Instruction: Generate impression based on findings.

Input: There is a 3.9 x 3.8 cm partially solid and cystic enhancing mass within the right frontal lobe with marked surrounding vasogenic edema and mass-effect with compression of the right lateral ventricle and 9-mm leftward subfalcine herniation. There are three additional similar appearing but smaller masses with surrounding edema: a 1.1 x 1.8 cm mass within the right periatrial white matter, a 1.5 x 1.7 cm mass within the inferior left frontal lobe, and a 0.8 x 0.7 cm within the right cerebellar folia.

Output: Four intracranial metastases, the largest of which is within the right frontal lobe and results in marked mass-effect and 9-mm leftward subfalcine herniation.


Instruction: Generate impression based on findings.

Input: Exam is limited due to lack of contrast.The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology with the conus terminating at L1. The paravertebral soft tissues are unremarkable.L1-L2: Unremarkable.L2-L3: Unremarkable.L3-L4: Unchanged mild disc desiccation and minimal disc bulge with a small posterior probable annular fissure without spinal canal or neural foramen stenosis.L4-L5: There are postoperative findings related to prior laminectomy and discectomy. There is disc desiccation and disc bulge with a moderate superimposed central/left paracentral contiguous material that is mildly decreased in size compared with the prior exam. There is also moderate bilateral facet arthropathy and left sided ligamentum flavum thickening that has progressed since the prior exam. These findings result in moderate spinal canal stenosis that is nonetheless improved compared with the prior exam as well as mild bilateral neural foramen narrowing. There remains bunching of the cauda equina nerve roots.L5-S1: Mild disc desiccation but otherwise unremarkable.

Output: Disc bulge at L4-L5 with a superimposed prominence of tissue along the central/left paracentral location, which could represent residual or recurrent disk versus granulation tissue, as exam is limited due to lack of contrast in this postoperative patient. That in combination with facet arthropathy results in moderate residual spinal canal stenosis that is nonetheless improved compared with the prior exam. A contrast exam is suggested to distinguish between these entities.


Instruction: Generate impression based on findings.

Input: Biopsy proven pineocytoma WHO I status post repeated endoscopic stereotactic 3rd ventriculostomy for obstructivehydrocephalus. There are postoperative findings related to right transfrontal endoscopic third ventriculostomy and biopsy of a pineal tumor. There has been interval clearance of hemorrhage from the central defect in the remaining portion of the pineal tumor, which is otherwise unchanged in size, measuring up to approximately 25 mm. However, there is increased dilatation of the third and lateral ventricles, as well as the confluent periventricular white matter T2 hyperintensity, which is compatible with transependymal cerebrospinal fluid flow. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Interval evolution of postoperative findings without significant interval change in the size of the residual pineocytoma, but increased triventricular hydrocephalus associated with transependymal cerebrospinal fluid flow, which may indicate third ventriculostomy failure.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:9/1/1959)Reason: History of Brain mets please compare. 3 large ones treated with SRS History: NonePROVIDER/ATTENDING NAME: STEVEN J. CHMURA STEVEN J. CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam the left cerebellar lesion has decreased in size from 6 x 4 mm to 4 x 2.5 mm axial dimensions. A right middle cerebellar peduncle lesion measuring 2 mm is unchanged. The lesion adjacent to the dura of the left tentorial leaf adjacent to the left cerebellar hemisphere currently measures 9 x 5 mm and previously measured 11 x 7 mm the lesion in the right temporal lobe posteriorly measures 4 mm on the current exam and located along the collateral sulcus. It previously measured the same lesion adjacent to the dura broad-based the dura is present which previously measured 5 x 5 mm and now measures 7 x 9 mm axial dimensions. The lesion along the medial aspect of the right parietal lobe currently measures 6 x 6 mm and previously measured 6 x 6 mm. An extra-axial left middle frontal gyrus lesion is not readily identified on the current exam.There is redemonstration of a prior ventriculostomy tract through the right frontal lobeWithin the scalp soft tissues is redemonstration of a 32 x 6 mm subgaleal lipoma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple brain lesions scattered in both hemispheres as well as the posterior fossa some which are intraparenchymal and some which are extra-axial which are compatible with metastatic disease. There is a mixed response to treatment with some lesions being smaller on the current exam and others being larger as detailed above, however, overall there appears to be a overall decrease in the amount of metastatic volume.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. They're stable since the prior exam.


Instruction: Generate impression based on findings.

Input: Presents with bowel obstruction status post lysis of adhesions. Intraoperative findings concerning for Crohn's disease. Negative colonoscopy. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The stomach is significantly distended as is the small bowel to the level of the distal ileum which is distended with air with a collapsed long-segment of terminal ileum. There is a marked caliber discrepancy between the proximal and distal small bowel. These findings are compatible with a small bowel obstruction appearing similar to the prior CT. The terminal ileum slightly distends on post-contrast imaging, speaking against a long-segment stricture. The ileocecal junction is well seen (series 5 image 18). There is no significant thickening, abnormal T2-weighted signal intensity, restricted diffusion or postcontrast enhancement of the small bowel wall. No adjacent inflammatory changes.There is no evidence of a flow-limiting stricture.No evidence of sinus tract or fistula formation. No free fluid or loculated fluid collection.The colon is essentially decompressed without evidence of active inflammation or flow limiting stricture.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings of a small bowel obstruction with a transition point in the distal ileum without specific evidence of active inflammation or fibrostenotic disease, favoring underlying adhesive disease. No specific evidence of bowel compromise/ischemia. The appearance is similar to the prior CT.


Instruction: Generate impression based on findings.

Input: Clinical question: 60 year-old female with metastatic NSCLC. Signs and symptoms: Disease progression in bone, restaging. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates normal anatomical morphology as well as signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Post enhanced images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges to suggest metastatic disease.Calvarium and soft tissues of the scalp demonstrate normal signal intensity and without detectable abnormal enhancement.Negative images through the orbits and including axial fat sat post enhanced series.Normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities. Mild mucosal thickening of left maxillary sinus however is noted.

Output: 1.Negative pre-and post enhanced brain MRI.2.Mild left maxillary sinus disease.


Instruction: Generate impression based on findings.

Input: Reason: follow up s/p uterine artery embolization History: uterine fibroids and menorrhagia PELVIS:UTERUS, ADNEXA: Uterus is slightly decreased in size measuring 12.2 x 10.6 x 10.3 cm, previously 14.7 x 12.1 x 10.6 cm.Multiple intramural and subserosal fibroids have decreased in size since the prior exam with decreased enhancement status post uterine artery embolization.. A large fundal fibroid measures 7.0 x 5.7 cm (905/392), previously 8.0 x 7.6 cm. A subserosal fibroid adjacent to the cervix which was previously moderately enhancing has decreased in size measuring 7.1 x 5.6 cm (905/312), previously 6.6 x 8.3 cm. The anterior portion of this lesion is no longer enhancing on postcontrast images.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: Small amount of free fluid in the pelvis.

Output: Expected response status post uterine artery embolization with a decrease in size and enhancement of multiple fibroids.


Instruction: Generate impression based on findings.

Input: 55-year-old male with left-sided weakness There is no evidence of acute intracranial hemorrhage or midline shift. There has been continued evolution of the previously seen subacute stroke in the distribution of the right MCA with more prominent encephalomalacia (involving the right frontal, parietal and temporal lobes) and associated ex vacuo dilatation of the right lateral ventricle. A second previously noted focus of encephalomalacia in the right occipital lobe is also again seen appearing similar to the prior MRI of the brain from 3/2011. Additional patchy areas of hypodensity are seen in the periventricular and subcortical white matter likely represent small vessel ischemic disease of indeterminant age. A hyperdense proximal right MCA is again noted which may represent intraluminal clot, grossly unchanged.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. A left ethmoid sinus benign osteoma is again noted.

Output: 1. No acute intracranial hemorrhage. CT is insensitive for the early diagnosis of acute nonhemorrhagic CVA.2. Continued evolution of an old right MCA CVA.


