Instruction: Generate impression based on findings.

Input: There is persistent severe hydrocephalus with essentially unchanged thin ribbon of gray and white matter surrounding the ventricular cavities. There is associated enlargement and deformity of the calvarium. There is somewhat increased bowing of the thinned brainstem towards the left due to the right lateral ventricle, resulting in new compression of the 4th ventricle. There is a left parietal approach ventriculostomy catheter. The septum pellucidum is absent. There is no evidence of intracranial hemorrhage. The major cerebral flow voids are intact.

Output: Persistent severe hydrocephalus with an unchanged thin ribbon of tissue surrounding the ventricular cavities and increased deformity and bowing of the brainstem with new compression of the 4th ventricle.


Instruction: Generate impression based on findings.

Input: 43 years Male (DOB:3/3/1973)Reason: Radicular low back pain. History of spinal stenosis and sciatica. PATIENT IS 406 lbs. History: severe back painPROVIDER/ATTENDING NAME: KRISTINE CHRAPEK CHRISTINE S JUN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a large left paramedian disc extrusion present with disc material compressing the thecal sac and effacing it. There is effacement of the fat at the left lateral recess and to some degree at the right lateral recess. Disc material extrudes behind the inferior aspect of the L5 vertebral body and superior aspect of the S1 segment. This extrusion appears to have progressed relative to the prior exam from 7/10/2015. There is loss of disc space height and disc desiccation at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion present at this level which impresses on the left-sided exiting nerve root. There is unchanged prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a large left paramedian disc extrusion present at L5-S1 which creates spinal stenosis and compresses the nerve roots at the left lateral recess. This has progressed since the prior exam from July 2015.2.There is a left far lateral disc protrusion present at L4-5 which impresses on the left-sided exiting nerve root. There is unchanged prior exam.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with cerebral aneurysm. Assess for aneurysm stability. A 14 x 11 mm mildly T2 hyperintense lesion within the left aspect of pons has not significantly changed in size accounting for differences in imaging technique.A few scattered nonspecific small foci of T2 hyperintensity within the cerebral white matter are also not significantly changed from prior. No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected.There is no finding to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is patent and normal in size.A 4 x 3 mm medially directed aneurysm arising from the anterior genu of the left ICA has not significant changed in size or shape. No new aneurysms are suspected. No significant intracranial vascular stenosis is seen.

Output: 1.Stable nonspecific T2 hyperintense lesion within the left aspect of the pons.2.No significant interval change in size or morphology of a 4 x 3 mm aneurysm arising in the vicinity of the left superior hypophyseal artery.


Instruction: Generate impression based on findings.

Input: Benign multicystic peritoneal mesothelioma status post multiple surgeries. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size signal intensity and enhancement without a focal lesion biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: The spleen is normal in size and morphology without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No free fluid or loculated fluid collection in the upper abdomen. No evidence of bowel obstruction or inflammation.BONES, SOFT TISSUES: Midline abdominal wall surgical changes without complication.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Thick-walled peripherally enhancing right adnexal region cystic lesion measuring 5.3 x 4.8 cm. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a small volume of septated cystic lesion with thin septation in the deep pelvis measuring up to 4.2 x 3.1 cm axially and 6.1 x 2.4 cm in the sagittal plane associated with thin septations. There is also mild smooth peritoneal surface thickening anteriorly in the left hemi-pelvis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Complex right adnexal region cystic lesion and septated cystic lesion with septations in the deep pelvis, findings suspicious for disease, given the patient's history of multicystic peritoneal mesothelioma and a similar appearance on prior studies.


Instruction: Generate impression based on findings.

Input: Upper extremity weakness/numbness. There is reversal of the usual cervical vertebral lordosis. In addition, there are disc-osteophyte complexes at C3 through T1 with generally substantial neural foraminal narrowing bilaterally at these levels. However, there is no spinal cord compression and the spinal cord displays normal signal. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: Disc-osteophyte complexes at C3 through T1 with generally substantial neural foraminal narrowing bilaterally at these levels, but no spinal cord compression.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: ataxia and dysphagia. There are extensive, largely confluent, T2 hyperintense and T1 hypointense lesions involving the supratentorial and infratentorial white matter. In particular, there is a new enhancing lesion in the midline medulla. There are several nearly enhancing lesions, including within the left superior frontal gyrus, parietal lobe, posterior right frontal corona radiata, and right occipital lobe. On the other hand, previously demonstrated abnormal enhancement has resolved. There is a developmental venous anomaly in the right frontal lobe. The ventricles are stable in size and configuration, including diffuse cerebral volume loss as well as cavum septum pellucidum and vergae. The skull, orbits, and extracranial soft tissues are unremarkable.

