Instruction: Generate impression based on findings.

Input: Diagnosis: Headache(784.0)Clinical question: r/o tumorSigns and Symptoms: facial numbnessHistory of breast cancer. Possible metastases. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: Reason: new ischemia, brain metastasis History: new RLE weakness, left neck mass There is encephalomalacia involving the right superior and middle temporal gyri as well as the right inferior parietal lobule. There is associated susceptibility effect in the right parietal lobe gyri.No foci of diffusion restriction are appreciated intracranially.There are T2 and flair signal hyperintensity is present along the left basal ganglia and left internal capsule and to a lesser degree right basal ganglia.T2 and flair signal hyperintensity associated volume loss is present along the left corticospinal tract extending from the cerebral cortex to the medulla.There is a punctate signal hypointensity on the susceptibility weighted images in the left cerebellar hemisphere. Another one is present in the left occipital lobe subcortical white matter . Small punctate hypointensities on the susceptibility weighted images associated with a small amount of encephalomalacia are present in the right frontal lobe and left parietal lobe.No abnormal enhancing masses are appreciated intracraniallyNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute ischemic cerebral infarction appreciated.2.There is encephalomalacia involving right parietal lobe and the right temporal lobe along the inferior division of the middle cerebral artery distribution.3.Punctate microhemorrhages are present some of which are associated with small foci of encephalomalacia4.remote lacunar infarct is present in the left basal ganglia.5.Findings suggest wallerian degeneration along the left corticospinal tract extending from the cerebral cortex to the medulla.6.No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: Female 18 years old with headaches, fatigue-based double vision. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or other acute abnormality.


Instruction: Generate impression based on findings.

Input: 37 year old with history of heart transplant in may 2015, hypertension, hyperglycemia presenting with pericardial effusion s/p drainage. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 67 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying myocardial fibrosing, infiltrative, or inflammatory process. Native T1 times are moderately elevated at 1160 ms in the mid interventricular septum. Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 178 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant morphology.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 is normal in size. There is IVC continuation of the azygous vein, which is enlarged and empties in the SVC normally. PericardiumThe pericardium is moderately thickened with evidence of increased T2-signal and late gadolinium enhancement of the visceral and parietal pericardium. Based on myocardial tagging, the pericardium is tethered to the myocardium. On real time cine imaging, there is no obvious interventricular discordance during respiration noted. There is a small, loculated complex appearing pericardial effusion located posteriorly. Extracardiac FindingsThere are small bilateral pleural effusions, left greater than right. Sternotomy wires are present. 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 pericardium is moderately thickened with evidence of increased T2-signal and late gadolinium enhancement of the visceral and parietal pericardium. Based on myocardial tagging, the pericardium is tethered to the myocardium. On real time cine imaging, there is no obvious interventricular discordance during respiration noted. There is a small, loculated complex appearing pericardial effusion located posteriorly. These findings suggest that the pericardium is significantly inflamed. 2. Normal left ventricular size and systolic function (LVEF 55%) without evidence of underlying myocardial late gadolinium enhancement suggesting the absence of replacement fibrosis or overt inflammation; however, the native myocardial T1 time is moderately elevated which could be seen in the setting of subclinical edema or mild diffuse interstitial fibrosis. 3. Normal right ventricular size and systolic function (RVEF 59%). 4. Small bilateral pleural effusions 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: Migraine with aura, not intractable, without status migrainosus [G43.109], Reason for Study: ^Reason: rule out structural cause for headaches History: HA, visual disturbance No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 73 year old man with history of lymphoma, mild LV dysfunction, referred for stress cardiac MRI prior to stem cell transplant. MEDICATIONS: ASA, lisinopril, Toprol XL. 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 mild to moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 118 ml/m2 (normal range: 74+/-15), the LVEDV is 241 ml (normal range 142+/-34), the LV end systolic volume index is 74 ml/m2 (normal range 25+/-9), the LVESV is 150 ml (normal range 47+/-19), the LV mass index is 51 g/m2, and the LV mass is 105 g. LV dysfunction is global with regional variation.Left AtriumThe left atrium is severely dilated. 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 79 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve has reduced leaflet excursion with evidence of flow acceleration consistent with the diagnosis of aortic valve stenosis. Correlation with echocardiography suggested to determine the severity of aortic valve stenosis. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Mild to moderate LV dilation with moderately reduced systolic function (LVEF 38%).4. Normal RV size and systolic function (RVEF 57%).5. Severe left atrial dilation.6. Aortic valve stenosis noted, severity not characterized on this study. Correlation with echocardiography suggested.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 35 years Male (DOB:12/23/1980)Reason: assess for structural abnormality History: twitching of left handPROVIDER/ATTENDING NAME: ADIL JAVED ROBERT T KAVITT The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Incidental noted is made of a 5 mm pineal region cystic type lesion.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.

Output: There are no MRI findings which can explain the patient's hand twitching. There is no intracranial mass lesion appreciated.


Instruction: Generate impression based on findings.

Input: 28-year-old female with transient alteration of mental status. There is new hyperintense T2/FLAIR signal in bilateral posterior occipital lobe white matter. There is also very mild new increased T2/FLAIR signal within the subcortical white matter of bilateral, left greater than right, posterior frontal and parietal lobes. Increased T2/FLAIR signal is present in the right temporal lobe cortex posteriorly and inferiorly adjacent to the temporal horn of the right lateral ventricle, and may be involving the hippocampus.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval development of areas of increased T2/FLAIR signal predominantly within the bilateral posterior occipital lobe white matter, corresponding to regions of hypoattenuation on previous CT. Additional frontal and parietal lobe abnormalities as well, with findings compatible with posterior reversible encephalopathy syndrome (PRES).2. No evidence of acute infarct, intracranial hemorrhage, mass effect or midline shift.


Instruction: Generate impression based on findings.

Input: There are post-treatment findings with persistent diffuse pharyngeal mucosal space, retropharyngeal space, and parapharyngeal space edema. Otherwise, there is an infiltrative, enhancing conglomerate of left level 2 lymph nodes measures up to 35 x 55 mm in axial cross-section. The lesions at least partially encase the left internal carotid artery and narrow the left internal jugular vein. In addition, a left level 3 lymph node measures 12 x 14 mm in axial cross-section. Furthermore, there is a nodule within the deep parotid space, which measures 12 x 16 mm. There is no significant lymphadenopathy in the right neck. There is fatty atrophy of the submandibular glands. The thyroid gland is unremarkable. There is mild plaque at the carotid bifurcations. There is multilevel degenerative spondylosis. There is mild sinus mucosal thickening. There are bilateral lens implants. There is patchy T2 hyperintensity in the cerebral white matter, which may represent chronic small vessel ischemic disease.

Output: Post-treatment findings with persistent extensive left neck tumor that displays hypermetabolism on PET.


Instruction: Generate impression based on findings.

Input: Evaluate for findings consistent with toxoplasmosis given positive test and undergoing treatment. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral white matter T2 hyperintensity bilaterally. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are mild scattered paranasal sinus secretions and there is fluid within the bilateral mastoid air cells. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial toxoplasmosis or tumor. 2. Diffuse cerebral white matter T2 hyperintensity bilaterally may be treatment-related. 3. Nonspecific fluid within the bilateral mastoid air cells, which may be related to intubation.


Instruction: Generate impression based on findings.

Input: Popliteal fossa pain.Assess menisci. Assess ligaments MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Very small popliteal cyst. Otherwise negative


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits although there is straightening of the normal lumbar lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology with the conus terminating at L1. The paravertebral soft tissues are unremarkable. At T11-T12 and T12-L1 there is mild facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foramen stenosis.L1-L2: There is a mild disc bulge asymmetric to the right as well as mild facet arthropathy and ligamentum flavum thickening. There is no significant spinal canal or neural foramen stenosis and no significant change.L2-L3: There is a mild disc bulge as well as mild facet arthropathy and ligamentum flavum thickening. These findings result in unchanged mild bilateral neural foramen stenosis and no significant central canal stenosis. Findings are unchanged.L3-L4: There is a mild disc bulge with a superimposed right foraminal herniation. There is also mild facet arthropathy and ligamentum flavum thickening. This results in mild bilateral neural foramen stenosis and no significant central canal stenosis. The findings are unchanged.L4-L5: There is a moderate disc bulge as well as facet arthropathy and ligamentum flavum thickening bilaterally. This results in moderate right and mild left neural foramen stenosis and moderate spinal canal stenosis. The findings are unchanged.L5-S1: There is a mild disc bulge as well as bilateral facet arthropathy, right greater left, and ligamentum flavum thickening. Findings result in moderate bilateral neural foramen stenosis and no significant central canal stenosis. The findings are unchanged.