Instruction: Generate impression based on findings.

Input: 25-year-old female with abdominal pain ABDOMEN:LUNG BASES: Linear atelectasis at lung bases. Trace left-sided pleural effusion.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Percutaneous cystostomy catheter. Bladder wall is thickened likely secondary to cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Fat stranding around the anus and in the subcutaneous tissues of the left gluteal region are unchanged. Again, pelvic MRI may be helpful for further evaluation if clinically indicated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Trace bilateral pleural effusion. Fat stranding in the pelvis, not significantly changed from previous study.Percutaneous cystostomy catheter.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There are several foci of FLAIR/T2 signal abnormality with diffusion restriction in the pre-and postcentral gyri on the left as well as the precentral gyrus on the right. Additionally, regions of diffusion restriction in the globus pallidi bilaterally. Some of these foci including the globus pallidi bilaterally demonstrates contrast enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position and there is no evidence of midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mild to moderate mucosal thickening of the maxillary sinuses bilaterally.MRI CERVICAL SPINE:Alignment is anatomic. Vertebral body heights are well-maintained. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position.

Output: 1.Left pre-and postcentral gyri, right precentral gyrus, and bilateral globus pallidi lesions which demonstrate diffusion restriction as well as enhancement. Differential considerations include toxic/metabolic versus hypoxic/ischemic injury.2.No abnormalities within the cervical spinal cord as clinically questioned.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other convulsionsClinical question: h/o epilepsy s/p ablation; preop planning for additional ablationSigns and Symptoms: preop planning There are small foci of enhancement and susceptibility effect present along the medial aspect of the right temporal lobe at the hippocampus and amygdala which are stable when compared to the prior exam from July.The patient is status post burr hole placement at the left occipital bone as well as right parietal bone just lateral to the lambdoid suture in the long the right squamous temporal bone.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The examination is stable when compared to the previous exam from July. Exam was performed for stereotactic guidance.


Instruction: Generate impression based on findings.

Input: 69-year-old female with history of persistently elevated lipase, endoscopic ultrasound concerning for cystic lesion in the pancreatic tail. ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense simple and minimally complex cysts are scattered throughout the liver. The largest is in the inferior right lobe of the liver measuring 6.9 x 5.7 cm (series 501, image 18).SPLEEN: No significant abnormality noted.PANCREAS: There is a cystic focus in the body/tail the pancreas measuring 0.9 x 0.5 cm with possible communication with the main pancreatic duct. The main pancreatic duct is normal in caliber. There is restricted diffusion of the pancreatic tail distal to the cystic focus.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Probable hemangioma in the L4 vertebral body.OTHER: No significant abnormality noted.

Output: 1.Cystic focus in the body/tail of the pancreas without abnormal enhancement with questionable communication with the pain pancreatic duct. Findings are nonspecific at this size and the differential includes side branch type IPMN, small mucinous neoplasm, or small nonfunctioning islet cell neoplasm. A follow-up endoscopic ultrasound and/or MRCP may be considered in 6-12 months as clinically warranted.


Instruction: Generate impression based on findings.

Input: Male 56 years old Reason: Right knee pain, medial and anterior evaluate for meniscus tear, chondral injury History: Right knee pain MENISCI: There is a thin longitudinal, vertically orientated tear through the peripheral fibers of the posterior horn of the medial meniscus near its root. This was not clearly evident on prior study. It is present on at least two consecutive sagittal images. There is intrasubstance degeneration within the body of the medial meniscus. There is also mucoid degeneration resulting in a globular collection of intermediate signal within the anterior horn of the medial meniscus at its root which is new from prior study.Also seen is maceration of the anterior horn of the lateral meniscus with degeneration and extrusion of the body of the lateral meniscus that appears similar to prior. There is a new complex tear consisting of a complete longitudinal component involving the posterior horn of the lateral meniscus seen on several consecutive sagittal images.ARTICULAR CARTILAGE AND BONE: There is full thickness cartilage loss along the lateral tibial plateau anteriorly with underlying subchondral type edema and cysts which appear similar to prior study. There is also full-thickness cartilage loss along the lateral femoral condyle which appears similar to prior study. There is near full thickness to full-thickness degeneration along the far medial rim of the medial femoral condyle, similar to prior study. There are also subchondral cysts in the anterior aspect of the medial tibial plateau with degeneration of the overlying cartilage which appears to have progressed slightly compared to prior study. Relatively mild degeneration affects the cartilage of the patellofemoral joint which is similar to prior study. Tricompartmental osteophytes are noted.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament appear unremarkable. There is thickening of the lateral capsular ligament, unchanged in appearance compared to prior study.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Severe degenerative arthritic changes of the right knee with new tears of the posterior horn of the medial meniscus and posterior horn of the lateral meniscus and other findings as described above.


Instruction: Generate impression based on findings.

Input: HCC, cirrhosis. Assess response to TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: The more recent ablation cavity in the right inferior hepatic lobe measures approximately 2.8 x 2.1 cm (series 12, image 65) and appears similar to that seen on the prior study. The initial ablation cavity is redemonstrated in the right lobe and unchanged, measuring approximately 2.1 x 1.1 cm (series 12, image 52).Peripheral and superior to the initial ablation cavity in segment 5, there is a new ill-defined area of abnormally increased T2 and DWI signal, the largest component of which measures approximately 2.3 x 1.7 cm (series 3, image 19). This lesion is incompletely evaluated, as the postcontrast arterial phase images are suboptimally timed, however suggestion of hypointense signal on delayed phase images is suspicious for hepatocellular carcinoma. There is an adjacent associated branching hypoenhancing tubular structure (best seen on 3 minute delay sequences, series 13, image 57), which may represent expanded and invaded portal vein branches.Gallbladder sludge layers dependently. Gallbladder is hydropic morphology, which may related to fasting state, as there is no pericholecystic fluid or gallbladder wall thickening to suggest acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable ablation cavities.2.New segment 5 hyperintense T2/DWI ill-defined lesion, suboptimally evaluated due to timing of arterial phase postcontrast images. Imaging characteristics are suspicious for hepatocellular carcinoma and possible portal vein branch invasion.3.The patient will be called back for repeat arterial phase sequence.


Instruction: Generate impression based on findings.

Input: Infection skin. Check subcutaneous tissues and bones Extensive atherosclerotic changes with mild stranding of the subcutaneous soft tissues more pronounced proximally. No discrete soft tissue abnormality or evidence to suggest mass or fluid collection and appearance suggest mild cellulitis. The osseous structures are also grossly intact without overt findings to suggest osteomyelitis, however mild periosteal reaction cannot entirely be excluded along the distal fibula. If specific site of concern was identified this would increase sensitivity and serial imaging may be indicated. Specifically three-phase bone scan or possibly MRI if suspicion remains high.Moderate to more pronounced tricompartmental osteophytic changes of the knee are observed incompletely. Specifically a small loose body in the anterior aspect cannot be excluded. Consider dedicated plain film imaging.

Output: Nonspecific changes without overt findings to suggest osteomyelitis. Please see detail and recommendations provided


Instruction: Generate impression based on findings.