Output: Extensive demyelinating lesions in the supratentorial and infratentorial brain parenchyma with several nerve enhancing lesions and interval resolution of previously demonstrated abnormal enhancement in other areas.


Instruction: Generate impression based on findings.

Input: 49-year-old with history of left skin sparing mastectomy for IDC ER positive PR negative HER-2 negative in 2007. She is status post left implant reconstruction in 2008, as well as a right breast lift in 2008. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in the right breast.Minimal parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast or left chest wall. Status post left mastectomy and implant placement.The retropectoral implant on the left side appears intact.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 33 year old male with a history of synovial sarcoma of the left wrist s/p resection and radiation therapy. The field-of-view was increased to include the distal forearm. Foci of metallic susceptibility artifact are noted along the ulnar aspect of the wrist compatible with prior synovial sarcoma resection.We see no mass lesion to suggest tumor recurrence. Again seen is reticulation of the subcutaneous fat along the ulnar aspect of the forearm and wrist which appears to have decreased slightly when compared to the prior examination. There is mild edema and enhancement of the pronator quadratus muscle and extensor digitorum muscle which may reflect prior radiation therapy changes, appearing similar to the prior study. The extensor and flexor tendons appear intact.

Output: Posttreatment changes following synovial sarcoma resection without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: 76-year-old male with a hypermetabolic sellar mass and metastatic thyroid cancer to the posterior aspect of T9. BRAIN/PITUITARY:No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. The expected location of the pituitary gland, there is a mass that measure 1.4 x 1.3 cm sagittally and 2.1 cm coronally that appears to have slightly expanded the sellar space and superiorly comes near but does not abut the optic apparatus. No apparent mass effect is seen on adjacent structures. A small portion of the mass enters the left cavernous sinus and abuts the cavernous carotid, however without narrowing. The pituitary stalk is displaced rightward. No calcifications are visualized. The lesion is isodense to brain matter on T1/T2 and demonstrates heterogeneous enhancement.Further, there is a small T2 hyperintense frontal lesion measuring 8 x 9 mm (series #28, image 16) that is nonenhancing. This likely represents a prominent perivascular space adjacent to an area of chronic small vessel ischemic disease.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter without restricted diffusion, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Further, there is mild volume loss without a lobar predominant atrophy pattern.No abnormal meningeal enhancement. Major flow-voids are preserved.Orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. THORACIC/LUMBAR SPINE:There is redemonstration of the known thyroid metastasis centered posterior to the T9 vertebral body, though extending from T8 to T10. The lesion measures 45 x 39 mm in the sagittal plane (series #4, image 17). The mass appears centered between the left posterior elements of T8 and T9. The mass appears to invade the posterior elements of T8, T9, and T10 and vertebral bodies of T8 and T9. Anteriorly the mass severely narrows the spinal canal and the cord appears dysmorphic in appearance. Laterally, there is medial left rib invasion of T8, T9, and T10. The mass also abuts/infiltrates in the right medial T9 rib. There is obliteration of the T8-T9 and T9-T10 neuroforaminal spaces on the left.There is a separate lesion concerning for metastasis centered within the body of T10.Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is trace anterolisthesis of L4 on L5 trace retrolisthesis of L5 on S1. There is multilevel facet disease worse at L4-L5 and L5-S1. Bone marrow signal is benign. The conus medullaris is normal in position at the L1-L2 level.The right thyroid mass is redemonstrated. Further, there is a moderate left pleural effusion. There is extensive fatty deposition within the paraspinal and retroperitoneal spaces.

Output: 1. 1.4 x 1.3 sellar mass without abutment of the (distal likely represents a macroadenoma, or less likely a metastasis.2. Redemonstration of known thyroid metastasis posterior to the T9 vertebral body with invasion as above.3. A separate lesion concerning for metastasis is centered in the T10 vertebral body.4. There is a left pleural effusion.


