Instruction: Generate impression based on findings.

Input: Evaluate for new intracranial metastasis. History of renal cell carcinoma. There are innumerable enhancing lesions involving the cerebrum, cerebellum and brainstem, some of which are cavitating. The largest cavitating lesion is located within the right perirolandic region and measures 12 x 10 mm (series 101, image 22). The largest non-cavitating lesion measures 7 x 5 mm, located within the right middle temporal gyrus. There is extensive vasogenic edema associated with these enhancing lesions, most confluent within the right temporal, parietal and bilateral frontal lobes. There is local mass effect, but no midline shift or herniation. There are scattered foci of microhemorrhage throughout the brain parenchyma, some associated with the metastases. No definite left meningeal enhancement is identified.There are multiple enhancing calvarial lesions, the largest within the right frontal bone measures 22 x 11 mm and extends through the outer table of the skull into the diploic space.There is no evidence of acute infarct. An empty sella is incidentally noted. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. There is mild asymmetric increased fluid distension of the distal optic nerve sheath on the right. The orbits are otherwise unremarkable.

Output: 1.Diffuse supratentorial and infratentorial enhancing lesions, compatible with significant burden of metastases, some of which are cavitating and others associated with hemorrhage. There is extensive associated vasogenic edema and local mass effect, but no midline shift or herniation.2.Multiple enhancing calvarial lesions, also compatible with metastases.


Instruction: Generate impression based on findings.

Input: Dizziness. Neck pain. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Trace amount of low attenuation are present in the periventricular and subcortical white matter. Gray-white differentiation is preserved. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis. Follow-up/compare to MRI from 2014. Signs and symptoms: Multiple sclerosis. Compared to prior exam. Nonenhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates no evidence of any new lesions although demyelinating disease since prior exam. Stable mild supratentorial findings of demyelinating disease in the periventricular and subcortical white matter of cerebral hemispheres and minimally within the posterior fossa.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise for patient of stated age.Signal void of major intracranial arterial branches are identified.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, visualized paranasal sinuses and mastoid air cells.

Output: 1.Negative diffusion weighted series.2.No convincing evidence of any new lesions since prior study.3.Mild supratentorial and very minimal infratentorial findings of chronic demyelinating disease identical to prior study.


Instruction: Generate impression based on findings.

Input: Vvisual field testing abnormal, please evaluate for possible pituitary tumor. Pituitary: There is a pituitary mass with suprasellar extension that measures up to 29 mm. There is associated mass effect upon the optic apparatus, cavernous sinuses, and hypothalamus. Although the tumor abuts and perhaps partially encases portions of the internal carotid arteries, the flow voids are intact. Brain: There are two adjacent enhancing extra-axial masses along the left superior frontal convexity that measure up to 9 mm in width and 14 mm in width. The larger lesion demonstrates associated hyperostosis of the calvarium. There is no significant mass effect upon the underlying brain parenchyma. There are minimal scattered foci of nonspecific cerebral white matter T2 hyperintensity. There is no evidence of acute infarct. There are mild scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is diffuse cerebral volume loss. There is no midline shift or herniation. There is a right scleral band and bilateral lens implants.

Output: 1. Pituitary macroadenoma measuring up to 29 mm with supersellar extension and mass effect upon the optic apparatus, cavernous sinuses, and hypothalamus. 2. Two adjacent meningiomas along left superior frontal convexity that measure up to 9 mm in width and 14 mm in width. 3. Diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Left hearing loss. The left lateral semicircular canal appears to be mildly dysplastic along with a relatively small semicircular canal bone island. Otherwise, the rest of the left inner ear structures and the right inner ear structures are unremarkable. The bilateral internal auditory canals including the vestibulocochlear nerves are unremarkable. The bilateral cerebellopontine angles are intact as well. The petrous apices and temporal bones appear unremarkable. The imaged portions of the brain are normal. There is no evidence of tumors.

Output: The left lateral semicircular canal appears to be mildly dysplastic along with a relatively small semicircular canal bone island. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Sinonasal carcinoma status post induction chemotherapy followed by bifrontal anterior fossa skull base approach with frontal bone osteotomy, craniotomy and combined intradural and extradural approach to skull base tumor invading the dura, resection of tumor with complex dural closure with pericranial graft and split bone cranioplasty, microsurgical dissection, harvesting of abdominal fat autograft and insertion of a lumbar subarachnoid drain on March 11, 2010 followed by adjuvant chemoradiation completed July 10, 2010 and multiple complications. There are post-treatment findings in the anterior cranial fossa and sinonasal regions. There is encephalomalacia in the anterior frontal lobes, right more than left. There is unchanged partially enhancing soft tissue along the left frontal osteotomy site and along the roof of the ethmoid cavity. There is otherwise diffuse mucosal thickening and secretions within the imaged sinonasal cavities. There is no evidence of intraparenchymal brain tumors or acute infarction. 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. There is medial rotation of the bilateral globes.

Output: Post-treatment findings for sinonasal carcinoma with unchanged partially enhancing soft tissue along the left frontal osteotomy site and along the roof of the ethmoid cavity, which may represent granulation tissue and inflammation versus perhaps less likely tumor.


Instruction: Generate impression based on findings.

Input: 63-year-old male with prostate cancer. Staging exam.Additional history per EMR: PSA 2.5 in 2010 , 4.13 in 2012, 6 in 2013 and 5.5 in 10/2014.PSA on March 9, 2015 was 8.4. US guided biopsy on 5/6/2015, prostatic adenocarcinoma Gleason 6 in 1 of 7 cores on the left (3 were taken from the apex) and high-grade PIN presented in cores taken from the right and left base and the right lateral apex. Maximal involvement was 70% of the positive core from the left apex. PELVIS:PROSTATE:Prostate Size: 6.4 x 3.6 cm.Peripheral Zone: Scattered areas of T1 hyperintense signal likely reflect hemorrhage or scarring from recent biopsy. Lesions in the left base and right apex demonstrate hypointense signal on T2 and ADC sequences with possible enhancement of the left base nodule. The lesion in the left base also abuts the capsule, and extracapsular invasion therefore cannot be excluded.Central Gland: Multiple well-defined nodules without suspicious features.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy is identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lesions in the left base and right apex of the peripheral zone are suspicious for prostatic carcinoma. Lesion in the left base abuts the capsule and extracapsular invasion therefore cannot be excluded.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are stable, with mild disc narrowing again noted L2-L3 and L3-L4, with progression of now diffuse disc desiccation. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L2 level. There is developmental narrowing of the lumbar spinal canal due to shortened pedicles and slight prominence of dorsal epidural fat. There is slight thickening and redundancy of cauda equina nerve roots secondary to spinal stenosis as detailed below.Sagittal images again demonstrate a minimal disc bulge with left-sided prominence at T10-T11.At T11-T12, there is a shallow left paracentral disc protrusion with mild bilateral facet arthropathy and ligamentum flavum thickening.At T12-L1, there is no significant disk pathology or stenosis.At L1-L2, there is now a mild disc bulge with bilateral facet arthropathy and ligamentum flavum thickening again seen. There is mild central spinal canal stenosis and minimal left foraminal narrowing.At L2-L3, there is a mild to moderate disc bulge with significant bilateral facet arthropathy and ligamentum flavum thickening resulting in overall mild-moderate central spinal canal stenosis and minimal bilateral foraminal narrowing.At L3-L4, there is a stable mild diffuse disc bulge with moderate bilateral facet arthropathy and ligamentum flavum thickening resulting in overall mild central spinal canal stenosis. There is mild-moderate right and mild left foraminal narrowing. There is again abutment of the exiting right greater than left L3 nerve root.At L4-L5, there is redemonstration of a mild disc bulge. There is severe bilateral facet arthropathy and ligamentum flavum thickening resulting in moderate-severe central spinal canal stenosis and mild bilateral foraminal narrowing. There is lateral recess narrowing with again impingement of the bilateral descending L5 nerve roots.At L5-S1, mild disc bulge significant bilateral facet arthropathy and ligamentum flavum thickening. There is abutment of the descending S1 nerve roots bilaterally by disc material. There is no significant stenosis.