Input: Reason: Hx of metastatic colon cancer with lower back pain and bilateral hip pain History: lower back pain and bilateral hip pain There is extensive subcutaneous edema which shows little, if any, enhancement following gadolinium administration. This edema extends distally into both proximal thighs off of the field of view of this study. There is nonenhancing fluid signal intensity between the ischia and gluteus maximus musculature, bilaterally, likely reflecting confluent edema. There is also nonspecific edema of the adductor musculature of the hips and to a lesser degree the gluteal musculature, but we see no discrete rim-enhancing fluid collection to suggest abscess formation in the pelvis or proximal thighs. We see no focal bone marrow lesions. There does appear to be enhancement of the residual red marrow within the pelvis and proximal femora. There is metallic susceptibility artifact along the periphery of the rectosigmoid colon that has the appearance of suture material. Posterior to the suture line is an irregularly marginated enhancing nodular mass which demonstrates intermediate signal intensity on T1 and T2-weighted images, measuring approximately 2.5 cm in its greatest diameter, which could represent neoplasm. There is a Foley catheter within the bladder. There is free fluid within the pelvis which appears increased when compared to the prior CT examination.Although the psoas musculature is not completely imaged, there is edema and enlargement of the right psoas musculature with what appears to be a central area of nonenhancement that associated with peripheral rim enhancement, best seen on the sagittal postcontrast T1-weighted images. We cannot exclude the possibility of a psoas abscess or hematoma. Again seen is thrombus within the left common iliac vein extending into the IVC. There is a small fat-containing right inguinal hernia.There is no evidence of synovitis of the hips or sacroiliac joints. Moderate degenerative disc disease affects the level of L2/L3. Mild degenerative disc disease affects the level of L3/L4. There is susceptibility artifact within the subcutaneous tissues of the lower back which may represent suture material.

Output: 1. Extensive subcutaneous edema and additional nonspecific edema of the adductor musculature of the hips and to a lesser degree the gluteal musculature. Additionally, the right psoas muscle appears enlarged with heterogeneous signal intensity and enhancement that extends off of the field of view of this study. We cannot exclude the possibility of a psoas abscess or hematoma. This could be further evaluated with a contrast-enhanced CT examination of the abdomen and pelvis if clinically warranted.2. Enhancing mass posterior to the rectosigmoid colon at the site of surgical suture material may represent neoplasm.3. Interval increase in free fluid within the pelvis. Other findings as described above. These findings and recommendation were discussed with Dr. Ganjoo by phone at 1:00 PM on 6/15/2016.


Instruction: Generate impression based on findings.

Input: 52-year-old presents for breast cancer screening. Strong family history of breast cancer. Moderate parenchymal enhancement is noted bilaterally. There is a heterogeneous amount of fibroglandular tissue. No abnormal enhancement is seen in either breast. A similar degree of enhancement is again seen in both breasts, including the far posterior inferior right breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: eval for CVA , mets History: acute mental status change There is a focal area of restricted diffusion on the right side of the midbrain without evidence of focal hemorrhage indicating acute ischemic infarct.Scattered bilateral T2/flair high signal intensity lesions on periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Focal acute ischemic infarction on the right side of midbrain without evidence of hemorrhagic conversion.2. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Male 52 years old Reason: biliary stricture/ History: elevated bilirubin, cirrhosis ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates cirrhotic morphology. Patent hepatic vasculature. Multiple abdominal wall, splenic and gastroesophageal varices are noted. There is recanalization of the umbilical vein. There is a focal narrowing of the common hepatic duct which measures approximately 3mm in length. Although there is no biliary dilatation above this level the appearance is suspicious for a focal stricture. The liver demonstrates signal dropout on in phase imaging suggestive of iron deposition. Cholelithiasis.SPLEEN: Splenomegaly measuring 14.2 cm. PANCREAS: The pancreas demonstrates signal dropout on in phase imaging suggestive of iron deposition.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse abdominopelvic ascites. There is mild diffuse bowel wall thickening which is nonspecific in the setting of cirrhosis.BONES, SOFT TISSUES: Gynecomastia.

Output: 1.Focal narrowing of the common hepatic duct. Although there is no biliary dilatation above this level the appearance is suspicious for a focal stricture. 2.Cirrhotic liver morphology with splenomegaly, multiple upper abdominal collateral vessels and diffuse abdominopelvic ascites.3.Iron deposition within the liver and pancreas suggestive of iron deposition disease, pattern of involvement suggestive of primary hemachromatosis.


Instruction: Generate impression based on findings.

Input: 62-year-old male with mildly elevated creatinine of 1.6. Evaluate for renal abnormalities. This examination is limited by absence of oral and intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal pelvic calcifications are nonobstructive. Bilateral renal cysts. In the left midpole region dorsally there is a 1.4-cm partially exophytic solid lesion. This may be more fully evaluated with dedicated contrast enhanced CT or MRI examination. The lesion is best seen at axial image 36 of series 3 adjacent to a large benign simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes in the lower lumbar spine and pelvis.OTHER: No significant abnormality noted

Output: No acute abnormality to explain the elevation in creatinine. Suspicious left midpole lesion may be an occult renal mass, so contrast enhanced dedicated kidney MRI or CT exam is recommended for further evaluation.


Instruction: Generate impression based on findings.

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

Output: Successful fluoroscopically guided injection of gadolinium into the right hip joint for MRI arthrogram as well as intraarticular injection of Lidocaine and Kenalog.


Instruction: Generate impression based on findings.

Input: Left adnexal cyst. Further characterization recommended. PELVIS:UTERUS, ADNEXA: Patient is status post hysterectomy and salpingectomy. Within the left adnexa, there are 2 connected cystic lesions that have peripheral T1 hyperintensity, T2 hypointensity indicative of hemorrhagic content. The cysts have a thin wall and measure 2.1 x 1.4 cm and 1.7 x 1.4 cm (series 1201, image 77). There are no enhancing soft tissue components, thus we favor hemorrhagic cysts/endometriomas.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: Small volume of free fluid is identified within the pelvis.

Output: 1.Two lesions within the left adnexa, most likely representing hemorrhagic cysts/endometriomas.


Instruction: Generate impression based on findings.

Input: There are post-surgical changes related to a right parieto-occipital craniotomy for prior tumor resection with minimal enhancement along the resection cavity margin. There is interval enlargement of an enhancing mass in the right occipital lobe lateral and inferior to the postoperative cavity, which currently measures 21 x 25 mm, previously 12 x 12 mm.There is associated mild restricted diffusion and increased relative cerebral blood volume on perfusion imaging. There is interval increase in the degree of abnormal T2 signal surrounding the resection cavity. A few scattered foci of T2 hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. There is no new enhancing mass or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. A small lipoma is again partially visualized in the left posterior neck soft tissues.

Output: 1. Compared to 2/12/2015, there is enlargement of the right lateral occipital enhancing mass inferolateral to the resection cavity highly suspicious for tumor progression. There is also mild interval increase in surrounding FLAIR hyperintensity.2. Right medial occipital resection cavity demonstrates mild areas of peripheral enhancement along its margin similar to prior, which may represent treatment related change.


Instruction: Generate impression based on findings.

Input: 62 years, Male, new left arm weakness with hyperreflexia. There are multiple scattered punctate foci of restricted diffusion involving the bilateral cerebral hemispheres consistent with acute infarcts. Some of these are located near the gray-white junction in the right frontal lobe as well as several involving the deep white matter. Single punctate focus within the right globus pallidus is also seen. There are multiple foci of susceptibility in the brain consistent with chronic microhemorrhages. There are relatively larger foci of susceptibility involving the right basal ganglia and left thalamus. Few foci in a peripheral distribution are noted in the paramedian parietal distribution with greater distribution of these foci involving the pons, bilateral cerebellar hemispheres, and basal ganglia; distribution most compatible with chronic hypertension. There is confluent T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter with more focal lacunar infarcts noted in the basal ganglia and left temporal periventricular white matter.There is no evidence of intracranial mass or mass effect or abnormal enhancement to suggest metastatic disease. There is global parenchymal volume loss which is prominent for age. No hydrocephalus. No extra-axial collections. There is mild opacification of the paranasal sinuses. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: 1. Multiple scattered punctate foci of restricted diffusion in the bilateral cerebral hemispheres consistent with acute infarcts.2. Advanced chronic small vessel ischemic disease with multiple chronic lacunar infarcts. Multiple foci of chronic microhemorrhage are also seen with distribution favoring a chronic hypertensive etiology.3. No findings to suggest intracranial metastatic disease.Dr. Ali discussed findings with Dr. Kim (MICU) at 1340 hours on 8/4/2015


Instruction: Generate impression based on findings.