Instruction: Generate impression based on findings.

Input: Known left breast cancer on neoadjuvant therapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.In the left breast, there is faint residual non-mass enhancement posterior to the Hydromark clip located in the 9:00 mid depth measuring 1.4 cm, but otherwise the breast enhances normally. This includes no enhancement above background at the site of the posterior biopsy clip. No abnormal enhancement is seen in the right breast. A tortuous blood vessel is seen in the medial right breast on the MIP image mimicking an enhancing focus, but is normal in appearance. No abnormal axillary lymph nodes are identified in either axillary region. Right chest wall Port-a-cath is present. Multiple high T2 hepatic lesions are again noted, likely cysts or hemangiomas.

Output: Near complete resolution of abnormal left breast enhancement, with only faint residual non-mass enhancement measuring 1.4 cm posterior to the biopsy clip. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Lethargy. There is moderate patchy cerebral white matter T2 hyperintensity. There are also more focal areas of high T2 signal in the bilateral thalami. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small frontal scalp hematoma.

Output: 1. Probable chronic small vessel ischemic disease and lacunar infarcts in the thalami, but no evidence of acute cerebral infarction, intracranial hemorrhage, or mass.2. Small frontal scalp hematoma.


Instruction: Generate impression based on findings.

Input: 61 year old female with right knee osteoarthritis. MENISCI: The medial meniscus is completely eroded due to extensive synovial proliferation as discussed below. The lateral meniscus is within normal limits. ARTICULAR CARTILAGE AND BONE: Extensive bony erosion throughout the joint from synovial proliferation, as well as complete loss of articular cartilage in the medial and patellofemoral compartments. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Extensive synovial proliferation and underlying bony erosion, with destruction of the medial meniscus and medial/patellofemoral articular cartilage. Findings most likely represent PVNS.


Instruction: Generate impression based on findings.

Input: 16 year old male with history of brain tumor. Status post craniotomy now with fever and draining the scalp wound. Concern for abscess/osteomyelitis. Patient also had syncopal event. Extensive postoperative changes of left frontal craniotomy which extends across the midline is again identified. Epidural thickening is again identified with no distinct cavity formation. The changes appear similar to the prior study however without infusion possibility of an abscess cannot be entirely ruled out. An MRI examination is more sensitive for detection of abscess in this location.The bony density of craniotomy flap and adjacent calvarium remains similar to prior study and with no definitive osteomyelitis. Further evaluation with an MRI is recommended.Underlying brain parenchyma remains unremarkable with the exception of postoperative changes. No evidence of edema, hemorrhage, mass-effect, midline shift or hydrocephalus. Expected postoperative changes of transcallosal approach and is noted. There is no evidence of interval change.Soft tissues of the scalp overlapping the craniotomy demonstrates some thickening however these findings are also similar to prior study. Follow-up exam with an MRI is recommended.

Output: 1.No evidence of interval change since prior exam.2.To exclude an abscess an MRI examination with infusion is recommended.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of pituitary gland [D35.2] / Cerebral aneurysm, nonruptured [I67.1] Pituitary MRIThe pituitary gland shows partial empty sella appearance.There is no measurable residual or recurrent tumor within the sella.The pituitary stalk is located at midline without deviation.Bilateral cavernous sinuses, optic chiasm and suprasellar cistern appear to be within normal limits.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 3.5mm x 3.8mm sized right para ophthalmic aneurysm. Comparing to prior scan, the size and configuration of the aneurysm do not show any interval change.Otherwise, bilateral MCAs and ACAs appear to be normal. Vertebrobasilar system do not show any evidence of intracranial arterial aneurysm or luminal irregularity or stenosis.

Output: 1. No evidence of recurrent or residual tumor seen within the sellar.2. No change of right paraophthalmic aneurysm since prior scan.3. No other aneurysm was found. No intracranial arterial stenosis or irregularity.


Instruction: Generate impression based on findings.

Input: Reason: vertigo in Jan 2-13, MRI lesions, +OGCB History: ibid. Multiple T2 hyperintense foci in the pericallosal region (5/15) and adjacent to the left occipital horn (9/17) are similar to the prior study. There are two new T2 hyperintensities in the left cerebellar peduncle (8/24) and left temporal lobe (5/7). No diffusion restriction is evident.There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.

