in the left lobe measures 4.2 x 3 cm, not significantly changed from previous study. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple thyroid nodules. Dominant solid nodule in the left thyroid lobe is unchanged compared to previous study.


Instruction: Generate impression based on findings.

Input: Female 64 years old Reason: r/o nodules. r/o worrisome characteristics History: h/o thyroid nodules. had radiation to neck when she was young RIGHT LOBE MEASUREMENTS: 4.8 x 1.5 x 2.2 cmLEFT LOBE MEASUREMENTS: 3.5 x 0.9 x 1.3 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Both lobes of the thyroid are very heterogeneous and demonstrate increased vascularity. There is a solid-appearing nodule in the right lobe towards the upper pole measuring 1.1 x 1 cm. Multiple punctate bright spots likely representing colitis are noted throughout the thyroid including this nodule. There is another peripherally calcified 4 mm in diameter nodule at the inferior aspect of the right lobe.LEFT LOBE: Left lobe is also very heterogeneous. Solid-appearing nodule containing multiple punctate bright spots likely representing colloid. This nodule measures 0.9 x 0.6 cm in the left mid thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous thyroid with increased vascularity. This may be secondary to recent history of radiation versus thyroiditis. Clinical correlation is recommended. Small solid-appearing nodules in both lobes of the thyroid.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer. Need adequate staging. Signs and symptoms: None Enhanced head CT: 100 cc of Omnipaque 350 is administered for this exam.Examination demonstrates a small extra-axial enhancing mass along the inner table of the skull in the left frontal region measuring 10 mm in length and 5.4-mm in thickness. This finding is best appreciated on axial image 20 of series 4 and coronal reformatted image 61 on series 80328. There is no associated mass effect on the parenchyma by this lesion and there is no detectable edema of brain parenchyma. There is also no evidence of any associated bony changes with this finding. This finding is believed to represent a meningioma. Recommend follow-up with an MRI exam to entirely exclude a very remote possibility of metastatic lesion.There is no detectable parenchymal enhancement or enhancement of the leptomeninges to suggest metastatic disease. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact. Limited view of paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable. Limited images through the orbits are unremarkable.

Output: 1.Small extra-axial dural based enhancing mass measuring 10 times 5.4-mm in height suspect for a small meningioma. To entirely exclude the remote possibility of metastatic disease recommend a follow with an enhanced MRI examination.2.Negative enhanced CT of brain and calvarium otherwise.


Instruction: Generate impression based on findings.

Input: Post brain ablation for seizures: 3 month post op There are postoperative findings related to laser ablation of an exophytic hypothalamic hamartoma, which is unchanged in size, measuring up to 25 mm in width for example. There is concentric enhancement at the ablation site in the left lateral aspect of the lesion. The optic apparatus demonstrates normal signal characteristics. There is a non-enhancing T2 hyperintense focus in the region of the right anterior frontal lobe subcortical white matter that measures up to 12 mm, which has gradually increased in size, although there is no significant interval change. There is no evidence of acute cerebral infarction or hemorrhage. The ventricles are unchanged in size. There are findings related to prior frontal craniotomy and transcallosal surgery. There are small retained secretions within the left sphenoid and ethmoid sinuses.

Output: 1. Postoperative findings related to MRI guided laser ablation of a hypothalamic hamartoma, which is unchanged in size. 2. A nonspecific lesion in the region of the right frontal lobe that measures up to 12 mm has gradually increased in size. This may represent a hamartoma or low-grade neoplasm.


Instruction: Generate impression based on findings.

Input: 68 years Male (DOB:2/14/1948)Reason: assess for structural abnormalities History: upper extremity weakness, poor grip strengthPROVIDER/ATTENDING NAME: DAVID M LIEBOVITZ DAVID M LIEBOVITZ Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. Patchy foci of signal hyperintensity within the spinal cord at the C3-4 and C6-7 levels predominantly involving the cord more centrally. This is partly obscured by patient motion. There is mild reversal of the normal cervical curvature.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is right-sided facet hypertrophy of moderate degree at this levelAt C3-4 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes present at this level which are worse on the left versus the right side. There is some ossification of the posterior longitudinal ligament at this level as well there is encroachment of left-sided exiting nerve root effacement of spinal fluid ventral but not posterior to the spinal cord at this level. Overall there is mild spinal stenosis at this level.At C4-5 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present bilaterally at this level associated with encroachment of left-sided exiting nerve rootsAt C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present this level with narrowing and mild encroachment of left-sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present this level with narrowing and mild encroachment of left-sided exiting nerve roots. Overall there is mild spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.The cervical spine exam is degraded by patient motion.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a disc bulge present at this level associated with ligamentum flavum hypertrophy. There is a effacement of spinal fluid surrounding the nerve roots within the thecal sac at this level. There is effacement of the fat at the lateral recess bilaterally at this level. Overall there is moderate spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the cervical spine with encroachment of left-sided exiting nerve roots at C3-4 and C4-5 and to a lesser degree at C5-6. There is mild spinal stenosis present at C3-4 and C6-7.2.There is some cord signal abnormalities suspected (the exam is degraded by patient motion) at the C34 and C6-7 levels which probably represents some degree of myelomalacia possibly representing spondylitic myelopathy. It is nonspecific. Please correlate with patient's clinical symptoms. Please note the cervical spine exam is degraded by patient motion which will obscure evaluation of more subtle abnormalities.3.There is moderate spinal stenosis present at C4-5 as a result of degenerative changes.