Input: Check for rotator cuff tear. Pain ROTATOR CUFF: Mild tenderness thickening and increased signal within the subacromial supraspinatus towards the attachment with undersurface fraying yet without discrete specific findings of associated intrasubstance or transversing tear. The remaining rotator cuff appears intact and otherwise unremarkableSUPRASPINATUS OUTLET: Small underlying acromial focus is suggested, plain films would be helpful for confirmation. Mild degenerative changes otherwise scattered and observed including small subchondral cyst in the humeral headGLENOHUMERAL JOINT AND GLENOID LABRUM: Labrum is grossly intact within this limited nonaugmented examBICEPS TENDON: Minimal increased signal is also observed in the horizontal component, however the biceps tendon otherwise is well positioned. Mild additional tendinopathy cannot be excluded ADDITIONAL

Output: Moderate supraspinatus tendinopathy with questionable associated or minimal changes of the biceps tendon


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is a small right posterior communicating artery. There is a small left P1 segment with predominantly fetal origin of the left PCA. There is dominant right vertebral artery. The vertebral arteries and basilar arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. No significant stenosis of the intracranial arterial circulation. No evidence of aneurysm. 2. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Reason: f/u of ADEM vs NMO spectrum, p/w L sided numbness, R abducens palsy, HA History: f/u of ADEM vs NMO spectrum, p/w L sided numbness, R abducens palsy, HA. Brain: There has been marked interval decrease in the extent of signal abnormality within the brainstem, with a residual subcentimeter focus of high T2 signal in the right paramedial posterior pontomedullary junction. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There are unchanged mildly low-lying and pointed cerebellar tonsils. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There are persistent subcentimeter foci of high T2 signal in the spinal cord at the level of C3 on the right and C6 on the left. There is no evidence of abnormal enhancement within 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 no significant spinal canal or neural foramen stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Interval decrease in size of the demyelinating or inflammatory lesion within the brainstem and persistent lesions within the cervical spinal cord. 2. Unchanged mildly low-lying and pointed cerebellar tonsils, which may represent Chiari I malformation.


Instruction: Generate impression based on findings.

Input: PTLD outside the CNS. There is an unchanged patchy area of T2 hyperintensity in the periventricular white matter adjacent to the left frontal horn, which measures up to 10 mm. There is also milder T2 hyperintensity diffusely in the periventricular white matter diffusely. Otherwise, there is no evidence of acute infarct or mass. There are a few subcentimeter foci of susceptibility effect in the bilateral cerebral hemispheres. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The bone marrow of the skull appears to be unchanged.

Output: 1. Unchanged nonspecific patchy area of T2 hyperintensity in the periventricular white matter adjacent to the left frontal horn. Otherwise, no convincing evidence of CNS PTLD, although assessment is limited due to the lack of intravenous contrast.2. A few subcentimeter foci of susceptibility effect in the bilateral cerebral hemispheres are nonspecific, but may represent chronic microhemorrhages.


Instruction: Generate impression based on findings.

Input: 12 years Male (DOB:7/28/2004)Reason: rule out CVA History: h/o sickle cell disease with altered mental status prior to intubation for acute chestPROVIDER/ATTENDING NAME: DIANA LILY MITCHELL CATHERINE A. HUMIKOWSKI MRI of the brainThere are multiple foci of signal loss and susceptibility weighted imaging in the corpus callosum as well as subcortical white matter which were not evident on the prior exam. The largest one appears to be in the left parietal lobe subcortical white matter where it is also visible on routine imaging. Additional moderate-sized bones associated with the FLAIR signal hyperintensity are present in the subcortical white matter of the frontal and parietal lobes as well as the temporal lobes and occipital lobes.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 mucosal thickening which was also present on the prior exam. The visualized portions of the mastoid air cells are opacified which is new since the prior exam. The visualized portions of the orbits are intact.The cerebellar tonsils remain approximate 5 mm below the level of foramen magnum and are unchanged since the prior exam.The nasopharyngeal tonsils appear thickened. Although nasopharyngeal thickening was present on prior exam there some new or mucosal thickening underneath the right nasopharyngeal tonsil which is not completely included on this exam. There is diffuse marrow replacement which is not unusual sickle cell and was also present on the prior examMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Although the distal internal vasculature appears somewhat attenuated this is nonspecific finding there is no convincing specific vessel occlusion or stenosis appreciated.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are identified. The left posterior communicating artery is medium-sized whereas the right posterior communicating artery is very small The vertebral arteries are similar in size.

Output: 1.There are numerous microhemorrhages scattered throughout subcortical white matter and the corpus callosum. Most of these are only seen on susceptibility weighted imaging. There is evidence that some of these are subacute in nature. These were not present on the prior exam from 2014. Although the cause is uncertain possibilities may include vasculopathy of sickle cell disease or a vasculitis associated with sickle cell disease. Findings were reported to Dr Tara Calhoun at the time of this interpretation.2.No evidence for cerebrovascular occlusive disease. 3.No evidence for intracranial aneurysm.4.There is greater no nasopharyngeal soft tissue thickening on the current exam versus the prior exam, however, this is not completely evaluated on this exam.5.Opacification of the mastoid air cells. This could be a result of retained secretions from nasopharyngeal soft tissue thickening or dilatation sinus.


Instruction: Generate impression based on findings.

Input: Reason: ?rotator cuff tear. prior normal MRI, but persistent perceived weakness. left shoulder pain and perceived weakness History: left shoulder pain and weakness ROTATOR CUFF: The muscles and tendons of the supraspinatus, infraspinatus, subscapularis and teres minor are normal in appearance. There is no evidence of rotator cuff tear.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. Incidental note is made of varicosities in the spinoglenoid notch. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small fluid-filled defect in the posterior glenoid labrum compatible with a partial thickness tear. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Partial-thickness tear of the posterior glenoid labrum.2.Low signal and thickening of the axillary pouch consistent with a frozen shoulder.


Instruction: Generate impression based on findings.

Input: 14-month-old female with newly diagnosed neuroblastoma. Neck CT:Due to the lack of body fat, the lesions seen on prior MRI study are more difficult to delineate on this CT study. Again noted are masses in bilateral neck, primarily at level 2 of the internal jugular chain, consistent with lymphadenopathy. There is also a mass measuring 16 x 12 mm in the right lower neck, probably in the carotid space at the level of the thyroid. These findings are compatible with history of neuroblastoma.The osseous structures and limited view of the upper lungs appear unremarkable.There is nonspecific opacification of the paranasal sinuses, left middle ear and mastoid air cells.

Output: 1. Right neck mass, and bilateral adenopathy, compatible with history of neuroblastoma. The findings are similar to recent MRI study, and are actually better visualized on the prior MRI due to the lack of body fat.2. Nonspecific paranasal sinus, left middle ear and mastoid air cells inflammatory changes.


Instruction: Generate impression based on findings.