Output: Multiple scattered T2 hyperintensities including pericallosal T2 lesions. There are 2 new lesions in the left cerebellar peduncle and left temporal lobe. Overall these findings are suspicious for a demyelinating process, such as MS.


Instruction: Generate impression based on findings.

Input: Left upper extremity hyperreflexia Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: No abnormal signal in the cervical cord. No significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Ms. Valerio is a 30 year old female with a history of chest radiation. Personal history of osteosarcoma, off clinical therapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, limiting the sensitivity of MRI.In the right retroareolar region, there is a stable circumscribed mass with benign type kinetics. This was previously evaluated via ultrasound in 2013 and is compatible with a benign fibroadenoma. Stable intramammary lymph node in the medial left breast. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Incidental note is made of a T2 hyperintense left lower thyroid nodule, measuring approximately 1.6 cm. This may have been present on prior MRI from 2013, although this is not certain. It is also not seen with certainty on recent CT Chest from 2013.

Output: (1) No MRI evidence for malignancy in the breasts. (2) Left lower thyroid nodule identified. A dedicated US Thyroid exam can be performed if clinically warranted.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 64 years, Male, esophageal neoplasm. New onset confusion. Evaluate for brain metastases. There is no restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter. There is an additional focus of T2 hyperintensity within the right precentral gyrus, with curvilinear susceptibility, possibly small focus of hemorrhage with adjacent edema. There is no associated diffusion restriction or enhancement. There are prominent Virchow Robin spaces. Brain parenchyma is otherwise unremarkable for age.There is no abnormal meningeal enhancement. Major flow-voids are preservedThere is a mild rounded contour of T1 hyperintensity along the the posterior pituitary gland, which may represent a proteinaceous cyst or atypical appearance of the bright spot. Postcontrast images of the pituitary gland appear grossly unremarkable. The left lens is surgically absent. There is minimal mucosal thickening of the left maxillary sinus. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Periventricular and subcortical T2 hyperintense foci are nonspecific, but statistically most likely to represent small vessel ischemic disease.2.Focus of susceptibility within the right precentral gyrus subcortical white matter, probably microhemorrhage with minimal adjacent edema.3.No enhancing lesion is identified.


Instruction: Generate impression based on findings.

Input: 77-year-old male. Ultrasound noted dilated pancreatic duct. MRCP recommended for additional follow-up. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver morphology consistent with chronic liver disease. No suspicious hepatic mass. No biliary ductal dilatation. Patent hepatic vasculature. SPLEEN: No significant abnormality noted.PANCREAS: Diffuse mild dilatation of the pancreatic duct measuring up to 5 mm in the neck, unchanged. No obstructing lesion or focal pancreatic mass is identified. Normal T1 signal intensity of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Coarsely calcified cystic lesion in the mid left kidney is 1.9 x 1.8 cm, previously 2.2 x 1.9 cm (series 101, image 16), not significantly chanegd. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fat containing umbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable diffuse pancreatic ductal dilatation with no obstructing lesion. No suspicious pancreatic mass. Unchanged complex calcified left kidney cystic lesion.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity pain. History of metastatic lung cancer. Thoracic Spine: There is no evidence of fracture. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There are partially imaged postoperative findings related to right lower lobectomy.Lumbar Spine: There is an enhancing mass in the right aspect of the thecal sac at the L5 level, which measures up to 12 mm in length. There may also be a small amount of enhancing tumor on the left side of the thecal sac at this level. There appears to be engorgement of the surrounding venous structures at this level as well. In conjunction with mild disc bulging, facet hypertrophy, and ligamentum flavum thickening, there is severe spinal canal stenosis at L4-5. There is also mild bilateral neural foraminal narrowing at L4-5 and L5-S1. There is no significant spinal canal or neural foraminal stenosis at the other levels of the lumbar spine. A punctate focus of enhancement in the left posterolateral spinal canal at the level of L3-4 along the length of a vessel may represent focal dilatation of the vessel. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved, aside from multilevel small intravertebral disc herniations. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Enhancing tumor in the right aspect of the thecal sac, and perhaps also in the left aspect of the thecal sac at the L5 level may represent metastatic disease or peripheral nerve sheath tumor for example. In conjunction with mild disc bulging, facet hypertrophy, and ligamentum flavum thickening, there is severe spinal canal stenosis at L4-5.