Output: Unchanged mild to moderate multilevel degenerative changes with multilevel facet arthropathy and at most moderate spinal canal stenosis at L4-L5.


Instruction: Generate impression based on findings.

Input: Status post cardiac arrest with no movement of LUE. Focal neurological signs. Status post intubation.There is an area of focal low density in the right occipital lobe with loss of the gray-white matter differentiation and sulcal effacement consistent with an acute infarct is seen.A second area of area of focal low density in the right frontal lobe posteriorly extending to the right precentral gyrus is seen. The overlying gray matter is preserved. There is no associated ex vacuo dilatation of the anterior horn of the right lateral ventricle and the age of this lesion is indeterminate. Overlay of an acute infarct in this region cannot be excluded on CT and MRI is more sensitive at detecting acute ischemia/infarct.There is no evidence of intracranial hemorrhage, hydrocephalus or midline shift. There are background changes of periventricular low attenuation consistent with chronic small vessel ischemic change. The ventricles and basal cisterns are normal in size and configuration.There is diffuse thickening of the calvarium particularly marked over the frontal bones and sphenoid wings. The skull base appears unremarkable and the visualized paranasal sinuses and mastoid air cells are normally pneumatized and clear.

Output: *Probable acute infarct in the right occipital lobe.*There is a second area of low density in the right frontal lobe posteriorly, age is indeterminate. Overlay of an acute infarct in this region cannot be excluded on CT and MRI is more sensitive at detecting acute ischemia/infarct.*Mild chronic small vessel ischemic change is demonstrated.


Instruction: Generate impression based on findings.

Input: 4-year-old female patient with constipation and abdominal pain. Question of spina bifida. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is within normal limits. The conus medullaris is normal in position terminating at the level of L1-L2. There is expected dependent movement of the cord and cauda equina with prone positioning. No evidence of a posterior element spinal defect. There is no abnormal enhancement.The right kidney is not visualized. The bladder is distended. A small amount of free fluid is noted in the pelvis.

Output: 1. No specific evidence of spina bifida or tethered cord.2. Absent right kidney.


Instruction: Generate impression based on findings.

Input: cT1N0 nasopharynx squamous cell carcinoma status post treatment. There are post-treatment findings in the neck. There has been continued interval decrease in size of the right posterior nasal cavity mass, which now measures up to approximately 4 mm, previously 6 mm. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is elevated T2 signal in the trapezius muscles bilaterally, which may be due to denervation effects. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids appear to be intact. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck with continued interval decrease in size of the nasal cavity mass.


Instruction: Generate impression based on findings.

Input: There are multiple metastatic lesions within the cervical and thoracic vertebral column. In particular, there has been interval increase in size of the lesions within the C2 through C4, and C7, where there is now epidural extension into the right spinal canal that results in mild spinal canal stenosis, but no spinal cord compression. However, there is obliteration of the right C2-3 neural foramen by the tumor. Nevertheless, the vertebral body heights are preserved. There are an unchanged probable hemangioma in the T1 and T2 vertebral bodies. There is unchanged loss of the usual cervical lordosis. There is degenerative spondylosis with minimal spinal canal stenosis at C3-4, C4-5, and C6-7, mild left neural foraminal stenosis at C3-4, mild-to-moderate right neural foraminal stenosis at C4-5, severe left and moderate right neural foraminal stenosis at C6-7, and mild right neural foraminal stenosis at C7-T1. There is a probable Thornwaldt cyst, which is unchanged.THORACIC SPINE

Output: 1.Post-operative and post-radiation treatment findings in the spine with overall increase in the vertebral metastases in the cervical spine and in T1 through T5 and T9. The tumor involving the T6 through T8 vertebrae appears similar, although precise comparison is limited due to the presence of hardware artifacts and there still appears to be severe spinal canal stenosis with compression of the spinal cord. 2.Interval decrease in the marrow signal and tumor enhancement in the lower lumbosacral spine related to radiation treatment.3.An unchanged subcentimeter lesion in the cauda equina nerve roots at the L3 level may represent a peripheral nerve sheath tumor.4. Interval increase in size of an upper mediastinal lymph node metastasis.5. Unchanged degenerative spondylopyosis in the cervical spine and lower lumbar spine.


Instruction: Generate impression based on findings.

Input: There is hypoattenuation in the right cerebellar hemisphere corresponding to the right cerebellar infarct seen on recent MRI. Mild local mass effect with mild contour deformity of the fourth ventricle again seen. No new mass effect or evidence of hemorrhagic transformation is seen. There is a focus of hyperattenuation involving the left anterior superior frontal gyrus possibly representing a small cavernous malformation, unchanged. No surrounding edema is seen. There is an area of encephalomalacia in the right lateral occipital lobe also seen on prior MRI. Focus of likely encephalomalacia involving the anterior inferior frontal lobes also again seen.No midline shift or herniation. No hydrocephalus. Calvarium is intact. Paranasal sinuses and mastoid air cells are grossly clear.

Output: 1. Evolving right cerebellar infarct without significant change in mild local mass effect and no hemorrhagic transformation.2. Encephalomalacia involving the right occipital lobe and bilateral anterior inferior frontal lobes is again demonstrated.3. Probable small cavernous malformation involving the left anterior superior frontal gyrus is again seen.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for PSC H/O IBD History: Elevated GTTP and ALT H/O IBD ABDOMEN:LIVER, BILIARY TRACT: Liver parenchyma appears normal. No intrahepatic biliary ductal dilatation. Common bile duct measures 5 mm. There is apparent narrowing of the mid common bile duct on MRCP images, however this appears normal on single shot T2 coronal images and is thought to likely represent artifact.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enlarged right lower quadrant lymph nodes. Above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific evidence of primary sclerosing cholangitis.2.Above average stool burden with enlarged right lower quadrant lymph nodes.


Instruction: Generate impression based on findings.

Input: Enlarging shoulder mass ROTATOR CUFF: There is mildly increased signal in the distal fibers of the supraspinatus reflecting mild tendinosis. There is no evidence of rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Right shoulder lipoma without aggressive characteristics.


Instruction: Generate impression based on findings.

Input: Please IT12 with thin slices to determine/quantitate compression and retropulsion. A or or Again noted is an approximate 50 to 75% compression deformity of the T12 vertebral body. There is retropulsion of bone fragments into the spinal canal. Bone fragments extend approximately 9 mm posterior to the posterior vertebral line. As noted on the recent MRI, there is no evidence of spinal canal stenosis. The adjacent intervertebral disk spaces are maintained. Few foci of air density are seen in the adjacent intervertebral disks and within the compressed T12 vertebral body. Remaining thoracic vertebral bodies are normal in height and slightly heterogenous in density consistent with osteopenia. Degenerative osteophytes and intervertebral disk space narrowing is seen involving the visualized lower cervical spine.

Output: Compression deformity of the T12 vertebral body with retropulsion of bone fragments, as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Hypoxic encephalopathy. Signs and symptoms: Cardiac arrest. Non-infused CT of brain.Examination again demonstrates a hematoma in the left thalamic region. Poorly defined borders of hematoma are consistent with breakdown. The overall size of this hematoma remains similar to prior exam of 24 hours earlier. Very extensive surrounding vasogenic edema with associated mass effect is again identified and with no appreciable change. Edema appears to extend inferiorly from the thalamus into the left cerebral peduncle. Mass effect on the third ventricle and midline shift remains similar to prior exam. Mild guided patient of lateral ventricles remains similar. Minimal amount of blood within bilateral occipital horns remain stable. Extensive periventricular and subcortical foci of low-attenuation although nonspecific however there are concerning for small vessel disease of indeterminate age.Further follow-up with an MRI is recommended.