Input: 33 years Male (DOB:10/22/1982)Reason: S/P resection of brain lesion, hemingioblastomas of the brain and spine, yearly follow up History: 6 month follow upPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI brain:There is redemonstration of multiple enhancing nodules scattered in the posterior fossa and to a lesser degree supratentorial brain. One located in the vermis associated with a cystic component has an enhancing component which measures 9 x 10 mm sagittal dimensions on the current exam than on prior exam the enhancing spine measured 11 x 10 mm. Another along the inferior aspect of the vermis currently measures 7 x 4 mm sagittal dimensions and previously measured 7 x 4 mm sagittal dimensions. One centered at the colossal sulcus currently measures 7 x 6 mm sagittal dimensions and previously measured 7 x 6 mm. Additional smaller nodules are scattered throughout the posterior fossa. There is associated FLAIR signal hyperintensity surrounding many of these lesions which was also present on the previous exam and has not changed substantially. Cystic components likewise are also stable.Patient status post posterior fossa surgery.A ventriculostomy tract course of the right frontal lobe to the right lateral ventricle.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical spinal cord is a distorted in the C3 vertebral body level inferiorly. There is abnormal signal centered in the right hemicord extending from the C3 vertebral body level down to the upper thoracic spine level. There is a heterogeneous lesion within the spinal cord centered at the T1 but extending from C7 down to T2. It measures approximately 41 x 8 mm sagittal dimensions and 11 x 8 mm axial dimensions. On the exam from 5/31/2015 and measured 8 x 11 mm axial dimensions and 41 x 8 mm sagittal dimensions. There are small associated enhancing foci located at the periphery of the spinal cord which are unchanged. One of these enhancing foci is at the C7 vertebral level at the right posterior lateral aspect of the spinal cord and measures 4 x 4 x 8 mm. Another is at the T1 level also on the right posterior lateral aspect of the spinal cord and measures 7 x 4 x 4 mm. A third enhancing focus is present along the left hemicord posterior laterally and measures approximately 3 mm.The cervical vertebral bodies are appropriate in overall alignment. There is reversal of the normal cervical curvature centered at C6 where there is a compression fracture. The patient is status post laminectomies at C4, C5 and C6. The patient appears to be status post right hemicord surgery in the lower cervical spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Since the prior exam the patient's multiple posterior fossa lesions and corpus callosum lesion have remained stable. This cyst in the mural nodule appearance of a couple of these lesions suggest that these are most likely related to hemangioblastomas in the setting of von Hippel-Lindau disease.2.There is a spinal cord lesion centered at the cervicothoracic junction which appears stable compared to previous exam.3.There is a mild C6 compression fracture present with reversal of the cervical curvature.4.Patient status post cervical spine surgery.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: chronic low back pain with daily pain History: as above For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. There is focal annular fissure at the level of L45 with diffuse bulging of disc which abuts thecal sac. The L45 disc shows disc dessication.Other lumbar intervertebral discs are normal.

Output: Focal annulus fissure with diffuse bulging of disc, L45 with disc dessication.Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with esophageal cancer, status post chemotherapy, evaluate for disease to status and compared with prior. Signs and symptoms: Pericardial cancer. Pre-and post-enhanced brain MRI:Examination demonstrate interval improvement in postoperative enhancement in the left frontal lobe since prior exam. There is however no significant change of the surrounding flair hyperintensity in the pattern of vasogenic edema demonstrate no significant change.There is revisualization of right inferior frontal, right anterior temporal and superior left cerebellar and right inferior cerebellar enhancing metastatic lesions without definitive evidence of interval change since prior exam in their size and pattern of enhancement.Residual surrounding flair hyperintensity of these lesions also remain nearly identical to prior exam.There is periventricular and subcortical flair hyperintensity of bilateral cerebral hemisphere likely representing treatment/radiation changes.There is no evidence of new metastatic lesions.

Output: 1.Revisualization of multiple supra-and infratentorial metastatic lesions without convincing evidence of change in their size, pattern of enhancement or their surrounding or hyperintensity.2.Slight interval decrease in postsurgical enhancement at the surgical site in the left frontal lobe.3.No detectable pneumatized and lesions.4.Stable white matter flair hyperintensity suggestive of treatment-related changes.


Instruction: Generate impression based on findings.

Input: Reason: RCT? History: pain ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is a full-thickness tear of the anterior supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 1.5 cm in the AP dimension. There is also delamination of the articular surface fibers with minimal retraction. There is thickening and intermediate signal intensity within the infraspinatus indicating mild tendinosis. The infraspinatus muscle and tendon appear intact. The subscapularis muscle and tendon appear intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a moderate amount of fluid within the subacromial subdeltoid bursa which may reflect a bursitis. Moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is branching signal in the superior glenoid labrum indicating a tear. Similarly there is heterogeneity and increased signal intensity within the anterior and inferior glenoid labrum likely representing degeneration/degenerative tearing.There are small inferomedial humeral head osteophytes.BICEPS TENDON: The tendon of the long head of the biceps appears intact with thickening and increased signal indicating tendinosis. There is circumferential fluid within the tendon sheath of the long head of the biceps which may reflect a mild tenosynovitis versus fluid extension from the joint. ADDITIONAL

Output: Full-thickness tear of the supraspinatus with delamination as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical shunt: Primary CNS lymphoma, status post therapy. Signs and symptoms: Restaging, please compare to last MRI. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate a stable extensive posttreatment changes of the left frontal lobe with regions of encephalomalacia and mild expansion of left frontal horn similar to prior exam. Mild thickening changes of right anterior frontal lobe is also noted which as well remains stable since prior MRI exam from 11 -- 3 -- 14. On the post enhanced images there is no detectable abnormal enhancement to suggest residual and or corners of tumor. This is a similar observation as prior study and without change.Slight prominence of cortical sulci similar to prior exam is again noted. Ventricular system remain slightly prominent and with maintained midline similar to prior study.Multiple a small patchy foci of flair hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres remain fairly similar to prior exam and considering patient's stated age likely representing chronic small vessel ischemic strokes. Possibility of some overlapping posttreatment changes cannot be entirely excluded.Calvarium demonstrate post op changes and unremarkable otherwise.Unremarkable images through the orbits in including axial fat sat post enhanced series.

Output: Stable post treatment changes of bilateral frontal lobes (left greater than right) and without evidence of residual or corners of disease.


Instruction: Generate impression based on findings.

Input: 34-year-old male with epigastric pain, loose stool, history of pancreatitis. Pancreas secretin protocol to rule out ductal abnormalities, pseudocyst, parenchymal changes compatible with chronic pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: The T2 hypointense appearance of the hepatic parenchyma with paradoxical increased signal intensity on the out-of-phase sequence is compatible with iron deposition. No intra or extrahepatic biliary ductal dilatation. Scattered subcentimeter T2 hyperintensities are too small to characterize, favor cystic.SPLEEN: Splenic parenchyma with paradoxical increased signal intensity on the out-of-phase sequences compatible with iron deposition.PANCREAS: Normal parenchymal enhancement. No pancreatic ductal dilatation. No surrounding fluid collections. Appropriate secretin response. No pancreatic ductal anomaly.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. The subcentimeter T2 hyperintensities of the right kidney are too small to characterize, favor cystic. Symmetric contrast uptake and excretion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence for sequelae of chronic pancreatitis. No pancreatic ductal dilatation or pancreatic ductal anomaly. Appropriate response to secretin.2.Iron deposition involving the liver and spleen. Findings were discussed with Dr. Gelrud via telephone on 11/2/2016 at 14:39.


Instruction: Generate impression based on findings.

Input: MRI Brain: There are unchanged post-treatment and post-biopsy findings with encephalomalacia and hemosiderin staining in the right cerebellar hemisphere. Areas of high T2 signal, most notably in the right periventricular parietal white matter, are unchanged. There are also unchanged foci of susceptibility effect in the left anterior cingulate gyrus and right globus pallidus. There is no evidence of acute 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 skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the right maxillary sinus.MR Spectroscopy: Spectroscopy was performed at multiple TEs of the dominant right periventricular parietal lesion as well as normal contralateral white matter. The spectroscopic patterns obtained from the lesion and from the contralateral normal tissue demonstrate minimal difference, if at all.

Output: Sequelae of treated lymphoma of the right cerebellar hemisphere and left cingulate gyrus, which appear stable. Areas of signal abnormality in the right parietal periventricular region are stable as well with no evidence of new lesions. Spectroscopic assessment of one of the right parietal periventricular lesions demonstrates no evidence of any aggressive or actively proliferative process.


Instruction: Generate impression based on findings.

Input: 3-year-old with history of tethered cord repair and syrinx. Follow-up exam. There are postoperative findings related to prior tethered cord release. The conus medullaris terminates at the L1-2 level. There is unchanged curvilinear structure in the region of the filum terminale with T1 hyperintense components, which may be related to surgery. There is slight ventral translation of the conus medullaris and cauda equina nerve roots on the prone versus supine images. There is unchanged caliber of the syringomyelia that extends from the cervical spine cranial to the highest image level and extends to the conus medullaris. The vertebral body and intravertebral disc heights are maintained. The vertebral column alignment is anatomic. There is no significant neural foraminal or spinal canal stenosis. The vertebral bone signal is unremarkable.