Instruction: Generate impression based on findings.

Input: Clinical question: 71-year-old female with stage IV non-small cell lung cancer and known brain metastases. Restaging CT. Signs and symptoms: Same Enhanced head CT:No contrast was given for this study. This examination was performed after an enhanced CT of chest abdomen and pelvis.Examination again demonstrates an enhancing high convexity left anterior parietal metastatic lesion measuring 12.8 x 13.2-mm in size. This is associated with extensive surrounding vasogenic edema and effacement of adjacent cortical sulci. Very subtle mass effect on the left lateral ventricle is also present. There is approximately 3 mm midline shift to the right. Precise comparison to prior exam is not possible due to severely degraded images on prior MRI exam secondary to motion. Within this limitation however there is suggestion of possible minimal reduction in the size of tumor. Compared to prior nonenhanced head CT the degree of vasogenic edema on overall mass effect remains similar.There is no evidence of any additional foci of parenchymal or leptomeningeal enhancement to suggest additional metastatic lesions. Calvarium is also intact.There is a focus of vascular enhancement at the level of the supraclinoid right internal carotid artery suggestive of atherosclerotic aneurysmal dilatation or an aneurysm of the supraclinoid right internal carotid. This finding was noted on prior MRI exam. This finding measures approximately 9.6 x 6.6-mm in size. Recommend further follow-up with a CTA or MRA of intracranial circulation.Multiple attempts to contact with the referring clinical physician failed. Findings were relayed to Dr. Rhee Charles (pager 2869) via paging system at time of review of the exam.

Output: 1.Revisualization of a left parietal metastatic focus with extensive surrounding edema. The overall surrounding vasogenic edema and mass effect remain similar to prior study. There may be slight interval decrease in the measurement of tumor.2.Either atherosclerotic aneurysmal dilatation or a berry aneurysm of the proximal right supraclinoid internal carotid artery.


Instruction: Generate impression based on findings.

Input: Reason: is there a UCL tear or other injury? History: swelling and pain, especially medially The anterior bundle of the ulnar collateral ligament, particularly its proximal fibers, are not visible, suggesting a full thickness tear. The proximal fibers of the lateral collateral ligament as well as the lateral ulnar collateral ligament are thickened and of increased signal intensity suggesting a sprain.Although the brachialis tendon and myotendinous junction appear intact, there is a large fluid-filled defect of the medial half of the distal brachialis muscle, indicating a high grade tear. Furthermore, there appears to be a complete tear of the pronator teres muscle 3-4 cm anterior to its origin from the medial epicondyle, with an intervening fluid collection that is continuous with the fluid-filled brachialis defect. There is edema within the torn proximal and distal fibers of the pronator teres. We suspect that there is also a full thickness tear through the adjacent flexor carpi radialis muscle. Furthermore, we see no discrete low signal intensity common flexor tendon arising from the medial epicondyle, suggesting a tear of this structure as well. There is mild edema within the palmaris longus and flexor digitorum superficialis muscles. The flexor digitorum profundus and flexor carpi ulnaris appear intact. The biceps muscle and tendon appear normal as do the triceps muscle and tendon. There is subcutaneous edema medially. There is edema along the myotendinous junction of the anconeus, suggesting a strain. There is mild increased signal intensity within the common extensor tendon, suggesting a strain injury with adjacent edema. The median nerve is visible coursing through the aforementioned fluid-filled intramuscular gaps, and appears intact. The ulnar nerve likewise appears intact. The radial nerve appears intact. There is edema within the radial head, concentrated laterally, with focal poor definition of the cortex that may represent a nondisplaced fracture, but this is equivocal. There is a joint effusion/hemarthrosis which appears to communicate anteriorly with the aforementioned intramuscular gap.

Output: 1.Full thickness tear of the anterior bundle of the ulnar collateral ligament. 2.High grade injuries to the flexor/pronator musculature and common flexor tendon as above3.Edema within the radial head suggesting a bone contusion and possibly an incomplete nondisplaced fracture. 4.Other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate bone metastasis in pelvis and femoral necks, concern for impending fracture History: bone metastasis in pelvis and femoral necks. BONE MARROW: Innumerable foci of signal abnormality throughout the pelvis and visualized femora compatible with extensive osseous metastases.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Extensive osseous metastases involving the visualized axial and appendicular skeleton, including the femoral necks, which places the patient at risk for pathologic fractures. No evidence of pathologic fracture currently.


Instruction: Generate impression based on findings.