Output: Overall stable exam since prior study.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, status post craniotomy. Evaluate postoperative cyst fenestration and catheter placement. Fragmentation of the right calvarium is again seen compatible with multiple prior craniotomies. Findings are also redemonstrated compatible with right hemispherectomy.A presumably extradural fluid collection is seen within and along the right craniotomy containing an air-fluid level. The thickness of this fluid has decreased when compared to the prior examination. A catheter is in place spanning from this fluid collection to the left, across the residual left cerebral hemisphere, along or through the left thalamus, terminating within the left temporal lobe.A cyst within the anteromedial left temporal lobe, just anterior to the catheter, is unchanged in size. Two cysts are also seen posterior to the catheter. The more lateral of these cysts is unchanged in size. The more medial cyst is smaller and no longer contains an air-fluid level as on the prior examination.Extensive chronic cerebral dysmorphism is unchanged. The white matter surrounding the residual left sided ventricular system remains T2 hyperintense.

Output: 1.A catheter is in place traversing the residual left cerebral hemisphere, spanning from the right sided extradural fluid collection across to the left temporal lobe.2.A cyst which is anterior to the catheter, within the anteromedial left temporal lobe, is unchanged in size. One cyst posterior to the catheter is unchanged in size, while the other cyst posterior to the catheter is smaller.3.The extradural fluid collection along the right craniotomy defect is decreased in size as well.4.Chronic dysmorphism of the brain and sequelae of right hemispherectomy are unchanged.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disturbance of skin sensationClinical question: thoracic cord compression?Signs and Symptoms: R>L LE numbness and pain The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.Schmorl's nodes are present at the inferior endplate of T7, T9, T10 and T11 and superior endplate of T12 andT11. There are small discrete effusions present at T7-8 and T8-9 as well as T11-12.The patient is status post anterior spine fusion at C5-6 and C7-T1 and posterior element fusion with instrumentation at C5-6.

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


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with subarachnoid hemorrhage and negative angiogram. Subarachnoid blood product is redemonstrated predominately collected along the ventral brainstem but with some blood product evident in the ventricular system and scattered along the cerebral sulci. The overall quantity and distribution of this blood product is not significantly changed allowing for differences in technique.A right frontal approach ventriculostomy catheter remains in place, tip at the right foramen of Monro. Ventricles remain dilated but to a similar degree as that seen before.T2 hyperintensity and mild encephalomalacia is evident effecting the bilateral paramedian frontal lobes and the left opercular region.The pons and medulla are distorted likely from the effect of substantial adjacent blood product. There is patchy T2 hyperintensity within both the pons and the medulla, and there is a single punctate focus of susceptibility within the parenchyma of the right dorsal pons. Otherwise, no discrete lesion is seen. On postcontrast sequences, there is mild diffuse dural enhancement, likely reactive to hemorrhage and surgical intervention. No definite enhancing lesions are seen within the brainstem, posterior fossa, or in the cerebral hemispheres.

Output: 1. Redemonstration of extensive subarachnoid hemorrhage, predominantly along the ventral brainstem but also scattered throughout the cerebral sulci and intraventricularly.2. Patchy signal abnormality is seen through the pons and medulla, and there is a single punctate focus of presumed blood product within the right dorsal pons. However, no definite discrete or enhancing lesion is seen to suggest the etiology for the subarachnoid hemorrhage.3. Persistent ventriculomegaly with a stably positioned right frontal approach ventricular catheter.4. Encephalomalacia involving the bilateral frontal lobes and the left opercular region may reflect remote ischemic injury.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with Ewing's sarcoma and new calvarial epidural metastases. Brain:The marrow space of the calvarium and skull base is diffusely heterogeneous and infiltrated.The dura along the left cerebral hemisphere is almost uniformly thickened and enhancing with an undulating pattern of nodular thickening which measures up to 8 mm in thickness at the parietal vertex. Abnormal enhancing tissue is also evident within the extracranial scalp, particularly at the left parietal vertex where a tumor nodule measures up to 8 mm thickness.Epidural and extracranial tumor is also evident centered on the left sphenoid wing. These lesions extend into the left middle cranial fossa and also into the left orbit exerting mass effect upon the lateral rectus muscle.Smooth dural thickening is evident to a lesser degree along the right cerebral hemisphere. Slightly nodular tumor is seen along the right greater sphenoid wing, and along the floor of the right middle cranial fossa with extension along and into the right cavernous sinus and Meckel's cave. Tumor is also suspected within the right sphenoid sinus with inferior extension to potentially involve the right nasopharyngeal mucosal space.As noted on the prior CT, epidural thickening does appear to involve the space between the occipital bone and the inferior aspect of the superior sagittal sinus. This results in some degree of sinus narrowing.Although areas of epidural thickening do exert minimal mass effect on the adjacent brain parenchyma, no evidence of brain invasion or parenchymal edema is seen. No pathologic parenchymal enhancement is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.Spine:All visualized osseous elements of the spine demonstrate diffuse marrow replacement with patchy superimposed pathologic enhancement. Vertebral body heights are, however, preserved, and spinal alignment is anatomic.Within the limitations of mild motion degradation, no evidence of any significant epidural tumor extension is seen. At most, there appears to be some mild extraosseous tumor extension along the right lateral mass of C2.The spinal canal is preserved with no evidence of significant stenosis at any level. The spinal cord itself shows normal morphology and signal characteristics. The conus terminates normally at the T12-L1 level.

Output: Diffuse infiltrative tumor involvement of the calvarium and skull base is seen. This results in fairly widespread involvement of the epidural space. The left sided dura is most significantly involved with scattered undulating areas of nodular epidural tumor. Prominent epidural and extracranial tumor is seen at the left parietal vertex.Tumor is evident centered on the left greater sphenoid wing with extension into both the left middle cranial fossa and the left orbit. There is mass effect upon the left lateral rectus muscle.Epidural tumor is seen along the right greater sphenoid wing extending along the floor of the middle cranial fossa, up along and into the right cavernous sinus and Meckel's cave. Tumor is also highly suspected within the right sphenoid sinus with inferior extension potentially into the nasopharyngeal mucosal space. Also of note, epidural tumor is evident along the inferior aspect of the superior sagittal sinus resulting in some degree of venous sinus narrowing.Marrow space tumor is evident diffusely throughout the spine. However, no evidence of any significant epidural tumor extension is seen. The spinal canal is preserved and the spinal cord is free of significant abnormalities.


Instruction: Generate impression based on findings.

Input: History of alcoholic cirrhosis. HCC screening, follow up on nonspecific lesions in liver and portal venous thrombosis The examination is degraded by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. The study is suboptimal to detect small hepatic lesions due to respiratory motion and ascites. The previously described right hepatic dome lesion (series 10, image 34) does not appear to have significantly changed and is too small to characterize.There appears to be complete thrombosis of the portal vein with cavernous transformation. The splenic vein appears patent. The superior mesentery vein is not well-visualized and there are several mesenteric root collateral vessels, similar to prior. There is suboptimal evaluation of the hepatic arteries and veins.SPLEEN: Splenomegaly with spleen measuring up to 15 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left hydronephrosis has resolved. Stable renal cysts.RETROPERITONEUM, LYMPH NODES: An IVC filter is present. Prominent periportal lymph nodes are likely related to patient's liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A partially visualized umbilical hernia is again noted.OTHER: Large volume ascites, similar to prior.

Output: 1.Examination limited by motion artifact.2.Cirrhosis with portal hypertension and large jascites. 3.Nonspecific approximately 1 cm right hepatic dome lesion not significantly changed. Continued follow-up is recommended. For follow up examination, recommend paracentesis prior to MRI to reduce artifact.4.Portal vein thrombosis with cavernous transformation. Poorly visualized SMV with mesenteric root collateral vessels appearing similar to prior.5.Interval resolution of previously seen left-sided hydronephrosis.