Output: Slight interval progression of multilevel spondylotic changes within the lumbar spine with up to moderate-severe central spinal canal stenosis at L4-L5 due to disc disease as well as facet arthropathy and ligamentum flavum thickening. Impingement of descending L5 nerve roots bilaterally at this level. Underlying developmental narrowing of the lumbar spinal canal also noted.


Instruction: Generate impression based on findings.

Input: 50-year-old male with history of gallstone pancreatitis status post laparoscopic cholecystectomy in March 20, 2016. Patient now with pseudocyst with IR drainage. Evaluate pseudocyst and pancreatic ductal anatomy. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. The mid to distal common bile duct extending over a region of approximately 1.5 cm is now well opacified, likely secondary to inflammatory changes as detailed below. The proximal bile duct is dilated up to 1.0 cm; additionally, there is mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is increased T2 signal diffusely throughout the pancreas and peripancreatic tissues compatible with history of pancreatitis. Intrinsic T1 hyperintense signal is maintained throughout the pancreatic head, uncinate process, pancreatic body, and pancreatic tail.There is a complex rim-enhancing multiloculated fluid collection that insinuates the pancreas; predominantly, this fluid collection extends posteroinferiorly towards the liver. It additionally extends posteriorly towards the spleen and anterior inferiorly to the pancreas. The anterior inferior component measures 6.5 x 5.3 cm (series 1301, image 40) and the posterior component measures approximately 9.5 x 3.4 cm (series 1301, image 78). This fluid collection is best seen on the postcontrast arterial images 362; all the components are noted to be connected to each other.Suboptimal secretin images were obtained.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace bilateral pleural effusions.

Output: 1.Findings consistent with pancreatitis and complex multiloculated rim-enhancing peripancreatic fluid collection as detailed. Normal intrinsic T1 hyperintense pancreatic signal is maintained.2.Suboptimal secretion images were obtained; however, the pancreatic duct is smooth throughout with minimal smooth prominence to 3 mm in the pancreatic head without evidence of a mass/stricture.3.Narrowing of the mid common bile duct likely from extrinsic inflammatory changes resulting in mild extra and intrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Assess for cord compression. Back pain L>R with saddle anesthesias, bilateral lower extremity weakness, and incontinence Degenerative changes are seen at the craniocervical junction including small effusions involving the atlantooccipital joints which are nonspecific. The cervical vertebral bodies are appropriate in height. There is mild straightening of the cervical spine which may positional. Alignment is otherwise maintained. Bone marrow signal is benign. There is multilevel disc desiccation. Additional details regarding degenerative changes as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a disc osteophyte complex including a central disc protrusion which results in moderate to severe spinal canal stenosis with deformity of the cervical cord. There is abnormal T2 hyperintensity in the cervical cord at the C3-C4 level slightly more inferiorly. There is uncovertebral hypertrophy contributing to minimal neural foraminal narrowing bilaterally.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Small bilateral pleural effusions are partially visualized, relatively larger on the right.

Output: 1. Disc osteophyte complex at the C3-C4 level including a disc protrusion with moderate to severe spinal canal stenosis at this level. There is associated cord signal abnormality, which is favored to represent myelomalacia.2. Small bilateral pleural effusions are partially imaged.


Instruction: Generate impression based on findings.

Input: There are postsurgical findings related to transsphenoidal surgery. There is material with low signal components on T1 and T2 sequences within the sphenoid sinuses, which appears to have increased increased in size from prior examination now measuring 2.2 x 2.1 cm, previously 1.5 x 1.4 cm. There is persistent peripheral postcontrast enhancement of the sphenoid sinus related to mucosal inflammation. There is no evidence of tumor within the sella or parasellar region. There is no evidence of intracranial hemorrhage or acute infarct. There is a small right frontal lobe developmental venous anomaly. The brain parenchyma otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings related to transsphenoidal surgery without evidence of residual tumor.2. Findings suggestive of sphenoid sinus fungus ball with associated mucosal inflammation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Professional left-sided gaze, no right-sided weakness, fever, tachypnea Non-infused CT of brain.Axial 4-mm CT images of the entire head was performed.Images through posterior fossa are unremarkable.Images through supratentorial space demonstrate an area of low-attenuation in the periventricular white matter of right posterior frontal -- parietal region. This is not a specific however it may represent a small vessel stroke. Very subtle subcortical low-attenuation adjacent to the frontal horn of the right lateral ventricle may also represent a small vessel stroke finding. The age of these strokes cannot be determined on CT. if clinical concern for acute process is persist an MRI is recommended. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus is detected. Cortical sulci is unremarkable. Ventricular system and all CSF cisterns are unremarkable.

Output: Findings suspect that of small vessel disease of indeterminate age. No evidence of acute hemorrhage or cortical stroke.


Instruction: Generate impression based on findings.

Input: 76 years, Male, Reason: history urothelial cancer status post right nephroureterectomy in past, assess for recurrence History: history urothelial cancer status post right nephroureterectomy in past, assess for recurrence. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter left renal cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large left renal sinus cyst is slightly increased in size measuring 11.2 cm (6/12), previously 10.5 cm, and now causes severe hydronephrosis which is new. There is no associated ureteral dilatation, therefore the hydronephrosis is likely due to obstruction at the UPJ. Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Aneurysmal dilatation of the mid infrarenal aorta is unchanged measuring 4.0 x 3.3 cm (7/25), previously 4.0 x 3.3 cm BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of recurrent or metastatic disease given the limitations of an unenhanced exam.2.Increased size of left renal sinus cyst with new severe hydronephrosis and UPJ obstruction. Obstruction may be due to mass effect from the cyst or a crossing vessel.3.Stable infrarenal abdominal aortic aneurysm.Findings discussed with service at 3:00 p.m. on 2/18/2015.


Instruction: Generate impression based on findings.

Input: Pt with trochlear nerve palsy/recovering encephalopathy, hx of Multiple Myeloma. Please obtain CT head with special attention at skull bases, cavernous sinuses and orbits. There is no evidence of intracranial hemorrhage, mass or edema. Brain parenchyma is normal in attenuation and morphology. 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 bilateral globes, optic nerves, retro-orbital fat and extra-ocular muscles are unremarkable. MRI examination may be helpful to further evaluate patient's cranial nerve palsy, if clinically indicated.

Output: Normal brain/orbit CT.


Instruction: Generate impression based on findings.

Input: Altered mental status. Evaluate for a cerebral abscess. Status post evacuation 11/22/2016. Additional EMR indicates patient is undergoing a seizure workup. The exam is limited along the right convexity and adjacent scalp secondary to artifact from a ventriculoperitoneal shunt device. The right sided predominantly T1 hyperintense subdural collection is slightly smaller in size, measuring 16 mm in maximal thickness. The midline shift has improved from 5 mm down to 2 mm. Susceptibility and diffusion weighted images are limited in the presence of a right sided ventriculoperitoneal shunt device positioned under the scalp but there appear to be blood products within the collection. There is evidence of a right parietal burr hole and a intraparenchymal tract measuring up to 20 mm with T1 hyperintense fluid and restricted diffusion in the right parietal brain parenchyma, as well as mild surrounding enhancement. There is susceptibility abnormality in this region as well, indicating the presence blood products. There is extensive surrounding T2 hyperintensity. There is avid diffuse enhancement and thickening of the pachymeninges which also extends to the contralateral frontal region. There is a 2 mm thick subdural collection along the posterior left temporal lobe convexity. The right frontal approach ventriculostomy catheter is unchanged in position with the tip in the frontal horn of the right lateral ventricle. The right lateral ventricle has slightly less effacement compared to the prior exam. There is diffuse T2 hyperintensity in the right hippocampus. There is no evidence of territorial infarction. The major cerebral flow voids are intact. There is a left maxillary sinus mucous retention cyst.