Output: 1. Postoperative findings related to tethered cord release with slight ventral translation of the conus and cauda equina nerve roots.2. Stable long-segment syringomyelia.


Instruction: Generate impression based on findings.

Input: 40-year-old female with intermittent diarrhea, right lower quadrant pain, and history of Crohn's ileitis. Evaluate small bowel. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As below.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus with largest fibroid measuring up to 5.5 cm. Bilateral physiologic cysts are present.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant fibrofatty proliferation and vascular engorgement. There is a long segment stricture involving the terminal ileum measuring approximately 8 cm. There is an additional long segment stricture of the distal ileum measuring approximately 9 cm; the smallest diameter involving this segment is approximately 8 mm. The segments fail to demonstrate peristalsis and demonstrate areas of mucosal enhancement.Trace free pelvic fluid, likely physiologic in etiology.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings consistent with acute on chronic Crohn's disease involving the distal ileum with long segment strictures as detailed above.2.Fibroid uterus with the largest fibroid measuring up to 5.5 cm.


Instruction: Generate impression based on findings.

Input: Postop follow-up of left visual gyrus cavernous malformation Previously seen left fusiform gyrus cavernous malformation has been operated with remaining hemosiderin deposition and local encephalomalacia.There is no other susceptibility lesion.There is no abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Postop status of the left fusiform gyrus cavernous malformation.Postop no unusual finding.


Instruction: Generate impression based on findings.

Input: 73 year old woman with history of HF with preserved EF (LVEF 49%) and persistent dyspnea with exertion referred for cardiac MRI with vasodilator stress testing. MEDICATIONS: aspirin, atorvastatin, bisoprolol, lasix, Bidil, losartan First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 142 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 59 ml (normal range 31+/-10), the LV mass index is 51 g/m2, and the LV mass is 108 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 152 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild-moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is moderate tortuosity of the descending aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (35mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral lower lobe atelectasis. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 59%) without evidence of replacement fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 54%).5. Mild-moderate aortic regurgitation. 6. Main pulmonary artery dilation. 7. Mild biatrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, status post meningioma resection in 3/2014. Yearly surveillance, on antiseizure medications. Postoperative changes related to resection of large left frontotemporal meningioma is again seen without appreciable change in appearance of the resection cavity and small areas of encephalomalacia in the left frontal and temporal lobes. Again seen is linear dural thickening and enhancement in the left middle cranial fossa abutting the greater wing sphenoid wing and extending medially to the level of the superior orbital fissure and inferiorly to the foramen rotundum. The thickening measures approximately 6 mm, previously approximately 5 mm. The left greater sphenoid wing remains expanded with minimal medial bowing of the lateral orbital wall. No mass effect on the optic nerve at the optic canal. No abnormal signal in the optic nerve or intraorbital extension of the tumor.Chronic blood products are present in the surgical bed. Elsewhere, brain parenchymal morphology is unremarkable. No new pathologic enhancement is seen. No evidence of acute ischemia or hemorrhage. Ventricles are stable and normal in size. Major vascular structures remain patent.

Output: Postoperative changes related to resection of a large left frontotemporal meningioma are again seen. Compared to 1/19/2015, there is stable to perhaps minimal interval increase in thickness of the enhancing rind of tissue in the left middle cranial fossa which abuts the left greater sphenoid wing and extends medially to the level of the superior orbital fissure. This tissue measures 6 mm in thickness, previously 5 mm, and is suspected to represent minimal residual tumor. Optic canal remains patent.


Instruction: Generate impression based on findings.

Input: 46-year-old female with elevated liver enzymes and bilirubin. Status post heart transplant. Evaluate biliary/pancreatic ducts and setting of cholestasis and transaminitis. T.Bili of 1.4, AST 37, ALT, 63, Alk Phos 500. ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 3.6 mm in diameter. Normal distention of the gallbladder without wall thickening or inflammatory changes. No suspicious parenchymal lesions on this noncontrast exam. Decreased T2 signal intensity of the hepatic parenchyma suggestive of iron deposition.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. No peripancreatic inflammation. There are 2 well-circumscribed subcentimeter T1 hyperintense foci anterior to the pancreatic tail (series 801 image 75), which could represent sequelae from prior pancreatitis versus small lymph. A small foci are unchanged compared to the 7/14/2014 PET/CT exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral punctate T2 hyperintensities are too small to characterize, favor cystic. No hydronephrosis. Trace inferior right perinephric T1 hypointense signal intensity suggestive of old hemorrhage, likely related to prior renal biopsy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific T2 hyperintense focus of the left hemisacrum is only seen on the coronal T2 sequence (series 401 image 29) and could represent an osseous hemangioma. Susceptibility artifact from lower sternotomy wires are noted.OTHER: No significant abnormality noted.

Output: 1.No intra or extrahepatic biliary ductal dilatation. No evidence for cholecystitis.2. The T2 hypointense signal intensity of the hepatic parenchyma is suggestive of iron deposition, which could be related to prior blood transfusions.3. The subcentimeter T1 hyperintense rounded foci anterior to the pancreatic tail could represent sequelae of prior pancreatitis versus lymph nodes. In retrospect, these small foci identified on the 7/14/2014 PET/CT exam.4. Evidence of old hemorrhage inferior to the right renal pole likely related to prior biopsy.


Instruction: Generate impression based on findings.

Input: Rule out lumbar lesion, given chronic back pain and RLE tingling, numbness, also with osteomyelitis of toe, rule out infectious process of 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 minimal degenerative spondylosis in the lower lumbar spine, without significant spinal canal or neural foraminal stenosis. The imaged portions of the spinal cord displays normal signal and morphology. The cauda equina nerve roots appear to be unremarkable. There is no evidence of tumors or abscesses in the lumbar spine. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of metastatic disease or osteomyelitis in the lumbar spine.2. Minimal degenerative spondylosis in the lower lumbar spine, without significant spinal canal or neural foraminal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: eval for stress fx History: shin pain sports Left tibia/fibula:There is edema type signal within the medullary cavity of the mid diaphysis of the tibia compatible with stress reaction. We see no linear focus or definable fracture line. The remaining marrow signal intensity is normal. The soft tissues are normal.Right tibia/fibula:There is mild edema within the medullary cavity of the proximal tibial diaphysis along the posterior endosteum compatible with a stress reaction. We see no discrete linear focus or definable fracture line. The bone marrow signal intensity is otherwise normal. The soft tissues appear normal.

Output: Bilateral tibial stress reactions as described above. We see no discrete fracture line at this time.


Instruction: Generate impression based on findings.