Input: Male, 17 years old, with unilateral galactorrhea. Assess for pituitary mass. The pituitary gland is of normal size. No discrete masslike lesions are seen. A 2 mm long linear focus of hypoenhancement is evident in the midline of the gland at the junction of the anterior and posterior portions. Elsewhere, the gland demonstrates relatively homogeneous enhancement. The pituitary stalk also enhances normally and enters the gland at midline. The suprasellar cistern is patent. The visualized optic apparatus is unremarkable. Opacification of one of the right ethmoid air cells is seen.

Output: No definite sellar or suprasellar masses are identified. A linear focus of hypoenhancement at the junction of the anterior and posterior pituitary glands is favored to represent a pars intermedia cyst with microadenoma as a less likely diagnosis.


Instruction: Generate impression based on findings.

Input: Post right hemispherectomy follow up. Obstructive hydrocephalus. Optic atrophy. Re demonstration of right hemispherectomy with left parietal lobe approached ventriculostomy tube insertion status.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal small scattered susceptibility lesions on gradient echo especially on CSF spaces appear to be related to prior surgery related hemosiderin deposition.There are multiple various sized round to elliptical CSF containing areas were seen. They appear to arise form the left lateral ventricle occipital horn area and crossing over underneath of the left corpus callosum and reached to the CSF space on the right side. It is hard to discern that those CSF collection areas are connected with today's MRI, however, the MR signal intensity of the content of those areas appear to be the same and correspond to CSF.Extensive periventricular white matter high signal intensities indicate non specific, no change since prior scan. Posterior fossa structures appear to be normal.The paranasal sinuses and mastoid air cells are clear.

Output: Post right hemispherectomy status and left parietal approach ventriculostomy tube insertion.Multiple round to elliptical CSF containing areas from the left lateral ventricle to the right side CSF space, comparing to head CT scan on Jun 1 2015, no change of their number, configuration and size.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a T1 hyperintense lesion within the T4 vertebra, which likely represents a fat-containing hemangioma. The vertebral bone marrow signal is otherwise unremarkable. There is no pathologic enhancement. There is mild facet arthropathy of the lower thoracic spine. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is partially imaged left lower cervical and upper mediastinal lymphadenopathy, which encases the left common carotid artery. There is also partially imaged pretracheal lymphadenopathy. Incidentally noted is a right chest port.

Output: 1.No evidence of metastatic disease within the thoracic spine.2.Partially imaged left lower cervical and upper mediastinal lymphadenopathy encasing the left common carotid artery and pretracheal lymphadenopathy are better evaluated on CT neck soft tissue of 4/2/2015.


Instruction: Generate impression based on findings.

Input: Brain abscess. There is a heterogenously cystic lesion in the left parietal lobe that measures up to approximately 20 mm. There is extensive surrounding vasogenic edema. A previously demonstrated subcentimeter lesion in the left temporal stem is barely discernible due to the lack of intravenous contrast. There is a background of diffuse cerebral white matter T2 hyperintensity. There is unchanged marked prominence of the ventricles, particularly the third and lateral ventricles. There is no significant midline shift or herniation. Skin fiducial markers are present.

Output: 1. Preoperative planning MRI for a left parietal lobe abscess with extensive vasogenic edema. Assessment of the previously demonstrated left temporal stem lesion is otherwise limited due to the lack of intravenous contrast.2. Unchanged ventriculomegaly, which may represent a normal pressure hydrocephalus superimposed upon cerebral volume loss, 3. Unchanged nonspecific background of diffuse cerebral white matter abnormality.


Instruction: Generate impression based on findings.

Input: 59-year-old male with memory loss. History of HIV. Bilateral scattered T2/FLAIR hyperintense foci within the subcortical and periventricular white matter without restricted diffusion.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild encephalomalacia within the right posterior frontal lobe likely related to prior infarct. Overall the volume of the brain is relatively well-preserved. 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.The pituitary gland measures 13 mm in height which is above normal limits and demonstrates heterogeneous enhancement.

Output: 1. No specific findings to account for the patient's memory loss.2. Mild encephalomalacia in the right frontal lobe likely related to prior infarct. Relatively mild chronic small vessel ischemic disease is present elsewhere.3. Incidental note is made of a mildly enlarged heterogeneous pituitary gland. Further evaluation with a dedicated MRI pituitary study is suggested.


Instruction: Generate impression based on findings.

Input: Reason: rot cuff tendonitis, eval for tear History: shoulder pain Severely limited examination secondary to patient motion artifact.ROTATOR CUFF: Note is made of multiple foci of susceptibility artifact within the soft tissues along the superior lateral aspect of the shoulder likely postsurgical in etiology. There is fluid signal intensity traversing the anterior fibers of the supraspinatus indicating at least a high-grade partial thickness tear versus a full-thickness tear measuring approximately 11 mm in the AP dimension. There is no significant retraction. There is fatty infiltration along the myotendinous junction of the supraspinatus. A suture anchor is identified within the superolateral aspect of the humeral head indicating prior rotator cuff repair. There is mild fatty atrophy of the infraspinatus. The infraspinatus tendon appears intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small to moderate amount of fluid within the subacromial subdeltoid bursa. Mild to moderate osteoarthritis affects the acromioclavicular joint. Note is made of an os acromiale.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Suboptimal evaluation of the glenoid labrum secondary to the aforementioned patient motion artifact and lack of intra-articular gadolinium, however, there is heterogeneity and intermediate signal intensity within the superior labrum likely representing degeneration/degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is thickening of the intra-articular portion of the long head of the biceps indicating moderate tendinosis.ADDITIONAL