Output: 1.Decrease in size of the subacute right cerebral convexity subdural fluid collection with improvement in the midline shift and slight improvement in the right lateral ventricular effacement. 2.Avid diffuse pachymeningeal enhancement in the right cerebral hemisphere with extension to the contralateral frontal region is nonspecific and be reactive or related to superimposed. 3.A surgical defect in the right parietal lobe with surrounding edema may represent a subacute hemorrhagic lesion perhaps with superimposed infection and associated cerebritis.4.A small left temporal convexity subdural collection may represent addition hemorrhage or perhaps an empyema.5.Edema in the right hippocampus is likely related to seizure activity.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 24-year-old female with pain over the left sacroiliac joint. Evaluate for sacroiliitis. Note is made of mild increased signal abnormality along the inferior aspect of sacroiliac joints, left greater than right, which enhances on postcontrast sequences consistent with stated history of sacroiliitis which may be related to the patient's history of inflammatory bowel disease. There is also associated decreased signal abnormality about the sacroiliac joints which appears to correspond to sclerosis seen on recent CT examinations. The visualized musculature is normal in appearance. Multiple subcentimeter follicles are identified in the left and right adnexa. There is a 1.6 cm cystic lesion in the right adnexa which is likely physiologic in a patient of this age.

Output: Findings consistent with bilateral sacroiliitis, left greater than right, which may be related to the patient's known history of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with progressive loss of right hand function. History of breast cancer. Brain:No evidence of restricted diffusion, edema, mass effect or pathologic enhancement is seen. There are numerous scattered small foci of T2 hyperintensity in the cerebral white matter. A focus of susceptibility is present in the left frontal lobe which may represent a prior hemorrhagic event. No acute hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.C-spine:The cervical lordosis is straightened. Vertebral body heights are preserved. No marrow replacement or edema is seen. Bulky ossification of the posterior longitudinal ligament (OPLL) is seen from C2-3 through C6-7. This results in severe cord impingement which is discussed more fully below. Patchy cord signal abnormality is seen at several levels. No epidural collections are present. No pathologic enhancement is seen. C2-3: OPLL superimposed on disc osteophyte formation. Minimal cord impingement. Minimal cord signal abnormality. Moderate foraminal narrowing.C3-4: OPLL with impingement of the central cord. Right sided cord signal abnormality. Moderate left and mild right foraminal narrowing. C4-5: OPLL with right paracentral focality causing severe cord impingement and marked cord signal abnormality. Mild left foraminal narrowing. Left facet arthropathy. C5-6: OPLL with central focality causing severe cord impingement and predominantly left sided cord signal abnormality. Moderate left and mild right foraminal narrowing. Left facet arthropathy. C6-7: OPLL and mild disc osteophyte formation. Mild central cord impingement. Mild left foraminal narrowing. Left facet arthropathy. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Ossification of the posterior longitudinal ligament is seen through much of the cervical spine. This results in severe cord impingement at several levels, with cord signal abnormality which may represent a combination of edema and/or myelomalacia.2.No acute intracranial abnormalities. Findings which may reflect chronic microvascular disease.


Instruction: Generate impression based on findings.

Input: 43-year-old female with disturbance of skin sensation. History of metastases to the spine. Rule out cord compression. The spinal cord has normal signal characteristics and overall morphology. There is no evidence of spinal canal narrowing. There is abnormal STIR signal within the bone marrow consistent with metastatic lesions in the T8, L2, L3, and L4 vertebral bodies which have been present from prior studies dating back to 2014. There is mild endplate depression of the T8 level, slightly progressed compared to prior study which could represent early development of a pathologic fracture. There is a slight disc bulge at the L3-4 level without significant spinal canal stenosis.There are multiple new areas of signal abnormality suspicious for metastatic disease. There is heterogeneous marrow signal in the C6, T1, T2, and T3 vertebral bodies which is suspicious for metastatic disease. There is T1 hypoattenuation with associated STIR signal abnormality in the anterior-inferior portion of the T6 and T9 vertebral bodies. There is is an expansile lesion with increase in STIR signal within the spinous process at the T7 level. There is an expansile lesion with STIR hyperintensity in the L5 pedicle. Homogeneous STIR signal abnormality is also present within the sacrum suspicious for metastatic disease. There is mild increased STIR signal in the posterior soft tissues at the level of the L2-L4 levels which likely represents dependent edema, given normal marrow signal in adjacent posterior elements.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.Multiple new multilevel lesions as above suspicious for metastatic disease and consistent with disease progression. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 56 year old male with a history of hypertension, obesity, left ventricular hypertrophy with concern for hypertrophic cardiomyopathy on echocardiography. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 82 ml/m2 (normal range: 74+/-15), the LVEDV is 213 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 65 ml (normal range 47+/-19), the LV mass index is 86 g/m2 (normal range 85+/-15), and the LV mass is 223 g (normal range 164+/-36). There is severe, asymmetric left ventricular hypertrophy. The mid-wall septum ranges from 21-24 mm and the lateral wall is 12-14 mm. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 73%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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. There is no systolic anterior motion of the anterior mitral leaflet and there is no evidence of LVOT gradient. Pulmonic ValveThe pulmonic valve is not well-visualized.Tricuspid ValveThe tricuspid valve is not well-visualized.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is not well seen.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 70%).2. The right ventricle is normal in size and systolic function. (RVEF 73%).3. There is severe, asymmetric left ventricular hypertrophy. The mid-wall septum ranges from 21-24 mm and the lateral wall is 12-14 mm. There is no outflow tract obstruction or systolic anterior motion of the mitral valve noted. 4. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 5. There is biatrial enlargement. 6. Overall the findings could be consistent with hypertrophic cardiomyopathy without obstruction. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out thoracic disk or fracture. Signs and symptoms: Mid back burning pain after fall. Non-enhanced thoracic spine MRI:There is normal anatomical alignment of vertebral column.There is normal signal intensity of bony and soft tissue structures of the thoracic spine. No evidence of fracture or disk protrusion/extrusion present.There is normal signal intensity and caliber of thoracic cord.Three no appreciable degenerative changes of thoracic spine. There is no evidence of spinal canal or neural foraminal compromise or stenosis at any level.There is no detectable perispinal soft tissue abnormalities.Lowermost visualized thoracic spine and uppermost visualized lumbar spine are unremarkable.

Output: Negative nonenhanced MRI of thoracic spine as detailed above.


Instruction: Generate impression based on findings.

Input: Abnormality of gait [781.2], Reason for Study: ^Reason: r/o stenosis History: gait difficulties Extensive confluent high signal intensity lesions on bilateral periventricular white matter on FLAIR images indicating nonspecific ischemic lesions, comparing to prior scan, the extent of those lesions have aggravated.On Gradient echo images, there are multiple bihemispheric supra and infratentorial various sized susceptibility artifacts, these lesions could represent amyloid angiopathy. Possibility of cavernous malformation or calcifications are less likely. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, 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.C-Spine:The cranial-cervical junction is normal. There is exaggerated cervical lordosis. The cervical 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. Degenerative changes were as follows:C23: within normal limitsC34: within normal limitsC45: diffuse bulging of disc, no spinal stenosis, no neural foraminal stenosis.C56: diffuse bulging of disc, no spinal stenosis, no neural foraminal stenosis.C67: within normal limits.C7T1: within normal limits.L Spine: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 demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is no evidence of cord compression or mass. Degenerative changes are as follows:T12L1: within normal limitsL12: within normal limitsL23: diffuse bulging of disc with osteophyte especially on the right side of neural foramen resulting mild neural foraminal stenosis. L34: diffuse bulging of disc with bilateral ligamentum flavum thickening results mild bilateral neural foraminal narrowing. Modic 2 endplate changes are also seen.L45: disc dessication, Modic type 2 endplate changes. Diffuse disc bulging. No neural foraminal or spinal canal stenosis.L5S1: within normal limits

Output: 1. Interval progression of confluent patchy periventricular white matter changes since prior exam performed on Jun 5 2008.2. Multifocal various sized susceptibility artifacts indicate possibility of amyloid angiopathy. Clinical correlation is indicated.3. Degenerative changes of C and L spine as described above. Multilevel various sized disc degenerations. Mild neural foraminal stenosis at the levels of L23 and L34 were seen.


Instruction: Generate impression based on findings.