Instruction: Generate impression based on findings.

Input: Portable CT. Right temporal parietal bleed Extreme motion artifact obscure a significant amount of brain parenchyma and evaluation cannot be made. Note however is made of a hematoma measuring approximately 36 mm x 27.7-mm in the right posterior temporal. There is no evidence of surrounding vasogenic edema. To exclude possibility of a hemorrhagic mass MRI with infusion is recommended. The low-density of the edge of hematoma suggest its subacute state. Encephalomalacia along the course of right middle cerebral artery in the frontal region is consistent with an old stroke. There is ex vacuo dilatation of the right lateral ventricle.

Output: Very limited exam due to extensive motion. Right posterior temporal likely subacute hematoma and large area of cortical and subcortical right frontal encephalomalacia.


Instruction: Generate impression based on findings.

Input: Male 51 years old Reason: Pericholecystic fluid collection on CT. Rec'd by IR to evaluate the collection. History: Acute cholangitis BILIARY TRACT: Septated, complex, pericholecystic fluid collection measures approximately 4.7 x 4.2 x 4.7 cm. The gallbladder itself has a mildly thick-walled with a gallstone.No ring down seen to suggest adenomyomatosis.OTHER: No significant abnormalities noted.

Output: Septated, complex pericholecystic fluid collection could represent abscess/contained rupture.


Instruction: Generate impression based on findings.

Input: Known area of nonmass enhancement in the left breast. Family history of breast cancer, dense breasts. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. A few scattered cysts are again noted.In the far superior posterior medial left breast, the known area of nonmass enhancement is again seen. This has similar measurements to the prior exam, measuring 1.4 x 1.7 x 2.3 cm (previous 1.7 x 1.4 x 2.3 cm, AP x LM x CC). Slight differences in positioning may account for the small measuring differences. Kinetics are predominately persistent at this site. No new suspicious left breast enhancing lesion. Previously noted 5 mm focus in the right outer breast is not significantly enhancing today. In the right upper inner quadrant there is a focal area of non-mass enhancement that is morphologically similar to the area of issue in the left breast. Scattered enhancing foci in the right breast are present elsewhere, none uniquely suspicious.No abnormal axillary lymph nodes are identified in either axillary region.The recommendations below are a consensus of 3 attending breast radiologists.

Output: No significant change in the area of non-mass enhancement in the left breast. The stability and appearance make malignancy less likely. In a 45 year old, this is more likely to represent a variant of benign parenchymal enhancement, especially because similar, though less prominent enhancement is seen in the opposite breast. In terms of imaging follow up, the favored option to consider would be 6 month follow up MRI to document continued stability. If that cannot be performed, than a 12 month MRI is suggested. BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 68-year-old male with colon cancer ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic lesions have increased from the prior MRI but are similar to the recent CT. A left hepatic lobe lesion measures 2.1 x 1.9 cm, similar to the recent CT but new from the prior MRI. Localized intrahepatic ductal dilatation in the left hepatic lobe, similar to the prior exam. There is tumor abutting the right portal vein. Isointense signal within a small portion of the adjacent right portal vein likely represents volume averaging, as this appears patent on the same day CT. The main portal vein vein is narrowed by adjacent lymphadenopathy but is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple small cysts.RETROPERITONEUM, LYMPH NODES: Portacaval lymph node measures 2.2 x 1.3 cm (10/142), previously 1.8 x 1.1 cm on the prior MRI. Additional para-aortic nodes have increased since the prior exam.BOWEL, MESENTERY: Multiple mesenteric masses with a lesion anteriorly along the surgical scar measuring 2.9 x 3.6 cm (10/170). A left upper quadrant lesion measures 3.4 x 3.1 cm (10/128). An additional lesion is seen involving the descending colon. These are all increased from the prior MRI.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Elevation of left hemidiaphragm. Multiple right lower lobe pulmonary nodules with a prominent subpleural nodule measuring 1.0 x 0 cm (10/207), better evaluated on CT.

Output: 1.Hepatic and mesenteric metastases as well as retroperitoneal lymphadenopathy have increased since the prior MRI but are similar to the recent CT.2.Portal vein is narrowed but patent.3.Lung metastasis are better evaluated on CT.


Instruction: Generate impression based on findings.

Input: Male, 46 years old. Evaluate for large abscess or other issue on R leg soft tissues and foot. Swelling. No DVT. Foot wound. RIGHT LEG:There is circumferential subcutaneous soft tissue edema involving the entire length of the leg, compatible with cellulitis. No discrete fluid collection is identified in the soft tissues to suggest an abscess. There is also mild edema predominantly involving the anterior and the posterior compartment muscles of the leg extending toward the ankle. The underlying bones have normal cortical thickness and marrow signal abnormality.RIGHT FOOT:There is extensive subcutaneous soft tissue edema and inflammation about the forefoot. Deep skin/soft tissue ulceration is noted along the plantar aspect of the fifth toe. Susceptibility artifact in the soft tissues around the remaining great toe, compatible with postsurgical changes related to amputation, with adjacent shallow skin/soft tissue ulceration. An approximately 1 cm soft tissue collection along the plantar soft tissues of the first metatarsal without discrete fluid signal may reflect a small mature abscess. Adjacent punctate foci of fluid signal with peripheral enhancement are compatible with additional small foci of infection/developing abscesses adjacent to the first and second digits.Only the proximal portion of the fifth metatarsal remains, and there is progressive extensive cortical destruction and abnormal marrow signal within this metatarsal, compatible with osteomyelitis. The proximal phalanx is not present, and there is additional signal abnormality in the area of the proximal portion of the middle phalanx, compatible with additional area of osteomyelitis. The distal phalanx appears intact.There are postsurgical changes of disarticulation and amputation at the first metatarsophalangeal joint. There is mild increased STIR signal along the distal aspect of the first metatarsal, with only minimal abnormal T1 signal and no significant enhancement on postcontrast images, compatible with residual osteomyelitis, improved from the prior MR exam. The remainder of the bones of the forefoot/midfoot show normal cortical thickness and marrow signal.

Output: 1.Persistent osteomyelitis and progressive destruction of the fifth metatarsal. Improvement in osteomyelitis of the first metatarsal.2.Skin ulceration adjacent to the first and fifth metatarsals with extensive cellulitis of the forefoot and probable developing small abscesses adjacent to the first and second metatarsals.3.Cellulitis and nonspecific muscle edema involving the leg, without abscess or osteomyelitis.


Instruction: Generate impression based on findings.

Input: Dystonia, seizure like activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No seizure foci identified.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Right hemiparesis. Nonenhanced brain MRI:Diffusion weighted images demonstrates demonstrate a small nonhemorrhagic acute lacunar infarct along the posterior limb of left internal capsule and measuring approximately 8 mm in size. Tiny punctate foci of apparent restricted diffusion are noted in the splenium of corpus callosum on the left. This finding is believed to be an artifactual finding as a result of a punctate focus of susceptibility at the site on SWI.Flair and T2 weighted images demonstrate mild chronic nonhemorrhagic small vessel ischemic strokes primarily in the periventricular and minimally in the subcortical white matter of cerebral hemispheres and pons. The anatomical morphology and the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.The signal void in the major intracranial arterial branches are identified. Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced brain MRA:Patent and unremarkable bilateral vertebral arteries and bilateral pica branches. Basilar artery remains widely patent. Patent bilateral superior cerebellar and posterior cerebral arteries. Mild irregularity of superior cerebellar artery branches suggestive of mild atherosclerotic disease.Patent bilateral internal carotid arteries across the skull base and in their supraclinoid segments. Patent bilateral anterior and middle cerebral arteries and their branches with minimal atherosclerotic irregularity of the vessel. Enhanced neck MRA:Examination is severely degraded due to extensive motion artifact which precludes precise assessment of vasculature.The visualized aortic arch is unremarkable.The origins of major vessels are widely patent.Brachial cephalic and bilateral subclavian arteries demonstrate mild atherosclerotic plaques without significant vascular lumen compromise. Right common carotid, internal carotid and external carotid arteries are unremarkable.Left common carotid, internal carotid and external carotid arteries are unremarkable. Bilateral vertebral arteries appear patent. The origins of vertebral arteries however cannot be properly assessed due to excessive motion artifact.