Input: 37 year old male with a history of non-ischemic cardiomyopathy following viral illness (first diagnosed in 2011) who was admitted for acute decompensated heart failure and ventricular tachycardia with shock/discharge from Life Vest. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 307 ml/m2 (normal range: 74+/-15), the LVEDV is 674 ml (normal range 142+/-34), the LV end systolic volume index is 267 ml/m2 (normal range 25+/-9), the LVESV is 586 ml (normal range 47+/-19), the LV mass index is 70 g/m2 (normal range 85+/-15), and the LV mass is 154 g (normal range 164+/-36). There is global hypokinesis with regional variation. Late gadolinium enhancement images were suboptimal due to artifacts and patient breathing. There is a mid-myocardial stripe of late gadolinium enhancement in the septum. Additionally, there appears to be a small area of late gadolinium enhancement confined to the the mid to apical inferolateral and lateral walls which is subendocardial in nature and could be suspicious for old myocardial infarction versus coronary embolic event. The overall quantity of this late gadolinium enhancement in this region is not enough to explain this patient's cardiomyopathy. In addition, there is significant artifact on late gadolinium enhancement images. T1 mapping could not be performed due to technical challenges. Two thrombi noted in the left ventricle - one at the apex and one at the mid septal wall. 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 16%, the RV end diastolic volume index is 170 ml/m2 (normal range 82+/-16), the RVEDV is 373 ml (normal range 142+/-31), the RV end systolic volume index is 144 ml/m2 (normal range 31+/-9), and the RVESV is 316 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation. There is bileaflet tethering. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is 41 mm at the sinus of Valsalva.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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsInterstitial changes noted in the lungs of unclear etiology. 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. Significant motion and breathing artifact throughout the scan that impairs diagnostic quality images. 2. The left ventricle is severely dilated with severely reduced systolic function (LVEF 13%). There is global hypokinesis with regional variation. 3. The right ventricle is severely dilated with severely reduced systolic function (RVEF 16%). 4. There is global hypokinesis with regional variation. 5. There is a mid-myocardial stripe of late gadolinium enhancement in the septum. Additionally, there appears to be a small area of late gadolinium enhancement confined to the the mid to apical inferolateral and lateral walls which is subendocardial in nature and could be suspicious for old myocardial infarction versus coronary embolic event. 5. Two thrombi noted in the left ventricle - one at the apex and one at the mid septal wall. 6. There is at least moderate mitral regurgitation. 7. Severe biatrial enlargement.8. Extracardiac findings as described above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 52 year old with coronary artery disease s/p myocardial infarction who has chronic stable angina and is referred for viability assessment. MEDICATIONS: ASA, metoprolol, atorvastatin. Left VentricleThe left ventricle is moderately dilated with mild to moderately reduced systolic function. There is hypokinesis of the basal to mid inferolateral and anterolateral walls. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 264 ml (normal range 142+/-34), the LV end systolic volume index is 76 ml/m2 (normal range 25+/-9), the LVESV is 157 ml (normal range 47+/-19), the LV mass index is 92 g/m2, and the LV mass is 191 g. The basal to mid inferior and inferolateral walls and the basal anterolateral walls has evidence of a myocardial infarction which involves approximately 50% of the wall thickness. Following the administration of dobutamine 20mcg/kg/min, the overall LV ejection fraction improves. All of the segments without evidence of myocardial infarction have evidence of increased contractility. Additionally, the infarcted basal and mid inferior walls demonstrate increased contractility during dobutamine infusion. This suggests that these segments are viable. The other segments that have a myocardial infarction in them do not improve with dobutamine and are likely not viable. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderate left ventricular dilation with mild to moderate reduction in systolic function (LVEF 41%).2. There is a large, nearly transmural myocardial infarction. There is evidence of viability in 2 of the 5 myocardial segments that are affected by the scar. Additionally, all of the segments that do not have evidence of myocardial infarction are also viable. 3. Normal RV size and systolic function (RVEF 52%).4. Moderate dilation of the left atrium.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Small posterior-disc osteophyte complex, contributing to mild right greater than left foraminal stenosis. No significant spinal canal stenosis.C4-C5: Small posterior-disc osteophyte complex, contributing to mild right greater than left foraminal stenosis. No significant spinal canal stenosis.C5-C6: No significant disc bulge, spinal canal or foraminal stenosis.C6-C7: No significant disc bulge, spinal canal or foraminal stenosis. C7-T1: No significant disc bulge, spinal canal or foraminal stenosis.

Output: Mild degenerative spondylosis of the cervical spine, with mild foraminal stenosis as described in the findings section, but no significant spinal canal stenosis or spinal cord signal abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are new postoperative findings related to transphenoidal resection of pituitary macroadenoma with intrinsic T1 shortening in the inferior aspect of the mass in the sphenoid sinus likely representing fat packing, given drop out of signal on FLAIR images, as fat saturated post-contrast images are not available. The 3-D T1 postcontrast images are not acquired inadvertently. There are minimal blood products in the mid to inferior aspect of the mass. The predominant portion of the mass still remains, with interval resection along the base and central portion of the mass. However, the overall contour and marginal extent appears unchanged at present measuring 19 x 34 mm in sagittal dimension. There is persistent mass effect on the optic chiasm, impressing upon the inferior aspect of the hypothalamus (left more than right), without significant change.There is new diffuse smooth dural enhancement which is likely postsurgical. There is no acute infarct, or midline shift. There is no suspicious intracranial enhancement elsewhere within the brain. There are scattered subcortical and periventricular white matter T2 signal abnormalities which are nonspecific, and probably represent moderate chronic microvascular ischemic changes. The ventricles and sulci are unchanged.

Output: Expected new postoperative findings related to transphenoidal pituitary macroadenoma debulking. No significant interval change in mass effect or overall marginal extent of the mass at this time.


Instruction: Generate impression based on findings.

Input: 62-year-old male with fever and tenderness. Rule out osteomyelitis. There is serpentine increased signal abnormality within the left femoral head with associated deformity and subchondral collapse consistent with patient's known history of avascular necrosis. Moderate degenerative changes affect the left hip. There is fluid within the left femoral acetabular joint with associated enhancement on postcontrast sequences indicating a synovitis likely related to the aforementioned avascular necrosis. There is diffuse subcutaneous edema about the left thigh most pronounced along the medial and lateral aspect of the thigh with associated skin thickening. There is diffuse increased signal abnormality within the musculature of the left hip and thigh. There is a 12.4 x 8.2 x 24.6 cm (TR X AP X CC) encapsulated collection with fluid signal intensity and internal septation along the anterior aspect of the femoral diaphysis which demonstrates peripheral enhancement on postcontrast sequences, suspicious for abscess formation. There is no definitive increased bone marrow signal abnormality to suggest osteomyelitis of the underlying bone. There is also nonspecific diffuse subcutaneous edema and increased signal abnormality within the musculature of the right thigh as seen on the large field-of-view images. Extensive metallic susceptibility artifact from a right total hip arthroplasty limits evaluation of the right hip. There is a small left knee joint effusion.

Output: 1. 24.6 cm encapsulated collection along the anterior aspect of the femoral diaphysis consistent with abscess formation. There is extensive subcutaneous edema and edema type signal abnormality within the musculature of the left thigh also suspicious for cellulitis/pyomyositis. No evidence of osteomyelitis. 2. Avascular necrosis of the left femoral head with associated subchondral collapse/fracture. There is a small left hip joint effusion with enhancement indicating a synovitis, likely related to the aforementioned avascular necrosis.3. Small knee joint effusion.


Instruction: Generate impression based on findings.

Input: Evaluation of the internal auditory canals is limited without contrast. Given this caveat:There are several scattered foci of T2 hyperintensity throughout the white matter, primarily in subcortical white matter locations, without associated mass effect or restricted diffusion. Incidental note is made of multiple T2 hypointensities along the dura and inner surface of the calvarium at the convexity, most likely representing hyperostosis. This has no significant associated underlying mass effect upon the brain, however is more extensive than that typically seen for a patient of 43 years.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are clear. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally.