Input: Left hypothalamic brain lesion. There is redemonstration of a left hypothalamic 14 x 8 mm T2 hyperintense lesion, previously measuring 14 x 10 mm. It is associated with a small nodule of enhancement measuring 3 mm, previously 4 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is diffuse mucosal thickening of the paranasal sinuses with mucous retention cysts/polyps within the left maxillary sinus.

Output: No significant change in size of the left hypothalamic T2 hyperintense lesion with stable to slightly decreased nodular focus of enhancement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for perirectal abscess or fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a perirectal fluid collection/abscess measuring 2.3 x 1.2 cm (series 4/41) adjacent to the right posterolateral rectum. There is mild mass effect onto and mild wall thickening of the adjacent rectum. This is associated with a fistulous tract extending inferiorly and towards the left where it crosses the midline (series 4 image 29 through 39) in the intersphincteric space. There is suspected communication with the 5-6:00 position/dorsal aspect of the anal canal (series 4/29).There are mild presacral inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Peri-anal fistula originating at the 5 to 6 o'clock position/left dorsal aspect of the anal canal predominantly extending within the intersphincteric space superiorly and terminating in a 2.3 cm perirectal abscess. Mild mass effect and wall thickening of the adjacent rectum. Overall the abscess and fistula tract is decreased in size and extent compared to 2010.


Instruction: Generate impression based on findings.

Input: History of cystic pancreatic lesion. Evaluate for change and/or abnormality. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with fibrotic changes compatible with cirrhosis. Loss of signal on in phase imaging is compatible with iron deposition. There is no biliary ductal dilatation. There are multiple scattered T2 hyperintense lesions, which are too small to characterize, likely cysts. The gallbladder is normal in appearance. There are subcentimeter T1 hyperintense lesions within segment 8/7 (series 12, image 17), with no evidence of washout of the larger lesion on subtraction imaging, compatible with a dysplastic nodule. The smaller lesion is too small to characterize.SPLEEN: Large splenorenal shunts are identified.PANCREAS: A T2 hyperintense cystic lesion with two mildly thickened septations within the uncinate process measures 5.0 x 3.6 cm (series 9, image 20), previously 4.6 x 3.0 cm. There is no enhancing mural nodularity. Possible tiny side branch IPMN within the pancreatic head. The main pancreatic duct is normal in caliber. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left basilar subsegmental atelectasis.

Output: 1.Increased size of uncinate cystic lesion now measuring 5 cm, with two mildly thickened septations, but no enhancement.2.Cirrhotic morphology of the liver, with dysplastic nodules, but no suspicious enhancing lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain metastases status post radiation without confirmation of diagnosis; Stealth sequence - 1 mm cuts no fiducial. Signs and symptoms: Preop planning. Pre-and post-enhanced Stealth brain MRI:The examination is severely limited secondary to fairly extensive streak artifacts from patient's halo. Previously known tumor in the right thalamus and right cerebral peduncle is only partially visualized and appears as a ring enhancing mass. It measures approximately 18 X 15 -mm in size and is only partially visualized. No convincing evidence of any additional abnormal enhancing lesions.No acute new finding since prior study.

Output: Pre-and post-enhanced surgical planning stealth head CT partially re-demonstrates a necrotic rim enhancing mass in the right thalamus/right cerebral peduncle measuring 18 x15-mm in size.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for OA History: hip pain Moderate to marked osteoarthritis of the left hip, appearing similar to prior radiograph. Soft tissue edema seen on prior MRI scan cannot be reliably assessed on current study.

Output: Moderate to marked osteoarthritis of the left hip.


Instruction: Generate impression based on findings.

Input: 75-year-old female hemiplegia, thrombocytopenic. May have had lead. Subtle area of low density in the left cerebellar hemisphere is suspected of possible nonhemorrhagic cerebellar stroke. Further evaluation with an MRI is recommended.Images through the supratentorial brain parenchyma are essentially unremarkable.

Output: 1.No evidence of acute hemorrhage.2.Suspected left cerebellar stroke. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Reason: eval liver lesion masses HCC, compare MRI 2/11/16, coronary calcification, vessel patency History: cirrhosis, HCV, HCC ABDOMEN:LIVER, BILIARY TRACT:Cirrhotic liver contour.A segment 8/4A lesion measures 13 x 7 mm, unchanged from the prior exam. This lesion has low T2 signal and does not restricted diffusion-weighted images. Arterial enhancement is not observed on the study, however there is washout and suggestion of a capsule on delayed images.2 additional segment 7/8 lesions which are hyperintense on arterial phase but not seen on additional phases are likely perfusional.Cholelithiasis and sludge without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole subcentimeter T2 hyperintensity, likely a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace right pleural effusion.

Output: 1.Segment 8/4a lesion is stable in size. 2.Additional arterial enhancing lesions are likely perfusional.3.Pancreatic divisum.


Instruction: Generate impression based on findings.

Input: Left sensory stroke, likely lacunar. There is an apparent punctate area of mildly restricted diffusion and T2 hyperintensity in the posterior right thalamocapsular junction region. Otherwise, there is mild scattered cerebral white matter T2 hyperintensity without corresponding restricted diffusion, which likely represents chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid within the right mastoid air cells.

Output: An apparent punctate area of mildly restricted diffusion and T2 hyperintensity in the posterior right thalamocapsular junction region likely represents an early subacute lacunar infarct.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are ultrasound dated 7/6/2015 and post procedure mammogram dated 7/6/2015 performed at St. Mary Medical Center. For comparison,MRI dated 7/1/2015, mammogram dated 6/26/2015, ultrasound dated 6/24/2015 and priors are available. This is a continuation of prior submitted outside studies for which interpretation was already performed (Accession number 15188354). A followup right breast ultrasound was performed based on outside interpretation of MRI.Ultrasound: A targeted right breast ultrasound was performed in the areas of questionable abnormal enhancement seen on prior MRI.1. 6:00 position 1 cm from the nipple - oval, circumscribed, hypoechoic mass measuring 7 x 3 x 4 mm.2. 5:00 position 0.5 cm from the nipple - round, hypoechoic circumscribed mass measures 3 x 4 x 6 mm.3. Right breast 7:00 position 1 cm from the nipple - subtle, indistinct, hypoechoic mass measuring 4 x 7 x 6 mm.The aforementioned lesions were targeted and biopsied with a 12 gauge biopsy gun. 3 cores were obtained from each target. Clips were then placed.Postprocedure mammogram: 3 standard views of the right breast were obtained post biopsy. 3 biopsy clips are noted in the retroareolar region.

Output: 1. Ultrasound guided right breast biopsies as above. Postprocedure mammogram demonstrates 3 retroareolar clips. Biopsy results as follows:Right breast 7:00 biopsy: Benign breast tissue with marked fibrosis and mild cystic dilatation of the ducts.Right breast 6:00 biopsy: Benign breast tissue with marked fibrosis with focal fat necrosis.Right breast 5:00 biopsy: Benign breast tissue with fibrocystic changes.These results are concordant with imaging findings. The biopsies can be submitted to University of Chicago for official interpretation if clinically warranted.2. Multifocal left breast mass with inferior extension as seen on mammogram and MRI with total extent of 29 x 15 mm. This mass has been biopsy proven to represent ILC grade 2.3. Clip not seen on post procedure mammogram. Clip placement recommended at the University of ChicagoBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: New ischemic stroke: vertigo. There is persistent high T2 signal in the right precentral gyrus and inferior frontal gyrus with new punctate foci of restricted diffusion. There is also mild gyriform susceptibility effect in the right precentral gyrus, which may represent microhemorrhages or cortical laminar necrosis. There is unchanged mild periventricular white matter T2 hyperintensity. The ventricles are unchanged in size and configuration. There is an unchanged subcentimeter arachnoid cyst in the anterior left circular sulcus. There is no midline shift or herniation. There are left ethmoid sinus secretions. The skull and scalp soft tissues are unremarkable.

Output: Late subacute to early chronic right precentral and inferior frontal gyri infarcts with superimposed punctate foci of acute infarction, but no midline shift or gross intracranial hemorrhage.Discussed with Dr. Guan at 10:10 AM on 4/6/15.


Instruction: Generate impression based on findings.

Input: Intra-articular contrast remains within the mid carpal joint. There are no findings to suggest disruption of the scapholunate or lunotriquetral ligaments based solely on fluoroscopic interrogation. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 14 seconds.