Output: 1.Pre-and post-enhanced brain MRI demonstrate an acute nonhemorrhagic lacunar infarct of the posterior limb of the left internal capsule measuring 8mm. Chronic small vessel ischemic strokes of mild to moderate degree and unremarkable exam otherwise.2.Nonenhanced brain MRA demonstrate patency of all intracranial vasculature. Very mild atherosclerotic irregularity of the vessel walls is however noted. 3.Enhanced neck CT is severely degraded due to extensive motion artifact. The origins of the vertebral arteries cannot be properly assessed. The vertebral arteries however beyond their origins appear patent bilaterally. No definitive vascular lumen compromise of bilateral common carotids, internal carotids or the external carotid arteries detected.


Instruction: Generate impression based on findings.

Input: History of right breast excisional biopsy. A percutaneous biopsy performed prior to that excision showed a radial sclerosing lesion with severe atypia bordering on low-grade DCIS. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Stable enhancing foci bilaterally. Mild post-surgical change in the right lumpectomy bed. No new abnormal lymph nodes are identified in either axillary region. The prominent right axillary node and mildly prominent left axillary nodes are stable.

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


Instruction: Generate impression based on findings.

Input: Ring finger fracture, concern for radial collateral ligament injury There is increased signal intensity within the radial collateral ligament at the proximal phalanx of the ring finger compatible with tearing which we suspect originates at the head of the proximal phalanx. There is mild edema within the head of the proximal phalanx as well. Mild thickening and increased signal intensity of the ulnar collateral ligament when compared to the other fingers may reflect a mild sprain; however, the small density seen on the prior radiographs along the dorsomedial aspect of the head of the proximal phalanx is not evident on this exam. There is focal signal abnormality within the volar aspect of the base of the middle phalanx which may represent the site of a small volar plate fracture suspected on radiographs although the fracture fragment itself is not well visualized on MRI. The flexor and extensor tendons of the ring finger are normal.

Output: Findings compatible with tearing of the radial collateral ligament; other findings as above.


Instruction: Generate impression based on findings.

Input: 66-year-old male with left shoulder pain for several months. Evaluate for rotator cuff tear. ROTATOR CUFF: Mildly increased T2 signal at the supraspinatus tendon insertion is compatible with tendinopathy. No evidence of rotator cuff tear or muscular atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is intact.BICEPS TENDON: The biceps tendon is intact with normal course and signal. ADDITIONAL

Output: 1.Tendinopathy at the supraspinatus insertion without evidence of rotator cuff tear.2.Findings suggestive of subacromial/subdeltoid bursitis.


Instruction: Generate impression based on findings.

Input: Adenocarcinoma of the prostate, preop PSA 6.2, s/p radical prostatectomy in 3/5/12, pT3aN0, Gleason 3+4, surgical margin positive (bladder base) with detectable post-operative PSA, maximum 0.4 with most recent value 0.25. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Status post prostatectomy.Extracapsular Extension: Status post prostatectomy.BLADDER: Soft tissue nodularity posterior to the right bladder near the urethral anastomosis with mild T2 increased signal (series 401 image 61) and ADC decreased signal (series 508 image 304) with enhancement of this lesion series 1301 image 1224). The appearance is similar to prior study.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Soft tissue in the right inguinal region likely relates to prior hernia repair.

Output: 1.Soft tissue nodularity posterior to the right bladder near the ureteral anastomosis as above. Appearance is similar to prior study. Given the low PSA value, attention on follow-up imaging.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Brain: Again seen are post-operative findings related to a suboccipital craniectomy and resection of the posterior arch of C1 for decompression of Chiari malformation. There is evidence of tonsillar cauterization/resection. There remains some crowding of the remaining cerebellar tonsils at the level of the foramen magnum, which is unchanged. A fluid collection at the surgical bed measures approximately 23 x 33 x 36 mm (AP x TR x CC) compared to 10 x 35 x 36 mm previously and extends inferiorly to the level of the mid C2 vertebral body. Although the collection appears larger in the AP dimension, this may simply represent conformational changes due to patient positioning rather than true increase in size. Even if there has been an increase, it has not increased dramatically. The dura or duraplasty is somewhat irregular in places but we see no obvious defects or gaps. There continues to be no significant edema around the fluid collection. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. C-spine: Normal cervical lordosis. The vertebral body heights are well-maintained. No focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber. There is a persistent thin syrinx at the right lateral aspect of the cervical cord, which, along with a prominent central canal of the cord, extends inferiorly to the thoracic region but is unchanged. There is no pathological intrathecal enhancement.There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Post-operative findings related to Chiari decompression. 2. Mild apparent change in the size of the fluid collection in the surgical bed may simply be related to changes in patient position. Even if there were an increase in size, the collection is not significantly larger. Persistent pseudomeningocele is favored as the diagnosis. Infection is less likely given lack of edema and no change in the enhancement pattern compared to the prior exam.3. Unchanged, mild syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Cavernous malformation and aneurysm surveillance. MRI: There is an unchanged subcentimeter lesion with susceptibility effect in the left cerebellar hemisphere with an associated developmental venous anomaly. There is also an unchanged punctate focus of susceptibility effect in the posterior right temporal lobe. There are a few scattered foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid in the left maxillary sinus.MRA: There is a left paraclinoid internal carotid artery saccular aneurysm, which measures up to 3 mm in width. There is a fetal right posterior cerebral artery, which is an anatomic variant. There is no evidence of significant steno-occlusive lesions.

Output: 1. Unchanged subcentimeter cavernous malformation with an associated developmental venous anomaly.2. An unchanged punctate focus of susceptibility effect in the posterior right temporal lobe may also represent a cavernous malformation or development venous anomaly. 3. Unchanged nonspecific scattered foci of T2 hyperintensity in the cerebral white matter.4. Unchanged left paraclinoid internal carotid artery saccular aneurysm, which measures up to 3 mm in width.


Instruction: Generate impression based on findings.

Input: Male 77 years old Reason: r/o internal derangement, Baker's cyst History: knee pain; mild OA seen on xray MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is normal. There is complete loss of cartilage of the lateral portion of the medial patellar facet measuring approximately 7 mm in width (series 401, image 19). There is tricompartmental generalized cartilage thinning, greatest in the medial compartment, without focal defect elsewhere. LIGAMENTS: The ACL, PCL, and MCL are intact. The lateral collateral complex is also intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Full-thickness cartilage defect in the lateral portion of the medial patellar facet. Generalized cartilage thinning elsewhere2.Baker's cyst.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, history of epilepsy and laser ablation. Surveillance scan. Sequelae of prior right temporal depth electrode placement and right medial temporal laser ablation are seen. This includes several right-sided burr holes, small areas of curvilinear parenchymal gliosis, and a small T2 hyperintense mildly hemosiderin stained medial temporal ablation bed.Low lying cerebral tonsils compatible with Chiari I malformation are demonstrated. Otherwise, cerebral morphology and signal characteristics are within normal limits. No significant parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra axial fluid is seen. The ventricles are normal in size and morphology.

Output: Expected findings status post right temporal depth electrode placement and right mesial temporal laser ablation.


Instruction: Generate impression based on findings.

Input: 49-year-old female with lower back pain.. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.L1-L2: No significant disc disease, spinal canal, or neural foraminal narrowing.L2-L3: No significant disc disease, spinal canal, or neural foraminal narrowing.L3-L4: Mild bilateral facet arthropathy. No significant disc disease, spinal canal, or neural foraminal narrowing.L4-L5: Moderate bilateral facet arthropathy. Loss of disc T2 signal and bulging disc with superimposed left foraminal annular fissure. Mild to moderate generalized spinal canal stenosis. Mild bilateral foraminal narrowing.L5-S1: Mild facet arthropathy. No significant disc disease, spinal canal, or neural foraminal narrowing.