Output: Limited examination secondary to patient motion artifact with findings indicating a high-grade partial-thickness to full-thickness tear of the supraspinatus without retraction as described above. Postsurgical changes of prior rotator cuff repair. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female 51 years old with radiating left lower extremity pain x6 months, evaluate for etiology of radiculopathy Minimal rightward curvature of the lumbar spine on coronal images. Minimal retrolisthesis of L4 on L5. Vertebral body heights are preserved. Mild degenerative endplate changes with Schmorl nodes noted within the inferior endplates of L4 and T11. Scattered vertebral body hemangiomas noted. No pathological marrow abnormality noted. Minimal diffuse loss of disc height with signal desiccation most prominent at T11-12 and L4-5. The distal spinal cord and conus medullaris are unremarkable and terminate at the T12-L1 level. Incidental circumaortic left renal vein, otherwise the paravertebral soft tissues are unremarkable. T11-12: No significant central or foraminal stenosis noted on sagittal images.T12-L2: Minimal bilateral facet arthropathy without significant central or foraminal stenosis.L2-L3: Mild bilateral facet arthropathy and ligamentum flavum hypertrophy without significant central or foraminal stenosis.L3-4: Moderate bilateral facet arthropathy as well as ligamentum flavum hypertrophy without significant central or foraminal stenosis.L4-L5: Central and paracentral disc extrusion superimposed on disc bulging with partial articular encroachment, which abuts the descending L5 nerve roots. Moderate bilateral facet arthropathy and ligamentum flavum hypertrophy. Moderate right and severe left foraminal stenosis as well as moderate central stenosis.L5-S1: No significant central or foraminal stenosis.

Output: Spondylosis as described above with L4-5 central and paracentral disc extrusion, which abuts the descending L5 nerve roots bilaterally and indents the thecal sac, and causes moderate right and severe left foraminal stenosis as well as moderate central stenosis. Correlate clinically for bilateral L5 radiculopathy.


Instruction: Generate impression based on findings.

Input: Male 29 years old Reason: hx of testicular cancer, evaluate for metastatic disease History: see above ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Biliary tree is without diagnostic abnormality.SPLEEN: Spleen is normal in sizePANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. Kidneys enhance normally.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.PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: Small left pelvic lymph node measures 10 x 7 mm on image 62/series 1402BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of pelvic ascites

Output: 1.No specific evidence of metastatic disease.2.New small pelvic ascites of unclear etiology.


Instruction: Generate impression based on findings.

Input: Episodic vertigo and persistent binaural tinnitus, most likely Meniere's disease. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of vestibular nerve or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Reason: episodes of dizziness History: history of breast cancer The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Additional high-resolution images through the temporal bones raise the question of dehiscence of the superior semicircular canals. Retro-reconstrucitons of the patient's recent CT of the head, raise the question of dehiscence of the right semicircular canal. The bony separation between the right superior semicircular canal and the adjacent middle cranial fossa is incomplete.

Output: 1.No evidence for brain metastases.2.Findings raise the question of a mild dehiscence of the right superior semicircular canal versus near dehiscence of the right superior semicircular canal . Please correlate with clinical symptoms.


Instruction: Generate impression based on findings.

Input: 31-year-old female. Viral hepatitis B. Evaluate for chronic liver disease and HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver contour is smooth. Hepatomegaly measuring 19.5 cm.Features of portal hypertension: None Portal vein: Patent Hepatic veins: PatentHepatic artery: PatentNo suspicious hepatic lesions. No biliary ductal dilatation.SPLEEN: No significant abnormality noted. Spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Tiny T2 hyperintense foci in both kidneys are likely cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ventral hernia containing unobstructed small bowel.BONES, SOFT TISSUES: Diffusely decreased marrow signal intensity in the visualized skeleton, which can be seen with red marrow reconversion.OTHER: No significant abnormality noted.

Output: No suspicious hepatic mass. Hepatomegaly with smooth contour of the liver.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of left oncocytoma and a suspicious right kidney mass who presents for evaluation of the right kidney mass.. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large left upper pole T2 heterogeneous lesion with enhancement consistent with the known oncocytoma; this lesion measures 7.1 x 7.4 cm. There is an additional right lower lobe complex lesion measuring up to 2.5 cm which demonstrates contrast enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ahaustration of the transverse and descending colon is noted. BONES, SOFT TISSUES: Metastatic disease of the left sacrum and lower lumbar spine noted.OTHER: No significant abnormality noted.