Output: Fluoroscopic guided right wrist arthrogram. Please refer to subsequent MRI arthrogram report for additional details.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: eval for acute stroke codeSigns and Symptoms: L hemiplegia L hemisensory MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR signal hyperintense lesions are present in the left lateral aspect of the pons and lower midbrain as well as the lateral aspect of the left thalamusThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.Lesions present in the left lower midbrain, left pons and left thalamus and posterior limb of the internal capsule are nonspecific but could be vascular related. Alternatively they could be related to demyelination.3.No evidence for intracranial cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.5.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Left masseter lesion. There is a skin marker overlying the left cheek. There has been increase in size of an enhancing T2 hyperintense focus within the left masseter muscle that measures approximately up to 18 mm, previously 15 mm. The lesion now has a more bulky rather than sheet-like morphology. There is no significant cervical lymphadenopathy. The left parotid gland and other salivary glands are unremarkable. The Waldeyer ring structures are unremarkable. The thyroid gland is unremarkable. The osseous structures are unremarkable. There is a right maxillary sinus retention cyst. The imaged intracranial structures and orbits are unremarkable.

Output: Interval increase in size of a left masseter lesion, which may represent a vascular malformation or tumor versus a mesenchymal neoplasm, for example.


Instruction: Generate impression based on findings.

Input: 66 year old woman with history of AL cardiac amyloid, s/p stem cell transplant, with recent increase in free light chains, referred for cardiac MRI for further evaluation of recurrent cardiac amyloid involvement. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 173 ml (normal range 109+/-23), the LV end systolic volume index is 47 ml/m2 (normal range 18+/-5), the LVESV is 99 ml (normal range 31+/-10). The interventricular septum thickness at end diastole is 12mm. There are no regional wall motion abnormalities present. Myocardial T1 times reflect underlying tissue properties, with studies describing healthy normal volunteers with times in 958 +/- 20 ms range. Cardiac amyloid increases myocardial T1 times, and a cut off of >1140ms is described for identifying patients with definite cardiac involvement and >1020ms as describing possible involvement. The interventricular septum, lateral and inferolateral myocardial T1 times are1076, 1061 and 1132 ms, indicating possible cardiac involvement.Left AtriumThe left atrium is enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 139 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no significant pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 57%.2. The interventricular septum, lateral and inferolateral myocardial T1 times are1076, 1061 and 1132 ms, indicating possible cardiac involvement.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 59-year-old male with worsening chronic right shoulder pain. ROTATOR CUFF: Note is made of a partial-thickness bursal surface tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity. There is no significant retraction. The supraspinatus muscle appears intact. The infraspinatus, subscapularis, and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Moderate degenerative changes affect the acromioclavicular joint. No fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint without evidence of effusion. Although this examination was not protocoled for evaluation of the glenoid labrum, the glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: Partial thickness tear of the supraspinatus without evidence of full-thickness rotator cuff tear. Degenerative changes and other findings as described above.


Instruction: Generate impression based on findings.

Input: Contrast rapidly opacified the radiocarpal joint. Upon flexion of the wrist, contrast also opacified the distal radioulnar joint via a tear in the articular disc of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for further information.Exposure time: One minute 33 seconds

Output: Tear of the articular disc of the triangular fibrocartilage complex


Instruction: Generate impression based on findings.

Input: Reason: eval for atfl tear History: ankle pain for months TENDONS: The anterior, medial, and lateral tendon complexes are within normal limits. The Achilles tendon appears normal.LIGAMENTS: There is a partial thickness tear of the anterior tibiofibular ligament (axial T1 image 14) with surrounding T2 hyperintensity suggestive of edema. The anterior and posterior talofibular ligaments are intact.ARTICULAR SURFACES AND BONE: T2 hyperintensity and T1 hypointensity in the distal tibial metaphysis suggests bone contusion. No osteochondral defect is identified. ADDITIONAL

Output: Partial thickness tear of the anterior tibiofibular ligament. Bone contusion in the distal tibial metaphysis. The anterior talofibular ligament is within normal limits as clinically queried.


Instruction: Generate impression based on findings.

Input: Weight loss. Adrenal mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. There are multiple small well-defined lesions T1-weighted hypointense lesions demonstrating peripheral nodular discontinuous enhancement which progresses centrally compatible with multiple cavernous hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal fossa lesion measures 2.7 x 2.1 cm (series 15/97). The lesion appears separate from the adrenal gland, pancreas, kidney and spleen. The lesion does not demonstrate loss of signal intensity on out of phase imaging to suggest a lipid rich adenoma. Lesion appears to demonstrate peripheral thick enhancement which appears to progress centrally. KIDNEYS, URETERS: Few simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The left retroperitoneal mass appears separate from the adrenal glands pancreas kidney and spleen. It demonstrates peripheral thick enhancement which progresses centrally. Differential considerations include a pheochromocytoma (correlate with urine markers), a hemangioma in a splenule (consider RBC scan) or neuroendocrine tumor of unclear origins.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post SRS for AVM. Evaluate and compare with January 2015 study. Signs and symptoms: As above. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination redemonstrates an enhancing arteriovenous malformation in the left superior frontal gyrus measuring at 13.7 x 9.2 mm in transaxial dimensions compared to prior study measurements of 18 x 11 mm. There is a draining vein arising from the superior aspect of the AVM and extending posteriorly and superiorly without appreciable interval change in its size. Prominent left anterior-superior vertebral artery is again identified representing feeding pedicle. There is mild gliosis surrounding the VM without change since prior exam. Additionally there are scattered foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres and minimally in the left basal ganglia without significant change since prior exam and likely representing chronic microvascular ischemic process.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.Nonenhanced brain MRA:Routine nonenhanced brain MRA is performed which does not include the region of arteriovenous malformation. Patient was notified and will return for repeat exam without additional charge. Visualized images demonstrate patent unremarkable bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries. This likely larger left anterior cerebral artery likely secondary to feeding patient's known arteriovenous malformation. Unremarkable bilateral vertebral arteries, PICA branches, basilar artery and its distal branches.

Output: 1.Pre- and post enhanced brain MRI demonstrate interval decreased size of an enhancing arteriovenous malformation in the left superior frontal gyrus measuring at 13.7 x 9.2 mm compared to prior study measurement of 18 x 11. No diffusion-weighted abnormalities and stable findings of mild chronic small vessel ischemic strokes.2.MRA of intracranial circulation was performed erroneously as a routine study which does not include the entire head. Patient will return for repeat exam without additional charge. Unremarkable MRA as detailed above.


Instruction: Generate impression based on findings.

Input: Persistent toe-walking, hypotonia, trouble with balance, feet turning in: headaches and lumbosacral area hemangioma. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.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 stenosis. The spinal cord displays normal signal and morphology. There is no evidence of mass lesions or abnormal enhancement in the spine. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of Chiari malformation, cerebral infarction, or intracranial tumor.2. No evidence of thoracic or lumbar spine lesions. The lumbosacral skin hemangioma is not discernible.


Instruction: Generate impression based on findings.

Input: HIV with bacterial meningitis, numerous other infections. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a faint patchy focus of T2 hyperintensity in the pons. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening in the paranasal sinuses, left greater than right, with apparent fluid and bubbly secretions. There is also fluid within the bilateral middle ears and mastoid air cells. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings suggestive of acute sinusitis and perhaps bilateral otomastoiditis, 2. Nonspecific faint patchy focus of T2 hyperintensity in the pons, which could potentially represent incipient progressive multifocal leukoencephalopathy isolated to the pons, but no evidence of intracranial abscess.REFERENCE:Rubin DI, Norris S, Flint R. Isolated pontine progressive multifocal leukoencephalopathy: unusual magnetic resonance imaging features. J Neuroimaging. 2002 Jan;12(1):63-6.


Instruction: Generate impression based on findings.