Output: Mild degenerative findings at the L4-5 level, including facet arthropathy and bulging disc. These result in mild to moderate generalized spinal canal and mild bilateral neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Ms. Williams is a 35-year-old female with a personal history of left breast lumpectomy in 2013 for triple negative IDC. Patient did not receive any chemotherapy or radiation therapy. Personal history of benign left MRI guided biopsy. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Few scattered enhancing foci are identified bilaterally, all of which appear stable in appearance and distribution when compared to prior examination. Stable postsurgical changes are identified in the left upper outer breast, at site of prior lumpectomy. Susceptibility artifact from biopsy marker clip is stable in the left upper outer breast. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: History of autoimmune hepatitis with concern for liver mass. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with reticular fibrotic changes. In the right hepatic dome segment 7/8 there is a 3.1 x 3.0 cm lesion demonstrating patchy arterial enhancement (series 1 101/302) which demonstrates washout on delayed phase imaging compatible with HCC.There are several small foci seen on delayed phase imaging without corresponding arterial enhancement which may represent perfusion anomalies. No additional suspicious arterially enhancing and washing out lesion is evident.No biliary ductal dilatation or vascular abnormality.Cholelithiasis without cholecystitis.Small porta hepatis lymph nodes are nonspecific in the setting of chronic liver disease. Some of these enhance but demonstrate no washout.SPLEEN: The spleen measures 15 cm in craniocaudal dimension without a focal lesion.PANCREAS: Mild fatty atrophy of the pancreas without pancreatic ductal dilatation or focal suspicious lesion. Pancreas divisum.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral simple appearing cysts and too small to characterize T2-weighted hyperintensities. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild basilar atelectasis.OTHER: No significant abnormality noted.

Output: Cirrhosis with a 3.1 right hepatic dome mass meeting imaging criteria for HCC. No additional suspicious lesion is identified. Porta hepatis lymph nodes are nonspecific in the setting of chronic liver disease.Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: 71-year-old female with back pain, evaluate for herniated disc. History of breast cancer. Thoracic MRI:There is a smooth, physiologic thoracic kyphotic curve. Mild chronic anterior wedge deformity is noted involving T7 and T8. Scattered foci of reactive endplate changes are noted throughout the mid and lower thoracic spine associated with disc desiccation and disc height loss.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates a small right paracentral disc protrusion and right facet hypertrophy without cord encroachment or stenosis.T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.Lumbar MRI:Redemonstrated is straightening of the lumbar curvature with some dextroscoliosis of the lower lumbar spine, unchanged. The vertebral body heights are preserved. The conus is normal in signal and morphology and terminates at appropriate level. The visualized paraspinal contents are unremarkable.There is variable disc height loss in the upper lumbar spine most prominent at the L2-3 level. Additional endplate degenerative changes including Schmorl's nodes are seen in the L1-L4 vertebral levels. These findings are unchanged.L1/2: Mild loss of disc height and without significant disc protrusion or neural foraminal or spinal canal compromise, unchanged. L2/3: Moderate disc disease with a small disc bulge and mild facet arthropathy. Minimal right neural foraminal narrowing. No spinal canal stenosis. These findings are unchanged.L3/4: Moderate disc disease, minimal disc bulge and mild facet arthropathy. No significant compromise of the spinal canal and neural foramina. These findings are unchanged.L4-5 and L5-S1: Mild disc disease without disc bulge or compromise of the spinal canal or neural foramina. These findings are unchanged.

Output: 1.Mild chronic anterior wedge deformity is noted involving T7 and T8.2.T10/11 demonstrates a small right paracentral disc protrusion and right facet hypertrophy without cord encroachment or stenosis.3.L2/3: Minimal right neural foraminal narrowing, unchanged.4.There is no acute disc herniation of the thoracic or lumbar spine.


Instruction: Generate impression based on findings.

Input: 53-year-old female with metastatic lung carcinoma, status post chemo, please compare to the previous study and evaluate for disease status CHEST:LUNGS AND PLEURA: Right pleural effusion and peripheral airspace consolidation/atelectasis not significantly changed.Reference right middle lobe mass (image 45 series 5) measures 24 mm previously measuring 27 mm.Adjacent satellite reference lesion (image 44 series 5) now measures 9 mm previously measuring 7 mm.Left lower lobe reference nodule (image 35 series 5) now measures 14 mm x 15 mm previously measuring 9 mm x 9 mm.MEDIASTINUM AND HILA: Right internal mammary lymph node previously described is stable at 3 mm in short axis (image 30 series 3).Subcarinal lymph node (image 42 series 3) is stable measuring 9 mm.No new hilar or mediastinal lymphadenopathy.Calcified left hilar lymph nodes compatible with previous granulomatous disease.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Sclerotic rib lesions unchanged.Carotic L1 for T12 lesion unchanged.A superior endplate compression deformity of T11 is new. No definite evidence of underlying metastatic involvement. MRI of the lumbar spine would be of value.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta and iliac arteriesBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Interval increase in size of left lower lobe nodule and right middle lobe satellite nodule suggestive of progression of metastatic disease.2.Stable right middle lobe mass, right pleural effusion and peripheral consolidation/atelectasis.3.Stable L1 sclerotic lesion.4.New superior endplate compression deformity of the T11 vertebrae.


Instruction: Generate impression based on findings.

Input: Female, 80 years old, with left neck fullness and mass noted to be present for one year by patient. The left lobe of the thyroid gland is markedly enlarged and heterogeneous containing areas of enhancing and nonenhancing solid tissue as well as several locules of cystic material which may reflect proteinaceous fluid or hemorrhage. The right thyroid lobe is also heterogeneous but is only mildly enlarged. The left lobe measures approximately 8 cm x 5 cm x 9 cm and causes significant displacement of the adjacent structures including the airway which is deviated to the right but not compromised. The left carotid and jugular vessels are displaced laterally by the mass. The arterial flow void appears to be preserved. Patency of the jugular vein cannot be accurately assessed. The lesion extends superiorly to the level of the angle of the mandible, and inferiorly into the mediastinum. Apart from the significant lesional mass effect, there does not appear to be frank invasion of the adjacent or overlying soft tissue structures. No pathologic adenopathy is detected. Vertebral marrow signal remains within normal limits and there are no findings to suggest intraspinal invasion. Multilevel disc degeneration is seen with a retrolisthesis of C5 relative to C4 and C6.

Output: The left thyroid lobe is markedly enlarged and very heterogeneous containing a mixture of enhancing and nonenhancing solid tissue as well as scattered cysts which may contain proteinaceous fluid or blood. The lesion exerts mass effect on the adjacent structures including the airway and the left cervical vessels. The differential diagnosis would include thyroid goiter as well as thyroid malignancy.


Instruction: Generate impression based on findings.

Input: Low back pain and leg numbness. Leukocytosis. Rule out epidural abscess. There are 5 lumbar-type, ribless vertebrae. The last well-formed disc is at L5-S1.Alignment is anatomic. The vertebral bodies are preserved in height. The intervertebral discs are preserved in height and T2 signal. There is no significant marrow signal abnormality. The spinal canal is preserved. The tip of the conus medullaris lies at mid L1 vertebral level. The conus medullaris shows normal shape and signal characteristics. Following contrast injection, there is no abnormal spinal cord, leptomeningeal, epidural or osseous contrast enhancement. Stranding, T2-hyperintensity and contrast enhancement in the subcutaneous fat at L3 and L4 levels is very nonspecific and may reflect dependent edema.The paraspinal soft tissues are notable for a 6 mm, well-circumscribed, T2-hyperintense, T1-hypointense, noncontrast enhancing lesion arising from the inferior pole of the right kidney which is probably a cyst.