Output: 1.Right lower lobe complex renal lesion measures up to 2.5 cm. Differential considerations include a cortical renal cell carcinoma versus oncocytoma. Biopsy may be considered if clinically indicated.2.Left upper lobe renal lesion consistent with patient's known oncocytoma.3.Nonspecific ahaustration of the transverse and descending colon. Diagnostic consideration includes inflammatory bowel disease.4.Metastatic disease of the left sacrum and lower lumbar spine noted.


Instruction: Generate impression based on findings.

Input: known cavernoma patient for preoperative scan for stealth. Re-demonstration of the left posterior aspect of fusiform gyrus ovoid shaped cavernous malformation, 14.6mm x 17.8mm. No change since prior exam in terms of size and configuration.There is about 4.7mm sized round high signal intensity area on the mesial and inferior aspect of the lesion could indicate internal subacute hemorrhagic focus.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No change of left posterior fusiform gyrus cavernous malformation since prior exam.


Instruction: Generate impression based on findings.

Input: 49 years Male Reason: asymmetric hearing loss, eval for acoustic neuroma History: asymmetric hearing loss, eval for acoustic neuroma Provider Name: JAYANT M PINTO JESSICA YESENSKY IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.Images of both right and left internal auditory canals images normal neural bundles with at least 4 neural bundle seen on the sagittal oblique views. There is normal appearance of the membranous labyrinth with no evidence of enlargement of the endolymphatic ducts at the level of the vestibular aqueduct bilaterally.There is a mucous retention cyst in the left maxillary sinus.

Output: MRI of the IACs are within normal limits. There is no evidence for acoustic neuroma.


Instruction: Generate impression based on findings.

Input: 58 year-old woman with history of breast cancer. Now with headache Low attenuation area identified in the left parietal area (image 20, series 514) at the level of the corona radiata is identified. An additional low density lesion is identified in the deep white matter in the posterior frontal area in the region of the precentral gyrus is seen. Given patient's history, metastases does remain a possibility and follow-up MRI is recommended.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: Two areas of low attenuation in the left parietal area and in the deep white matter of the precentral gyrus. Given the patient's clinical history the findings may represent metastatic disease. Follow up MRI with contrast is recommended as clincally indicated.


Instruction: Generate impression based on findings.

Input: Female, 17 years old, with headache postconcussion. Evaluate for hemorrhage. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable MRI evaluation of the brain.


Instruction: Generate impression based on findings.

Input: Nasal mucosal melanoma compare to outside MRI post 4 cycles of pembrolizumab . There is an apparent intermediate T2, enhancing mass in the inferior right nasal cavity, which appears to involve the right inferior turbinate. The abnormality is ill-defined and measures approximately 45 mm AP x 15 mm RL x 15 mm SI. There may be extension of abnormality into the right medial maxillary sinus and/or focal adjacent mucosal thickening. The rest of the paranasal sinuses are unremarkable. There is associated narrowing of the inferior portion of the right nasolacrimal duct, while the upper right nasolacrimal duct and sac are distended. There appears to be layering debris with in the lacrimal sac. There is also a nodule in the left lateral rectus muscle that measures up to 12 mm. There is nasopharynx and left nasal cavity are intact. The imaged intracranial structures are unremarkable.

Output: An apparent mass in the inferior right nasal cavity is compatible with recurrent nasal mucosal melanoma, with associated obstruction of the right nasolacrimal duct. A nodule in the left lateral rectus muscle that measures up to 12 mm is also compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarct. There are patchy foci of T2 hyperintensity throughout the supratentorial white matter in the subcortical and deep regions as well as a more prominent focus of T2 hyperintensity and volume loss in the right anterior temporal lobe that are unchanged compared with the 3/27/2012 exam. There are linear and punctate foci of susceptibility effect within the subarachnoid space, most prominent within the right frontal lobe, that are unchanged back to 7/19/2013 (our earliest susceptibility weighted imaging). The patchy enhancement within the right temporal lesion and the linear enhancement within the left frontal lesion is unchanged dating back to 6/22/2012 (our earliest postcontrast exam). The areas of somewhat linear enhancement within the left superior parietal lobule and the posterior left frontal lobe are less prominent and faintly visualized on today's exam. There is no elevated perfusion in the regions of signal abnormality or enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants.

Output: 1.Multiple patchy regions of signal abnormality are unchanged dating back to March 2012. The enhancement within some of these lesions is either unchanged or less prominent (although this may be technical) dating back to June 2012. The differential diagnoses include again includes inflammatory or granulomatous lesions with neoplasm felt less likely due to the long-term stability.2.Unchanged superficial siderosis of unclear etiology.


Instruction: Generate impression based on findings.