Input: Female 14 years old History: Pain in her wrists. Active golf player and violinist. RIGHT WRIST:LIGAMENTS: Ligament are intact without abnormal T2 signal or other abnormality.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: Flexor and extensor tendons are normal in appearance.BONES: There is a small wrist joint effusion with fluid surrounding the pisiform. There is a mild amount of edema within the inferior aspect of the lunate. No erosions or joint space narrowing.ADDITIONAL

Output: 1.Mild joint effusion in the right wrist without evidence of JIA.2.Normal examination of the left wrist.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of lower lobe, right bronchus or lung [C34.31] / Disseminated malignant neoplasm, unspecified [C80.0] / Dizziness and giddiness [R42], Reason for Study: ^Reason: mets lung cancer, ROS1+, on Crizotinib, c/o vertigo, concern for CNS mets. There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.There is focal encephalomalacia on the left parietal lobe inferior parietal lobule, in particular supra marginal gyrus indicating chronic ischemic infarct.Scattered minimal T2/flair high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, 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. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Chronic ischemic infarct on the left parietal lobe inferior parietal lobule.3. Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Tethered cord protocol prone and supine. There appears to be prominence or anterior translation of the posterior C1 arch, which bulges into the spinal canal. The vertebral column alignment is otherwise within normal limits. There is lumbarization of S1. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The conus medullaris is located at the L2-3 level and shifts in position between prone and supine imaging. There is no evidence of fibrofatty filum terminale. The paravertebral soft tissues are unremarkable. However, there is a colostomy.

Output: 1. Apparent prominence or anterior translation of the posterior C1 arch, which bulges into the spinal canal, which may be developmental or positional.2. No evidence of syringohydromyelia.3. The conus medullaris is located at the L2-3 level and shifts in position between prone and supine imaging. 4. No evidence of fibrofatty filum terminale.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:10/16/1964)Reason: STROKE W/UP History: L NUMBNESSPROVIDER/ATTENDING NAME: RICHARD KRAIG RICHARD KRAIG MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is mildly degraded due to patient motion.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are intact. The right posterior communicating artery is slightly larger than the left posterior communicating artery. The right posterior communicating artery is small. The anterior communicating artery also appears to be small The vertebral arteries are similar in size.There is extracranial origin of the posterior inferior cerebellar artery bilaterally.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery originates from the aortic arch.

Output: 1.There is no evidence for acute cerebral ischemic infarction.2.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.3.No intracranial mass lesion is appreciated.


Instruction: Generate impression based on findings.

Input: The pituitary gland appears small for expected age consistent with hypoplasia or atrophy. There appears to be a nodular area of tissue anterior of the sella which could represent the anterior pituitary. Posteriorly along the infundibulum, there is another small nodular area of tissue which could represent the posterior pituitary. These two areas are separated by a cleft of relatively nonenhancing tissue. Additionally, there is a thin lenticular, likely cystic focus, along the floor of the sella which appears to slightly elevate the pituitary parenchyma. This is best visualized on series 7, image 10. Otherwise, the infundibulum is intact and situated in the midline. The optic apparatus and cavernous sinuses are intact. No diffusion-weighted abnormalities are identified. The imaged intracranial structures are unremarkable. There is partial opacification of the right ethmoid air cells. The remaining visualized paranasal sinuses and mastoid air cells are clear.

Output: 1. Small pituitary gland consistent with hypoplasia or atrophy.2. Morphology of the pituitary gland is somewhat unusual, which may simply represent a sequela of hypoplasia, and is notable for a lenticular, possibly cystic focus, along the floor of the sella.3. If patient's outside exam can be made available for comparison, an addendum can be provided.


Instruction: Generate impression based on findings.

Input: There is redemonstration of an avidly enhancing mass with associated flow-voids centered in the left sphenopalatine foramen consistent with residual juvenile nasopharyngeal angiofibroma. Anteriorly, it extends minimally into the left posterior choana. The previously referenced mass is slightly decreased in size and marginal convexity, now measuring 2.2 x 2.5 cm on 1001/26, compared to previous comparable measurements of 2.8 x 2.8 cm. However, there is now a bilobed appearance with increased caudal extension along the paratracheal space, to the level just caudal to the upper left palatine tonsil which itself is minimally medially displaced. Additional prominent flow-voids are identified just caudal to the enhancing inferior lobule. This more caudal lobule of soft tissue enhancement measures 1.2 x 2.3 cm on 1001/34. The overall craniocaudal extent now measures 3.9 cm, previously 3.3 cm.There is a stable nonspecific oval T2 hyperintense focus along the floor of the left middle cranial fossa measuring approximately 6 mm of uncertain exact etiology (501/14 and 801/22). There is associated enhancement noted. However, correlating with previous CT, there is asymmetric thickening of the surrounding osseous floor of the left middle cranial fossa with ground glass appearance, and a small benign-appearing lucency with thin sclerotic margins, corresponding to the area of T2 abnormality, likely relating to an area of fibrous dysplasia. It is located just lateral to the left foramen ovale, as seen on prior CT.Visualized intracranial structures are unremarkable except for redemonstration of focal extra-axial prominence of CSF signal intensity along the medial aspect of the left middle cranial fossa consistent with an arachnoid cyst, with associated mild localized mass effect. There is mild scattered mucosal thickening in the visualized paranasal sinuses. There is prominent susceptibility likely secondary to dental amalgam. There is a small left frontal lobe developmental venous anomaly.

Output: 1. Interval slight decreased size of previously referenced and subsequently reportedly treated lobule of residual enhancing mass centered in the left sphenopalatine foramen consistent with residual JNA, although now with increased caudal extent along the left parapharyngeal space and essentially demonstrating more of a bilobed appearance, with mild localized mass effect on the left palatine tonsil. This is consistent with JNA progression.2. Stable 6 mm area of persistent T2 oval hyperintensity along the floor the left middle cranial fossa demonstrating homogeneous enhancement, which when correlating with prior CT appears to represent a small benign-appearing lucent lesion in an area of asymmetric osseous thickening and ground glass opacity, most likely relating to underlying fibrous dysplasia. Although the T2 hyperintense lesion suggests a focal cystic component of fibrous dysplasia, the enhancement suggests possibly more of a fibrocystic component which results in a differential CT appearance.


Instruction: Generate impression based on findings.

Input: 76 year old female admitted with possible CVA, DOE, elevated BNP with EF 18% on TTE of unclear etiology. Referred for cardiac MRI to rule out infiltrative disorders and RV thrombus. 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 severely dilated with severely reduced systolic function. The overall LV ejection fraction is 18%. The systolic dysfunction is global. There are no regional wall motion abnormalities present. The LVEDV is 221 ml (normal range 109+/-23), LV end diastolic volume index is 132 ml/m2 (normal range: 65+/-11), LVESV is 181 ml (normal range 31+/-10), and LV end systolic volume index is 108 ml/m2 (normal range 18+/-5). The LV mass is 166 g (normal range 114+/-24) and the LV mass index is 99 g/m2 (normal range 67+/-11). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Sigmoid septum is noted and is likely age related.The native T1 myocardial relaxation time is <1050 ms suggestive of absence of underlying diffuse fibrosis or infiltration.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 17%, the RVEDV is 228 ml (normal range 110+/-24), the RV end diastolic volume index is 166 ml/m2 (normal range 69+/-14), the RVESV is 232 ml (normal range 35+/-13), and the RV end systolic volume index is 128 ml/m2 (normal range 22+/-8). There is no right ventricle thrombus on contrast imaging.Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.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 normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsSmall left pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during induced hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is severely dilated with severely reduced systolic function. LVEF 18%. The systolic dysfunction is global. 4. The right ventricle is severely dilated with severely reduced systolic function. RVEF 17%.5. Severe biatrial dilation.6. Normal Native T1 myocardial relaxation time is <1050 ms suggestive of absence of underlying diffuse fibrosis or infiltration.7. No right ventricle thrombus on contrast imaging.


Instruction: Generate impression based on findings.