Output: 1.No sign of lumbar spinal infection.2.No significant degenerative disease of the lumbar spine.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of suboccipital craniectomy for resection of cerebellar metastases. There is a small resection cavity involving the cerebellar vermis in the midline and just to the left of the midline. Just superior lateral aspect of the resection cavity on the left there is an area of peripheral enhancement with T2 hypointensity measuring approximately 10 x 12 x 12 mm on the post gadolinium sequence which is minimally larger than prior. The T2 hypointensity measures 8 x 7 mm, previously 6 x 7 mm. There is surrounding T2/FLAIR hyperintensity which is also stable to minimally increased in the interval.Remainder of the brain demonstrates no new parenchymal or meningeal enhancement to suggest progression of metastatic disease.There is no diffusion abnormality. There are scattered T2/FLAIR hyperintense foci in the periventricular and subcortical white matter which are nonspecific but similar to prior and may represent mild chronic small vessel ischemic changes. Major flow-voids are preserved. 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. There is thinning of the left posterior sclera compatible with staphyloma. The right eye is irregular in shape also similar to prior. There is no enhancing lesion identified in either eye. These findings are stable compared to prior exams.

Output: Again seen are postoperative changes related to resection of cerebellar metastasis. Compared to 11/17/2015 there is minimal increase in size of a peripherally enhancing nodule with T2 hypointensity superolateral to the resection cavity. Surrounding edema is stable to minimally increased in the interval. These findings may represent evolving posttreatment changes given history of recent radiation; however recommend continued close follow-up to exclude the possibility of enlarging local recurrent tumor. No new lesion is seen elsewhere in the brain to definitively suggest tumor progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, history of hemoglobin SC disease, complicated in the past by acute chest syndrome, with colorectal cancer status post chemoradiation and partial colectomy, now with concerns for metastatic disease. Thoracic:Pathologic marrow replacement is seen involving the spinous process and right lamina of T2 without significant epidural encroachment. A larger area of marrow replacement is seen involving the left T11 pedicle and lamina with left dorsal epidural encroachment and a mild to moderate spinal canal stenosis. The cord is displaced anteriorly and to the right, but no evidence of cord invasion or pathologic cord signal is seen.Small peripherally enhancing lesions along the superior and inferior T12 endplates are nonspecific could reflect areas of pathologic marrow replacement or developing Schmorl's node deformities.A significant dextroscoliosis of the spine is evident centered at T7. Sagittal alignment is otherwise unremarkable.Vertebral body height is preserved.Except as discussed above, no significant spinal canal stenosis is seen. Small left paracentral disc protrusions are evident at T6-7 and T7-8. A right paracentral disc protrusion is evident at T10-11. No significant foraminal stenosis is detected.Incidental note is made of small bilateral pleural effusions. Multiple healed rib fractures are suspected on the left.Lumbar:Near complete marrow replacement of the L2 vertebral body is seen with central loss of height of approximately 40%. A combination of vertebral body retropulsion and epidural disease spread results in a moderate to severe spinal canal stenosis at this level with mild crowding of the cauda equina. The L1-2 and L2-3 neural foramina on the right are mildly narrowed as well.No other definite areas of disease are seen in the lumbar spine.The lumbar spine is mildly levoscoliotic. Sagittal alignment is within normal limits.With the exception of mild disc bulging and moderate to severe facet hypertrophy at L5-S1, no significant degenerative disease is seen. Except as above, no additional high-grade spinal canal stenosis or neuroforaminal narrowing is seen.

Output: 1.Multiple sites of osseous metastatic disease are seen including the right lamina of T2, the left pedicle and lamina of T11, the L2 vertebral body, and questionably the T12 vertebral body.2.Metastatic disease results in epidural encroachment and mild to moderate spinal canal narrowing at T11; as well as compression of the L2 vertebral body with epidural encroachment and moderate to severe spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Diplopia [H53.2] / Multiple sclerosis [G35], Reason for Study: ^Reason: r/o new lesions History: double vision Brain MRIMultifocal various sized patchy FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale are seen. Considering the difference of imaging technique and MR machine, the number and distribution appear to be stable and unchanged. However, on today's scan, there is focal FLAIR high signal intensity at the posterior aspect of mid pons adjacent to the anterior wall of the 4th ventricle at the level of middle which is more conspicuous than prior scan. There is about 5mm caudal herniation of cerebellar tonsil.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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIMotion artifacts degraded exam quality.There is normal cervical lordosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. There broad based disc protrusion central to left which abuts thecal sac at C67. However, there is no evidence of spinal canal stenosis or neural foraminal stenosis.Other intervertebral disc levels appear to be normal.

Output: 1. Multifocal various size bihemispheric periventricular white matter and centrum semiovale FLAIR/T2 high signal lesions consistent with multiple sclerosis lesions, unchanged since prior scan.2. More conspicuous FLAIR high signal posterior aspect of mid pons could be related to technical differences, however, clinical correlation is recommended.3. Broad based disc herniation central to left at the level of C67 without evidence of spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Right-sided weakness. Acute CVA. Non-enhanced CT of brain:There is evidence of a nonhemorrhagic acute left MCA cortical stroke in the left frontal lobe. There is subtle associated mass effect and effacement of adjacent cortical sulci. No evidence of midline shift.Patchy periventricular foci of low-attenuation is concerning for small vessel ischemic disease of indeterminate age. Follow-up with an MRI is recommended. Ventricular system is within normal range of size for patient's stated age of 70. No abnormalities of basal ganglia, thalami, pons or the cerebellum is detected. Mild vascular calcification of bilateral cavernous carotid are noted. Limited view of orbits, paranasal sinuses and mastoid air cells are unremarkable. Old healed fracture of posterior lateral wall of right maxillary sinus in this limited view is identified.

Output: 1.Acute left MCA frontal lobe nonhemorrhagic cortical stroke.2.Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Evaluate for frontotemporal dementia or other intracranial process leading to personality change: Suicide attempt, impulsivity, poor cognition. There is extensive patchy cerebral, brainstem, and cerebellar white matter T2 hyperintensity. There are also numerous punctate foci of susceptibility effect in the bilateral basal ganglia, thalami, brainstem, and cerebellum. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Extensive areas of white matter T2 hyperintensity and foci of susceptibility effect likely represent stigmata of chronic hypertensive encephalopathy.2. No specific findings to suggest frontotemporal dementia.3. No evidence of intracranial mass or acute infarct.


Instruction: Generate impression based on findings.

Input: Surgical changes including left frontal craniotomy and left frontal operculum tumor resection are again noted, with small left frontal surgical cavity with minimal associated susceptibility. Minimal increased FLAIR signal adjacent to the surgical cavity, as well as postsurgical dural thickening adjacent to the cavity, which are both unchanged. There are few tiny scattered foci of FLAIR signal abnormality in the subcortical white matter, which is nonspecific but likely represents minimal small vessel ischemic disease, similar to prior exam. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Surgical changes of left frontal tumor resection with no evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: right facial weakness History: right facial weakness Brain MRIMultiple scattered restricted diffusion on the left frontal lobe pre central gyrus and superoanterior aspect of the left external capsule without evidence of susceptibility artifacts indicating acute/subacute ischemic infarctions.Underlying brain shows patchy bihemispheric high signal intensities on T2/FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate more than 50% luminal stenosis at the proximal basilar artery just below bilateral AICA origin. In additional there are multiple (at least 2 foci) tandem luminal narrowings on the right MCA M1 segment which appear to be less than 50% luminal stenosis. There is no intracranial arterial aneurysm. There is no evidence of additional intracranial arterial luminal stenosis. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate ectatic changes indicating atherosclerotic change. Aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries were tortuous but no evidence of luminal stenosis. The vertebral artery origins are normal. There is no evidence of luminal stenosis on the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Multifocal right frontal acute ischemic infarctions without evidence of hemorrhagic transformation as described above.2. Multiple tandem luminal stenosis (less than 50%) on the left MCA M1 segment.3. More than 50% luminal stenosis, proximal basilar artery just below the level of bilateral AICA origins.4. Atherosclerotic changes of extracranial craniocervical arterial system without evidence of significant luminal stenosis.


Instruction: Generate impression based on findings.