Input: 80-year-old female with HCC status post TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The post ablation zone is seen along the right hepatic dome, segment eight. No abnormal enhancement suspicious for HCC. Nodular subcentimeter foci of enhancement without definitive washout seen on the prior exam is not as well noted on the current study and is felt to reflect perfusional defects related to dysplastic changes. Further attention on subsequent studies is recommended.No new focal liver lesions. Portacaval varices.SPLEEN: No significant abnormality noted.PANCREAS: Diffuse pancreatic parenchymal atrophy with dilated main pancreatic duct with side branch ectasia, unchanged compared to prior exam. Cystic lesions in the head and body of the pancreas compatible with IPMNs, unchanged. Stones are noted within the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered porta hepatis lymph nodes are unchanged. BOWEL, MESENTERY: Large hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of local recurrence within the right hepatic dome ablation zone. 2.Nodular subcentimeter foci of enhancement without definitive washout seen on the prior exam is not as well noted on the current study and is felt to reflect perfusional defects related to dysplastic changes. Further attention on subsequent studies is recommended.3.No significant change in diffuse pancreatic parenchymal atrophy with dilated main pancreatic duct, side branch ectasia, and IPMNs as described above. Pancreatic stones are noted.


Instruction: Generate impression based on findings.

Input: Proximal weakness There is moderate symmetric patchy diffusely-distributed increased T2 signal throughout all of the visualized musculature of the thighs bilaterally, compatible with myositis. No fatty atrophy is evident.The subcutaneous fat is normal in appearance, without masses or edema. The bone marrow signal is normal. Bilateral inguinal lymphadenopathy is noted.

Output: Findings compatible with myositis, as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other disturbances of skin sensationClinical question: eval for white matter attenuation or R parietal abnormalitySigns and Symptoms: eval for causes of L facial numbness. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses 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 lesions of a mild degree are nonspecific. At this age they are most likely vascular related. .2.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with blurry vision OD, concern for tumor. Moderate patchy periventricular T2 hyperintensity is seen, and to a less degree within the basal ganglia and pons. No restricted diffusion is evident. There is no evidence of parenchymal edema or mass effect. A few scattered punctate foci of susceptibility are seen compatible with chronic microhemorrhage. No significant intracranial hemorrhage or abnormal extra-axial fluid is detected. Ventricles are normal in size and morphology. No pathologic intracranial enhancement is seen.The globes are round and symmetric. A lens prosthesis has been placed on the right. The extraocular muscles demonstrate normal morphology. The optic nerves are of normal caliber and show no significant signal abnormality or pathologic enhancement. The intraconal fat is free of inflammation. No orbital tumor is observed. The optic chiasm and optic tracts are unremarkable.

Output: 1.Moderately advanced chronic small vessel and lacunar ischemic disease. No evidence of any acute brain parenchymal abnormality is seen.2.Unremarkable evaluation of the orbits with no evidence of any orbital tumor or other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Evaluate for focal therapy. History obtained from patient's chart: Lesion identified at the bilateral medial peripheral zone of the mid gland extending to the apex on outside MRI. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.2 x 2.9 cm.Peripheral Zone: Ill-defined low ADC and T2 signal in the medial peripheral zone (series 901, image 11).Central Gland: The transition zone contains hyperplastic nodules, compatible with benign prostatic hyperplasia.Seminal Vesicles: The seminal vesicles are normal in appearance.Extracapsular Extension: No.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Ill-defined low ADC and T2 signal in the medial peripheral zone on coronal imaging, may be seen in prostatitis. No definite evidence of neoplasm on this MRI.


Instruction: Generate impression based on findings.

Input: 71-year-old female with past medical history significant for HLD, HTN, DM, and 2 prior ischemic strokes, and mixed Alzheimer's and vascular dementia who presented to the ED with right sided weakness that started suddenly on 8/30/15. Brain MRI:There is a new focal diffusion restriction along the posterior limb of the left internal capsule (the territory of the anterior choroidal artery). Along the posterior aspect of this diffusion restriction, there is a tiny focus of susceptibility effect that may represent a small associated petechial hemorrhage. Also, there is a tiny focus of new diffusion restriction and T2 hyperintensity along the posterior surface of the right cerebellar hemisphere just medial to focal volume loss related to a previous infarct. The chronic left occipital parenchymal injury (encephalomalacia) has not changed since the previous examination. Similar abnormality involving the left precentral gyrus is also unchanged. These are most compatible with chronic infarcts. A tiny remote infarct causing focal volume loss involves the superficial/posterior part of the medial right cerebellar hemisphere, just lateral to the above described acute/subacute infarct. The frontoparietal scattered and confluent T2 hyperintense foci remain also not significantly changed. These are compatible with chronic microvascular ischemia/infarcts. There is no space-occupying brain lesion. There is no midline shift. The dilatation of the ventricles and the other CSF-containing spaces reflecting volume loss is unchanged. There is no intracranial hemorrhage.There is minimal ethmoidal and sphenoidal mucosal thickening. Otherwise, the paranasal sinuses and the mastoid air cells are clear. The orbits are normal. There is a 2.6 cm homogeneously T2 hyperintense, well-circumscribed, lobulated left parapharyngeal mass which is probably arising from the deep lobe of the left parotid gland. This mass has not significantly changed since January 2015 or the more remote neck soft tissue CT scan from August 9, 2013 and favored to represent a pleomorphic adenoma.Cranial MRA:The intracranial segments of internal carotid arteries show preserved caliber and flow-related signal with only slight asymmetry (the left being smaller which is probably explained by the hypoplastic left A1 described below). The left A1 segment is small (hypoplastic) but there is a large anterior communicating artery and right A1. The anterior and middle cerebral arteries are preserved in caliber and flow-related signal. There is slight narrowing and irregularity involving the distal right vertebral artery. The left posterior cerebral artery is small which may be related to decreased demand associated with the left occipital infarct. The right posterior cerebral artery and its branches are normal.Neck MRA:The aortic arch branching pattern is conventional. The cervical common and internal carotid arteries are tortuous but show no significant loss of caliber or flow/contrast-related signal. The vertebral arteries are also preserved without significant stenosis in the neck.