Input: Neck pain with history of cervical spinal fusion. Six views of the cervical spine demonstrate normal alignment. An anterior plate device is present with screws entering C4, C5, and C6 with associated interbody bone graft material at C4-C5 and C5-C6. There is moderate-severe loss of disc height at C5-C6. Bilateral, multilevel neuroforaminal narrowing affects the mid and lower cervical spine better assessed on prior MRI.Four views of the lumbar spine are provided. As described on 7/7/2015 MRI, please note that there are only 4 lumbar type vertebra present with accounting from C2 inferiorly. As result, the lumbosacral junction will be labeled L4-S1. There is once again grade 2 anterolisthesis of L4 on S1 with associated spondylolisthesis but without evidence of instability on the flexion and extension views. Moderate-severe degenerative disc disease affects L4-S1 with mild degenerative changes of the remaining lumbar levels. Vertebral body heights and disc spaces are otherwise preserved.

Output: 1.Please note that there are only 4 lumbar-type vertebrae present as described on 7/7/2015 lumbar spine MRI. As a result, the lumbosacral junction will be labeled as L4-S1.2.Anterior cervical fusion as described above.3.Stable appearing grade 2 anterolisthesis of L4 on S1.


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.he 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. 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: 18 seconds

Output: Successful right hip arthrogram injection. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: A 41 year old female with history of idiopathic aortitis, status post ascending aortic aneurysm repair and mechanical aortic valve placement in August 2010. The patient is asymptomatic and was referred to cardiac MRI to evaluate the stability of aneurysm and valve repair. 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 87 ml/m2 (normal range: 65+/-11), the LVEDV is 131 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 53 ml (normal range 31+/-10), the LV mass index is 36 g/m2 (normal range 67+/-11), and the LV mass is 56 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Septal bounce was noted.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 116 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveArtefacts were noted due to the mechanical aortic valve replacement, there is mild regurgitation (regurgitation fraction 14% by Q-flow analysis).Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is an ascending aortic graft with no aneurysm formation noted; however, there is mild dilation of the ascending aorta just distal to the anastomosis site of the graft. This finding was noted in the 2 previous MRI's (2012, 2013).Aortic diameters: Ascending aortic graft maximum diameter: 31mm (31 mm in 2013, 30 mm in 2012).Distal anastomosis: 22mm (23mm in 2013, 23mm in 2012).There is an area of mild dilatation just distal to the anastomosis site that measures 32 x 36mm - this has not changed when compared to the 2013 or 2012 CMR.Ascending aorta just proximal to brachiocephalic vessels: 31mm (30mm in 2013 and 2012).Distal arch: 23mm (23mm in 2013 and 2012).Descending aorta at the level of the main PA: 17mm (17mm in 2013 and 2012).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 FindingsSternal wires. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 59%, no evidence of an underlying fibrosing, infiltrative, or inflammatory process. Septal bounce was noted.2. The right ventricle is normal in size with normal systolic function, the RVEF is 57%.3. Mechanical aortic valve, there is mild regurgitation (regurgitation fraction 14% by Q-flow analysis).4. Ascending aortic graft, no aneurysm noted; however, there is mild dilation of the ascending aorta just distal to the anastomosis site of the graft.5. When compared to the prior study, no significant change is noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 70 year old with silicone implant presents for implant evaluation. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Bilateral retro-glandular silicone implants appear intact. No evidence of intra-/extra-implant rupture, or implant herniation.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for implant rupture or malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient is status post craniotomy/laminectomy for Chiari decompression, CSF leak. Signs and symptoms: Leaking fluid from surgical site. Nonenhanced brain MRI:Examination demonstrates postoperative changes of suboccipital midline craniectomy for Chiari decompression. There is no significant expansion of subarachnoid space on this initial postoperative study. Flattening deformity of cerebellar tonsil remains similar to prior study. There is expected postoperative epidural collection at the surgical site measuring approximately 40 mm in cranial cephalad axis and 9 mm in AP axis measured on sagittal images.There is minimal FLAIR hyperintensity of the medial aspect of bilateral cerebellar tonsils (R>L) representing post operative change (axial flair series 601 image 11 and coronal T2 series 801 image 24). This finding demonstrate no restricted diffusion.Unremarkable cerebral cortex, cortical sulci, ventricular system, brain myelination and CSF cisterns otherwise.

Output: 1.Postoperative changes of suboccipital craniectomy for Chiari decompression.2.There is no significant expansion of subarachnoid space at the surgical site and flattening deformity of cerebellar tonsils are again identified.3.Epidural collection at the surgical site within expected postop change and measuring 9 mm in AP and 40 mm intracranial cephalad access measured on sagittal images.4.There are tiny foci of FLAIR hyperintensity(R>L) of medial aspect of bilateral cerebellar hemispheres representing postoperative changes and without restricted diffusion.5.No convincing evidence of CSF leak on this study.


Instruction: Generate impression based on findings.

Input: Clinical question: 14-year-old with history of glioblastoma multiforme status post 42 days of radiation and adjunctive chemotherapy. Signs and symptoms: Brain tumor. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates significant interval decrease in edema since prior exam surrounding a left posterior temporal -- parietal surgical cavity. Small residual flair hyperintensity at the site surrounding the surgical cavity still persist. There is interval better visualization of adjacent cortical sulci and the left lateral ventricle secondary to decreased mass effect.There is also interval decreased size of the surgical cavity which demonstrate CSF signal intensity and measuring at 27 x 18-mm compared to prior study measurement of 34 x 28. The surgical cavity is well demarcated and demonstrate a very thin partial enhancement along its medial wall which appears to be contiguous with the trigone of left lateral ventricle. There is a small more nodular focus of enhancement at the site of attachment of surgical cavity with the trigone of left lateral ventricle as well as a second additional small focus of enhancement within the trigone. Findings could represent postoperative changes and a focus of enhancement in the trigone as well could represent a focus of choroid plexus. Further follow-up is holder is needed for better assessment. Enhancement along the inner wall of the surgical cavity has decreased since prior exam. There is also complete resolution of enhancement of the ependymal lining of the trigone and the occipital horn of left lateral ventricle since prior study. Ventricular system remain within normal size and without addition of midline.Postoperative changes of a left craniotomy and a small CSF signal intensity extra-axial collection demonstrates subtle interval decreased size.

Output: 1.Significant interval decreased peri-surgical vasogenic edema of the left posterior temporal, occipital and parietal lobe since prior exam.2.Interval decreased size of surgical cavity in left posterior temporal -- parietal with CSF signal intensity content.3.A thin band of enhancement along the medial wall of the surgical cavity extends from the trigone of left lateral ventricle to the inner table of skull and likely representing post surgical change. A tiny focus of enhancement within the left trigone is also noted. Enhancements at this sites are suggestive of post treatment /surgical change however further follow up is needed to entirely exclude possibility of residual tumor.4.Complete resolution of previously noted enhancement of the ependymal lining of the left trigone and occipital horn of lateral ventricle.


Instruction: Generate impression based on findings.

Input: Reason: please evaluate schwannoma in right brachial plexus and see if there is also a tumor on the left History: man with NF2 who is said to have tumor of both right and left brachial plexi. Limited images of the brain show bilateral enhancing lesions centered in the CP angles and IACs, right greater than left, likely vestibular schwannomas. There are additional enhancing lesions, anterior to the cerebellum as seen on coronal views as well as a lesion posteriorly within the foramen magnum which measures 1.6 x 1.5 cm (5/14). There are bilateral enhancing lesions around the C1-C2 thecal sac, right greater than left, causing no significant thecal sac compromise.There is minimal anterolisthesis of C4 on C5 and retrolisthesis of C6 on C7. Vertebral body heights are maintained. Multilevel disc desiccation without significant disc space loss. No abnormal marrow signal. Two small enhancing lesions are seen within the cord at C1-C2 which are suspicious for tumor.C2-C3: Enhancing left nerve root with mild expansion of the neural foramina likely represents a schwannoma. No spinal canal narrowing.C3-C4: No enhancing lesions. No spinal or neuroforaminal stenosis. C4-C5: Large enhancing lesion originating within the spinal canal causing expansion of the right neural foramina measuring 1.5 cm in width, similar to the prior exam. Small left extraforaminal lesion is unchanged. Lesion causes severe narrowing of the canal and deformity of the cord. C5-C6: Large, predominantly extraforaminal lesion on the right measuring up to 1.5 cm a second thickness, unchanged. Small enhancing extra foraminal lesion on the left is likely unchanged. No spinal canal stenosis.C6-C7: Small, predominantly extraforaminal enhancing lesions bilaterally without expansion of the foramina are likely unchanged. No spinal canal stenosis.C7-T1: Small predominantly enhancing extraforaminal enhancing bilaterally lesions without expansion of the foramina, likely unchanged. No spinal canal stenosis.Additional smaller schwannomas partially visualized within the thoracic spine.