Output: 1.There are several scattered foci of T2 hyperintensity throughout the white matter, primarily in subcortical white matter locations, without associated mass effect or restricted diffusion. These are nonspecific in appearance yet abnormal for patient age. The most likely differential diagnosis would include small vessel disease, vasculitis, less likely demyelination, or other etiologies as directed by clinical history.2.Negative, limited noncontrast MRI of the IACs.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with neck pain and a mass under the inferior border of both scapulae. Cervical:The cervical lordosis is straightened. There is a trace retrolisthesis of C5 relative to C6. Alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed below. No epidural abnormalities are suspected.Incidental note is made of opacification of the right mastoid air cells.C2-3: Left greater than right facet degeneration. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Left greater than right facet degeneration. Disc osteophyte formation asymmetric to the left. Mild generalized spinal canal stenosis without significant cord deformation. Severe left and mild right foraminal narrowing. C4-5: Bilateral facet degeneration. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation with a right paracentral focal component which mildly impinges upon the cord. There is a moderate generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. C6-7: Bilateral facet degeneration. Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Moderate right foraminal narrowing. C7-T1: Bilateral facet degeneration. No significant spinal canal or foraminal stenosis. Thoracic:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are detected.Incidental note is made of bilateral renal cysts. Please note that the scapulae are not adequately included within the field-of-view of this examination for assessment.Disc degeneration is seen in the thoracic spine primarily in the form of loss of disc height and T2 signal intensity. No significant disc bulging or disc herniations are detected.At T4-5, bulky facet and ligamentum flavum thickening is seen causing effacement of the right dorsal thecal sac but no cord impingement.At T6-7, right facet and ligamentum flavum thickening is also seen causing effacement of the right dorsal thecal sac but no cord impingement.At T7-8, bilateral facet and ligamentum flavum thickening is seen right more than left causing effacement of the dorsal thecal sac but no cord impingement.At T9-10, bilateral facet and ligamentum flavum thickening is seen causing mild effacement of the dorsal thecal sac.Lumbar:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is observed.The distal spinal cord, conus and nerve roots of cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Minimal disc bulging. No significant spinal canal or foraminal stenosis. L3-4: Mild facet degeneration. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L4-5: Moderate facet degeneration. Minimal bulging disc. No significant spinal canal or foraminal stenosis. L5-S1: Moderate facet degeneration. Mild bulging disc with a small superimposed central protrusion and right paracentral annular fissure. No significant spinal canal or foraminal stenosis.

Output: 1.Moderately advanced degenerative findings are seen in the cervical spine. At C3-4 there is a severe left foraminal narrowing. At C5-6, posterior disc-osteophyte complex formation results in a moderate generalized spinal canal stenosis and mild impingement upon the cord as well as a severe right foraminal narrowing.2.Relatively mild degenerative findings are seen in the thoracic spine predominantly affecting the facets and ligamentum flavum. No high-grade spinal canal stenosis is seen.3.Minimal degenerative disease is seen in the lumbar spine without significant spinal canal or foraminal stenosis.4.Please note that the scapulae are not adequately assessed on this examination. If evaluation of the scapulae and chest wall is desired, MRI of the chest would provide appropriate coverage.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapseClinical question: eval for CNS mets with hx of Lung Ca and prior CNS metsSigns and Symptoms: hx of lung ca, prior CNS mets, syncope There is redemonstration of a confluent periventricular and subcortical white matter T2 and FLAIR signal hyperintense. Compared to the previous exam from November this does not appear to have progressed significantly.There is redemonstration of a punctate focus of signal loss on susceptibility weighted imaging which has not changed since the prior exam.No abnormal enhancing mass lesions are appreciated intracranially to suggest brain metastases. 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 mild mucosal thickening involving the right maxillary sinus and mucous retention cysts in the left maxillary sinus as well as mucosal thickening in ethmoid air cells..Incidental note is made of partial empty sella.. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for brain metastases. 2.There is no evidence for acute cerebral ischemic infarction3.There is diffuse periventricular white matter signal change present which is most likely treatment related.


Instruction: Generate impression based on findings.

Input: 20 year old female with severe preeclampsia status post C-section 4/16/2009. Chronic hypertension. Now complaining of visual changes in left eye. There is no evidence of intracranial hemorrhage or edema. Gray white differentiation is preserved and no midline shift or herniation is present. The pituitary is prominent (series 2 image 5). This may be a physiologic finding related to the patient's postpartum state. However, given the presence of visual symptoms, the pituitary could be more accurately imaged with MRI if clinically warranted.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.The orbits are incompletely visualized.

Output: Prominent pituitary as detailed above. If clinically appropriate, this finding could be further evaluated with pituitary protocol MRI.This finding was discussed with Dr. Rosalyn Porter at 12:00 p.m. April 20, 2009.


Instruction: Generate impression based on findings.

Input: Female 26 years old with history of osteosarcoma of the right femur with pulmonary and right cerebellar mets s/p resection and CTX, evaluate tumor progression Exam is motion degraded limiting evaluation for small lesions. Again seen are posttreatment changes including right occipital craniotomy for right cerebellar lesion resection. Compared to multiple prior studies dating back to 7/8/2015, there is increase in nodular enhancement along the posterior margin of the resection cavity, which involves the craniotomy defect and measures approximately 19 mm AP x 6 mm transverse x 8 mm CC dimension. The cystic component of the resection cavity demonstrates decreased size/collapse, which is consistent with expected evolution of post-surgical changes. No new focus of parenchymal edema or new enhancing lesions are identified within the limitations of the motion degraded study. Subtle T2/FLAIR signal surrounding the resection bed suggestive of gliotic changes as well as foci of susceptibility suggestive of remote post-surgical blood products.There is no evidence of acute intracranial hemorrhage or restricted diffusion to suggest acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues demonstrate no gross abnormality.

Output: Slight increase in nodular enhancement along the posterior margin of the right cerebellar resection cavity. Given history of recent radiation, findings may represent post therapy changes or evolving postsurgical granulation tissue at the craniotomy bed. Recommend continued close attention on follow-up. No new lesions elsewhere in the brain parenchyma to definitively suggest progression.


Instruction: Generate impression based on findings.

Input: Female 2 years old Reason: 23 month old girl with history of Diamond Black-fan Anemia and transfusion related iron overload History: iron overload T2*sequences in short axis of the heart was performed to assess iron load. Recovery time was 30 ms on average on the interventricular septum and 27 ms over the free wall.

Output: 1. No evidence of cardiac iron load.


Instruction: Generate impression based on findings.

Input: Right thumb mass There is an ovoid focus of low T1/low T2 signal intensity measuring 1 cm in the longitudinal dimension within the subcutaneous fat of the thumb medial to the proximal diaphysis of the proximal phalanx. This is surrounded by additional intermediate signal intensity measuring approximately 1 cm in the transverse dimension which extends from the skin to the underlying bone and adjacent pulley. There is minimal if any enhancement of this mass and surrounding area following gadolinium administration. There is no deformity or invasion of the underlying bone. The remaining soft tissues of the thumb appear normal.

Output: Low signal intensity subcutaneous mass within the thumb with minimal if any enhancement. The signal characteristics suggest the possibility of a fibrous lesion or scarring.


Instruction: Generate impression based on findings.

Input: Reason: 70M with Gleason 9 prostate cancer s/p RARP 5/2016 and BCR History: assess for recurrent disease, PSA rose from 0.57 to 1.08 after prostatectomy. PELVIS:PROSTATE:Prostate Size: Patient is status post radical prostatectomy.Peripheral Zone: Patient is status post radical prostatectomy.Central Gland: Patient is status post radical prostatectomy.Seminal Vesicles: Patient is status post radical prostatectomy.Extracapsular Extension: Patient is status post radical prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Right internal iliac lymph node measuring 13 x 13 mm (series 1601 image 109).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mildly enlarged right internal iliac lymph node as above.2.No residual disease in the prostatic bed.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Female, 83 years old. Reason: evaluate for thyroid nodule History: hair loss, palpable nodule in left upper lobe RIGHT LOBE MEASUREMENTS: 5.6 x 2.1 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.9 x 2.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Mildly heterogeneous echotexture. A right upper pole nodule measures 0.7 x 0.4 x 0 .3 cm, well marginated, spongiform, with mild internal vascularity.LEFT LOBE: Mildly heterogeneous echotexture. A left lower pole nodule measures 0.8 x 0.7 x 0.5 cm, solid and heterogeneous, hypo-to isoechoic relative to background thyroid, with minimal internal vascularity and tiny echogenic foci which may reflect inspissated colloid.ISTHMUS: Mildly heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 2 lymph node measures 0.8 x 0.2 x 1.0 cm. A left level 2 lymph node measures 0.4 x 0.2 x 0.4 cm. A left level 3 lymph node measures 0.6 x 0.2 x 1.1 cm.OTHER: No significant abnormality noted.

Output: Bilateral subcentimeter thyroid nodules as described above.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma: MEN 1. There is no discernible pituitary tumor. The pituitary gland is not enlarged. The pituitary stalk and bright spot are intact. The imaged portions of the brain are unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: No discernible pituitary tumor.