Input: Is there transverse myelitis? Back pain in setting of disseminated zoster. The spinal cord displays normal signal and morphology. The cauda equina nerve roots are intact. There is no evidence of abnormal enhancement. 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 facet arthropathy at L4-5 and L5-S1 bilaterally, which results in slight neural foraminal narrowing at these levels. However, there is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There are bilateral pulmonary consolidations.

Output: 1. No evidence of transverse myelitis.2. Facet arthropathy at L4-5 and L5-S1 bilaterally, which results in slight neural foraminal narrowing at these levels. 3. Bilateral pulmonary consolidations, likely related to pneumonia.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute ischemia or infarction. There is a 5 mm wide extra-axial mass along the right perirolandic convexity without mass effect upon the brain. There may another similar lesion along the left temporal convexity that measures 2 mm in thickness. There is gyriform susceptibility effect in the right precentral sulcus. There are several supratentorial and infratentorial punctate foci of susceptibility effect. There are mild foci of white matter T2 hyperintensity. There is mild parenchymal volume loss. There is a small right maxillary sinus retention cyst. There are bilateral lens implants.

Output: 1. Findings consistent with age indeterminate small vessel ischemic disease without evidence of acute infarction.2. Several supratentorial and infratentorial punctate foci of susceptibility effect may represent chronic microhemorrhages, cavernous malformation. 3. Gyriform susceptibility effect in the right precentral sulcus may represent sequela of prior hemorrhage. 4. A 5 mm wide extra-axial mass along the right perirolandic convexity without mass effect upon the brain may represent a meningioma. Follow up with a brain MRI with contrast may be useful, if there are no contraindications.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: BRAIN: No evidence of progression of demyelinating disease. Unchanged multiple foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. 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. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.CERVICAL SPINE: Motion artifact degrades image quality. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is moderate loss of disc height at C6-7. The vertebral bone marrow signal is unremarkable. There is slightly increased minimal prominence of the central canal throughout much of the cervical spinal cord without evidence of demyelinating lesions in the spinal cord. There are scattered perineural cysts throughout the spine.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Tiny central disc protrusion. No significant spinal canal or foraminal stenosis.C4-C5: Disc-osteophyte complex, eccentric to the left, contributing to mild left foraminal stenosis. No significant spinal canal stenosis.C5-C6: Disc-osteophyte complex and uncinate spurs with partial effacement of the ventral thecal sac, contributing to minimal left foraminal stenosis. No significant spinal canal stenosis.C6-C7: Disc-osteophyte complex and uncinate spurs, contributing to moderate spinal canal stenosis and moderate to severe bilateral foraminal stenosis, relatively worse on the left. No definite associated cord signal abnormality.C7-T1: No significant disc bulge, herniation, spinal canal or foraminal stenosis. THORACIC SPINE: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild multilevel loss of disc height. There is an intraosseous hemangioma at the L1 vertebral body. The vertebral bone marrow signal is otherwise unremarkable. There is small central disc protrusion at T5-6, T6-7 and T7-8. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Unchanged scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, compatible with known chronic demyelinating disease. No new lesions or lesions with enhancement to suggest active demyelination.2. Unchanged trace prominence of the central canal throughout much of the cervical spinal cord, which is of doubtful clinical significance. No findings to suggest demyelinating lesions in the spinal cord. 3. Degenerative spondylosis of the cervical spine, with moderate spinal canal stenosis at C6-7 and moderate to severe bilateral foraminal stenosis similar to prior from 11/14/2013.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, cervical regionClinical question: R/O nerve root compression on the RSigns and Symptoms: Neck pain radiating to the RUE The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is no significant compromise to the cervical spinal canal or exiting nerve roots. There are minimal degenerative changes in the cervical spine.


Instruction: Generate impression based on findings.

Input: Left hip pain Moderate to severe osteoarthritis affects the hip with joint space narrowing and cystic changes involving both the femoral head and acetabulum. There is a moderate-sized joint effusion which demonstrates intermediate signal intensity and enhancement suggesting complex fluid and synovitis. Synovial thickening is also evident. There is abnormal morphology and signal intensity of the anterior and superior labrum representing degeneration and tearing. The marrow signal of the proximal femur is otherwise normal. The surrounding soft tissues and muscles of the left hip are normal.

Output: Osteoarthritis and cystic changes of the left hip with nonspecific synovitis and synovial thickening.


Instruction: Generate impression based on findings.

Input: 59 years Female (DOB:5/2/1956)Reason: breast cancer with brain metastases treated with SRS; please evaluate response History: brain metastasesPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 2.5 mm enhancing focus along the left parietal lobe in the superior parietal lobule which is also identified on the prior exam and not substantially changed. A couple punctate foci of enhancement present in the left middle frontal gyrus which are not clearly present on the prior exam. There is a punctate focus of enhancement in the right orbital gyrus along its medial aspect which is also present on the prior exam.On susceptibility imaging there is a punctate focus of signal loss in the left inferior parietal lobule which is not associated with contrast enhancement in those also present prior exam. An additional nodular focus of signal loss and susceptibility is present in the right precentral gyrus.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is redemonstration of multiple tiny lesions in the supratentorial brain which are compatible with metastatic disease. Two of these in the left frontal lobe could represent newly MR visible metastatic foci.


Instruction: Generate impression based on findings.

Input: 22-year-old male with history of Crohn's. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left lower quadrant ostomy with mild wall thickening, likely chronic in etiology.BONES, SOFT TISSUES: There are multiple faint suprasphincteric fistulae arising from the 9 o'clock position of the rectum extending into a small fluid collection along the right aspect of the rectum with maximal axial dimensions of 3.6 x 1.2 cm. This collection extends caudally to the right perianal skin surface. Interval placement of seton through this fistula.OTHER: No significant abnormality noted

Output: Interval placement of seton through a known suprasphincteric fistula/fluid collection appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 65 years, Male, new right chest wall mass with preliminary pathology demonstrating NSC. Evaluate for metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is a chronic right pontine infarct which was acute on prior MRI from 2013. There are patchy foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease and mildly progressed since prior. There are foci of T2/FLAIR signal abnormality in the right frontal corona radiata as well as in the left anterior subinsular region compatible with chronic infarcts which are new since prior. Post-gadolinium sequences are mildly motion degraded. However there is no abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. There is a partially empty sella which can be normal variant. Moderate polypoid opacification of the left maxillary sinus is again seen similar to 2/18/2013. There is also a small right maxillary mucus retention cyst. Calvarium and extracranial soft tissue structures are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Since 2/18/2013, there has been mild progression of chronic small vessel ischemic disease. There are small chronic infarcts which are new since prior study, as detailed above. Chronic right pontine infarct again seen.


Instruction: Generate impression based on findings.

Input: 42-year-old male with history of prostate cancer who presents for preoperative workup. PELVIS:PROSTATE:Prostate Size: 1.5 x 3.8 x 2.7 cmPeripheral Zone: There is a T2 hypointense lesion with corresponding low ADC signal in the left mid gland with extension towards the base and posterior bulging of the contour of the base; this lesion measures 1.5 x 0.7 cm. Additionally, there is a right base T2 hypointense lesion with corresponding low ADC signal measuring up to 0.7 cm (series 1101, image 18).Central Gland: Heterogeneous in appearance consistent with benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: There is bulging of the capsule posteriorly without definite evidence of extracapsular extension. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Prostate lesions as detailed above raise concern for carcinoma (particular lesion located in left prostate) without evidence of seminal vesicle invasion.2.Bulging of the left base prostate capsule posteriorly without definite evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: 28 year old man with atrial fibrillation, referred for cardiac MRI to evaluate for other underlying structural heart disease, fibrosis. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 80 ml (normal range 47+/-19), the LV mass index is 39 g/m2 (normal range 85+/-15), and the LV mass is 77 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 202 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace 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. The right superior and inferior pulmonary veins demonstrate immediate branches anatomy. 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 pericardial effusion.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%3. All four pulmonary veins drain normally into the left atrium. The right superior and inferior pulmonary veins demonstrate immediate branching anatomy, within 1 cm of the ostia. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.