Output: 1.Multiple schwannomas bilaterally throughout the cervical spine, the largest lesions on the right at C4-C5 and C5-C6, are overall unchanged from the prior exam. The lesion at C4-C5 causes severe spinal canal narrowing and deformity of the cord, similar to the prior exam.2.Two small enhancing lesions within the cord at C1-C2 are unchanged from the prior exam and likely represent a primary cord neoplasm.3.Multiple additional intracranial schwannomas partially visualized, including bilateral acoustic schwannomas.


Instruction: Generate impression based on findings.

Input: Right arm pain Within the anterolateral subcutaneous tissues overlying the mid diaphysis of the humerus is a solid nodule measuring 1 x 0.6 x 1.3 cm in the greatest transaxial and craniocaudal dimensions. The mass is isointense to skeletal muscle on T1 sequences and hyperintense to skeletal muscle on fat suppressed T2 sequences. Following contrast administration, there is a homogeneously solid enhancement. No additional lesions are identified. The marrow signal of the humerus is normal as is the caliber and signal intensity of the surrounding musculature.

Output: Solid nodule within the anterolateral subcutaneous tissue overlying the mid diaphysis of the humerus. Although the imaging characteristics are nonspecific, given the patient's history, this may represent a peripheral nerve sheath tumor. Referral to orthopedic oncology is recommended.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of schwannoma status post resection in 2014. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a wide mouth ventral hernia in the lower abdomen containing small bowel without evidence of complication.OTHER: No evidence of tumor recurrence.

Output: 1. No evidence of tumor recurrence.2. New lower abdominal ventral wall hernia containing small bowel without evidence of complication.


Instruction: Generate impression based on findings.

Input: 58-year-old female with PBC, cirrhosis, ascites. Evaluate strictures, biliary duct patency, pretransplant, cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology with sequelae of portal hypertension including a single dominant splenorenal shunt. The liver demonstrates right lobe atrophy, nodular border, and siderotic cirrhotic nodules. Superimposed on this are 3 large smooth homogeneous nodules/masses which have dramatically increased in size or are new since CT exam of March, 2016. The largest in the left hepatic lobe is hypointense on T2 measuring approximately 6 x 6 cm (series 5 image 15) and mildly hyperintense on T1. This lesion is isointense to the hepatic parenchyma all postcontrast phases (series 13 images 26, 120).The 2 lesions in the posterior right hepatic lobe are isointense on T2, hyperintense on T1, and show no restricted diffusion. The medial lesion measures 3.7 x 3.9 cm, and the lateral lesion measures 3.9 x 3.4 cm. On the 3/1/2016 CT exam, the lateral lesion in retrospect measured approximately 1.8 cm in diameter, and the medial lesion is not clearly identified retrospectively. Both lesions demonstrate diffuse substantial arterial enhancement with well-defined zones of washout on the venous phase and peripheral capsular enhancement on the delayed phase (series 13 image 400). The medial lesion also demonstrates focal early marked washout along the anterior border suggesting a "nodule within a nodule" appearance (series 13 image 302).Smaller bright T1 or hypointense T2 nodules are seen scattered about the liver of a small size and nonspecific, but mostly likely regenerative nodules or dysplastic nodules.There is focal dilatation of the proximal common hepatic duct measuring 12 mm in diameter (series 5 image 17) with attenuation of the right and left bile ducts. The common bile duct tapers smoothly, and there is no evidence for an obstructing lesion. This is new since the March 2016 CT examination, and is of uncertain significance and etiology.SPLEEN: Mild splenomegaly measuring 12.2 cm in length.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Only scattered minimally prominent lymph nodes are seen in the upper abdomen. No enlarged suspicious nodes for neoplastic disease are seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild to moderate abdominal anasarca.OTHER: No significant abnormality noted.

Output: 1.Siderotic cirrhotic morphology.2.Rapid development of large homogeneous masses in the right and left hepatic lobes as described above. Two of these lesions meet AASLD criteria for HCC, however the unusual imaging spectrum in this patient with a history of PBC warrants biopsy for confirmation before presumptive diagnosis.3. Focal dilatation of the proximal common hepatic bile duct new since March, 2016m with normal smooth tapering of the common bile duct. No obstructing lesion. The common hepatic duct had a normal appearance on the 3/1/2016 CT exam. 4. Marked attenuation of the intrahepatic ducts typical of PBC with limited visibility, but no focal abnormality seen.


Instruction: Generate impression based on findings.

Input: Knee pain, sickle cell disease The examination is limited by motion artifact.MENISCI: There is increased vertically oriented signal intensity within the posterior horn of the medial meniscus which may represent a small peripheral tear (image 12/32 of series 6). The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a diffusely heterogeneous appearance of the marrow representing hematopoietic reconversion relating to the known history of sickle cell disease.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Possible small vertically oriented tear of the peripheral fibers of the posterior horn of the medial meniscus.2. Diffusely heterogeneous appearance of the marrow relating to sickle cell disease.


Instruction: Generate impression based on findings.

Input: Right nasopharyngeal carcinoma, treated with and radiation and chemotherapy. There are post-treatment findings in the right nasopharynx without definite measurable tumor, although assessment is limited by the lack of contrast. There is interval decrease in size of the defect in the right nasopharyngeal treatment bed and adjacent prevertebral and parapharyngeal spaces, which is occupied, by what may represent scar or granulation tissue. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is persistent diffuse high T2 signal in the central skull base, eccentric to the right, and within the anterior arch of C1. There are denervation changes in the right masticator muscles. There is persistent fluid within the right middle ear and mastoid air cells. The thyroid and major salivary glands are unchanged. There is multilevel degenerative cervical spondylosis. There are also degenerative changes in the right temporomandibular joint. There is moderate mucosal thickening in the bilateral maxillary sinuses. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. Post-treatment findings in the right nasopharynx and cental skull base with evolution of the necrotic soft tissues in the region of the treatment bed, but no definite gross measurable residual tumor, although the assessment is limited by the lack of intravenous contrast. 2. Degenerative spondylosis of the cervical spine with spinal canal stenosis at C5 and C6.3. Findings suggestive of right Eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: There is a diffusely anomalous gyration pattern of the bilateral posterior perisylvian and perirolandic regions, which is compatible with polymicrogyria. There are also more focal areas of grey matter that extend toward the margins of the lateral ventricles bilaterally, which are compatible with transmantle dysplasia. There is an absent septum pellucidum and mild focal prominence of the temporal horn of the right lateral ventricle associated with mild malrotation of the right hippocampus. The ventricular system is otherwise not significantly enlarged. The corpus callosum, posterior pituitary bright spot, as well as the optic nerves and optic chiasm are grossly intact. There is a small focus of encephalomalacia in the lateral aspect of the inferior right cerebellar hemisphere and perhaps mild hypoplasia of the inferior cerebellar vermis. However, the brainstem appears to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is ethmoid sinus mucosal thickening and fluid within the mastoid air cells bilaterally.

Output: 1. Congenital bilateral perisylvian syndrome. 2. Nonspecific ethmoid sinus mucosal thickening and fluid within the mastoid air cells bilaterally.


Instruction: Generate impression based on findings.

Input: Autism and global developmental delay: assess myelination. The third and lateral ventricles are mildly prominent due to apparent mild deficiency of white matter bulk diffusely. However there is complete myelination of supratentorial and infratentorial white matter. There is a 10 mm wide arachnoid cyst overlying the anteromedial aspect of the left temporal pole. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild diffuse paranasal sinus mucosal thickening.

Output: 1. The third and lateral ventricles are mildly prominent due to apparent mild deficiency of white matter bulk diffusely. However there is complete myelination of supratentorial and infratentorial white matter. 2. Small arachnoid cyst overlying the anteromedial aspect of the left temporal pole.