Output: 1.Acute infarct involving the posterior limb of the left internal capsule involving the anterior choroidal artery territory. There is punctate focus of susceptibility effect involving the posterior aspect of the infarct which is new since prior and suspected to represent petechial hemorrhage. No frank intraparenchymal hematoma.2.Subtle focus of restricted diffusion involving the right posterior aspect of the right cerebellar hemisphere with T2 hyperintensity also suspected to represent a recent infarct. There is an adjacent area of gliosis likely related to remote ischemia. 3.Left occipital and precentral gyrus infarcts are chronic. Also, there is a moderate burden of white matter microvascular ischemia/infarcts.4.There is no significant stenoocclusive head or neck arterial disease. There is minimal narrowing involving the distal right vertebral artery.5. Probable pleomorphic adenoma involving the deep lobe of the parotid appears unchanged.Dr. Monther Qandeel has discussed the above findings with Dr. Bara Fintel on the day of the examination at 1500 hours.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with recent diplopia, dysphagia, prior diagnosis of MS recently overturned, now off MS medications. 10-15 scattered punctate foci of FLAIR hyperintensity are demonstrated within the white matter of the cerebral hemispheres. The corpus callosum, brainstem and cerebellum are preserved. No associated pathologic enhancement is seen.No evidence of edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. The ventricles are normal in size and morphology.

Output: Numerous scattered punctate foci of FLAIR hyperintensity are evident within the right matter of the cerebral hemispheres. Lesion morphology is not entirely specific and as such the differential diagnosis would include sequelae of prior demyelination, prior inflammation, migraine headache or a vasculitic process.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsions Unspecified convulsionsClinical question: Evaluate for possible new metastatic lesionSigns and Symptoms: New onset seizures, known brain mets There is redemonstration of multiple enhancing lesions in both hemispheres of the brain as well as the cerebellum most of which are associated with susceptibility effect. Compared to the prior exam from July, there has been some interval change. One in the left periventricular white matter which ring-enhancing and previously measured 21 x 13 mm axial dimensions now measures 15 x 11. One in the anterior aspect of the left frontal lobe previously measuring 23 x 15 mm now measures 25 x 18 mm. One in the left inferior parietal lobule has also increased in size and measures 10 mm axial dimensions whereas it previously measured 7 mm axial dimension. A right temporal lobe lesion currently measures 19 x 10 mm and previously measured 17 x 13 mm. One in the left cerebellar hemisphere previously measured 13 mm and now measures 19 mm. One in the right cerebellar hemisphere measures 8 mm and now measures 15 mm. Since the prior exam diffuse periventricular confluent white matter T2 and FLAIR signal hyperintensity has progressed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus and right ethmoid air cells. There are is partial opacification of the right sphenoid sinus. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: 1.Since prior examination multiple hemorrhagic brain parenchymal lesions compatible with metastases have overall increased in size and number.2.Since prior exam T2 and FLAIR signal hyperintensity involving the white matter has progressed. Most likely this white matter signal change is treatment related.


Instruction: Generate impression based on findings.

Input: History of metastatic thyroid cancer. Evaluate liver metastases. ABDOMEN:LIVER, BILIARY TRACT: Numerous gallstones within a distended gallbladder without specific evidence of acute gallbladder inflammation.Numerous hepatic metastases, some of which appear new. The reference lesion in the inferior aspect of the liver measures 2.0 x 1.8 cm on DWI imaging (series 5/131), compared to 1.7 x 1.4 cm previously. Some of the lesions demonstrate significant interval increase in size such as a peripheral lesion in the posterior segment of the right hepatic lobe (series 5/126). It measures 3.4 x 2.4 cm compared to 2.0 x 1.1 cm previously.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cysts and too small to characterize T2-weighted hyperintensities.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Probable osseous hemangiomata.OTHER: No significant abnormality noted.

Output: 1.Interval increase in size and number of hepatic metastases.2.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 61-year-old female with frozen shoulder. ROTATOR CUFF: Diffuse thickening and intermediate signal along the length of the supraspinatus tendon with undersurface fraying is suggestive of an intrasubstance tear along the fibers of the supraspinatus tendon. This appears to extend into the anterior fibers of the infraspinatus tendon as well. The muscle bodies of the infraspinatus and supraspinatus appear unremarkable. The muscle and tendon of the subscapularis are within normal limits.SUPRASPINATUS OUTLET: Mild to moderate degenerative changes affect the acromioclavicular joint. There is no significant fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Fluid signal undercuts the anterior/superior labrum, suggestive of a partial labral detachment. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Intrasubstance tear of the supraspinatus tendon and anterior fibers of the infraspinatus tendon.2.Partial detachment of the anterior/superior glenoid labrum.3.Mild to moderate arthritic degeneration of the glenohumeral and acromioclavicular joints.


Instruction: Generate impression based on findings.

Input: 25 years, Female, evaluate for posterior circulation stroke. Dizziness and giddiness. Sickle cell disease. Brain parenchyma appears within normal limits. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No parenchymal signal abnormality. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is diffuse T1 marrow signal hypointensity and mild calvarial thickening compatible with known sickle cell disease.

Output: 1. Brain parenchyma appears within normal limits. No evidence of acute infarct.2. Mild diffuse thickening of the calvarium with T1 marrow hypointensity which is compatible with known sickle cell disease.


Instruction: Generate impression based on findings.

Input: Knee pain and tenderness without improvement with conservative management. MENISCI: Intermediate signal within the posterior horn of the medial meniscus is compatible with mucoid degeneration without discrete tears. The lateral meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits without evidence of fracture. There is generalized thinning of the patellofemoral cartilage. The articular cartilage is otherwise intact.LIGAMENTS: There is discontinuity of the fibers of the anterior cruciate ligament compatible with complete tear. The posterior cruciate ligament is intact. The collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanisms is intact.ADDITIONAL

Output: Complete tear of the anterior cruciate ligament, favor chronic injury given lack of associated bone contusions or joint effusion. Additional findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Ostroff is a 44-year-old female with a strong family history of breast cancer, including mother, maternal aunt, maternal cousin, and paternal grandmother. She has a personal history of benign right breast biopsy and bilateral breast reduction. There is scattered fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Multiple circumscribed homogeneously enhancing foci are identified in both breasts, but these lesions are stable over several prior studies and do not demonstrate suspicious morphology or kinetics. No suspicious enhancement is seen in either breast. Signal artifact from biopsy clip is redemonstrated in the right upper outer breast, at the site of benign MR guided biopsy. No abnormal lymph nodes are identified in either axillary region.T2 hyperintense focus in the left hepatic lobe, compatible with a benign cyst.

Output: Multiple stable benign enhancing foci in both breasts. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 29 year-old male with left-sided weakness, evaluate for CVA.. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: fatigue, ataxia, and visual changes. There are numerous, greater than 10, foci of supratentorial and infratentorial white matter T2 hyperintensity, many of which display corresponding T1 hypointensity, which appear unchanged in extent, accounting for differences in technique. There is no evidence of corresponding abnormal enhancement. 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.

Output: No significant interval change in the extent of the demyelinating lesions and no evidence of active inflammation.


Instruction: Generate impression based on findings.

Input: Mild ventriculomegaly on antenatal screening ultrasound. The occipital horns and atria of the lateral ventricles are prominent. Axially, the atria measure up to 10 mm in width on both sides, which is the upper limit of normal. The remainder of the lateral ventricles are normal in size. Also, the third and fourth ventricles are not dilated. The corpus callosum is appropriately formed. Sulcation is appropriate for age. There is no focal parenchymal signal abnormality. The brainstem and cerebellum are normally formed.

Output: The atria and occipital horns of the lateral ventricles are top normal or mildly enlarged. No additional abnormalities are seen.


Instruction: Generate impression based on findings.

Input: Female, 39 years old. Reason: assess bleed R ICH-- going straight to OR History: altered mental status There is an acute right temporal lobe hematoma measuring 4.6 x 3.5 cm with surrounding vasogenic edema and associated 10 mm of leftward midline shift. Small amount of subarachnoid hemorrhage is also present. There is no evidence of hydrocephalus.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Acute right temporal lobe hematoma with associated vasogenic edema and midline shift.


Instruction: Generate impression based on findings.

Input: 53-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 3.8 x 4.8 x 3.8 cm.Peripheral Zone: There is a T2 hypointense lesion with corresponding restricted diffusion in the apex of the left peripheral zone measuring 6 x 7 mm. (Series 501, image 78)There is a 4 x 3 mm T2 hypointense focus with corresponding restricted diffusion in the right mid gland peripheral zone (series 1001, image 18).A prostatic utricle cyst is noted in the midline measuring 7 x 7 x 12 mm.Central Gland: In the region of the anterior fibromuscular stroma is asymmetric enlargement with mild increased signal on DWI and patchy early arterial enhancement suspicious for an anterior tumor. There is a prominent venous plexus just anterior to this region.Moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: The left mid gland peripheral zone lesion described above abuts but does not extend through the capsule.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focus suspicious for an anterior prostate tumor as described above.2.Left peripheral zone apex lesion suspicious for malignancy.3.Right mid gland peripheral zone lesion suspicious for malignancy.