Instruction: Generate impression based on findings.

Input: MS f/u progression The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of small periventricular white matter lesions, a small right internal capsule lesion, a left thalamus lesion and a right deep cerebellar lesion which are bright on FLAIR MRI and low signal on T1 that are smaller on the current exam compared to the prior exam.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 a mild degree of small periventricular white matter lesions, a small right internal capsule lesion and left thalamus lesion which are smaller relative to the prior exam from 8/4/14.


Instruction: Generate impression based on findings.

Input: History of biliary colic symptoms but no evidence of choledocholithiasis on recent ultrasound, evaluate for choledocholithiasis. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity and enhancement without focal lesions. There is no loss of signal on out of phase images to suggest fatty infiltration. The hepatic vasculature appears patent. The gallbladder appears within normal limits. No biliary ductal dilatation. No biliary filling defects are identified to suggest choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal appearance of the liver and biliary tree without evidence of choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Reason: h/o oligo s/p resection and RT History: surveillance The patient's vessels right frontal craniotomy for removal of a predominantly nonenhancing right frontal lobe mass known to represent oligodendroglioma. There is contrast enhancement along the surgical margins . Some T2 signal changes present along the brain parenchyma adjacent to the intratumor margins remains.A focus of diffusion restriction is present along the right half of the corpus callosum at the level of the genu.Since the prior exam there postoperative changes have regressed.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: 1.There is no convincing evidence for recurrent tumor at this time.2.A focus of diffusion restriction present at the right half of the genuine the corpus callosum is present. Is conceivable that this is related to injury.


Instruction: Generate impression based on findings.

Input: Evaluate hemorrhagic stroke in reported left frontoparietal areaSigns and Symptoms: as above MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a focus of heterogeneous signal present on T2 and FLAIR MRI which is predominantly high signal and associated with local volume loss located in the left centrum semiovale. Adjacent sulci are widened. This suggests this represents a focus of encephalomalacia. There is no associated contrast enhancement.Punctate foci of signal loss identified on susceptibility imaging in the right frontal periventricular white matter and right frontal subcortical white matter.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is fetal origin of the right posterior cerebral artery with a small right P1 segment. The left posterior communicating artery is medium-sized. The right A1 segment is slightly larger than the left A1 segment. The left posterior cerebral artery appears to be larger than the right posterior cerebral artery. The right vertebral artery is much smaller than the left vertebral artery. There is extracranial origin of the right posterior inferior cerebellar artery

Output: 1.There is a focus of encephalomalacia present in the left centrum semiovale.2.A couple microhemorrhages in the right frontal lobe in isolation are probably of little clinical significance.3.No evidence for acute cerebral infarction.4.No evidence for cerebrovascular occlusive disease.5.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: 50-year-old female with knee pain. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness articular cartilage degeneration along the lateral femoral condyle above the anterior horn of the lateral meniscus. There is full-thickness articular cartilage degeneration along the medial femoral condyle above the body of the meniscus. There is full-thickness articular cartilage degeneration affecting the lateral facet of the patella, medial facet of the patella, and lateral facet of the femoral trochlea. There is subchondral signal abnormality likely degenerative in etiology.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Degenerative arthritic changes including full-thickness articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Recurrent tongue cancer. Multiple excisions and chemoradiation. Completed treatment in July 2011. Assess for recurrence. No suspicious masses are appreciated within the oral cavity, pharyngeal, or parapharyngeal soft tissues. There is mild ill-defined T2 hypointensity in the left lateral aspect of the oral tongue which likely reflects scarring from previous resection and is not associated with suspicious pattern of contrast enhancement. The remainder of the tongue is fairly symmetric. There are tiny cervical lymph nodes (measure less than 5 mm even in their longest axis) which are unchanged. The thyroid gland is small. The left submandibular gland is atrophic which is likely related to prior treatment.Cervical spine is notable for multilevel spondylosis with low T1 signal, edema, and enhancement involving the C6 and upper aspect of the C7 vertebral bodies. Finding has progressed since prior studies from 2013. No destructive osseous lesions are appreciated.

Output: 1.There is no convincing evidence of tumor recurrence or cervical lymphadenopathy.2.Significant interval increase in edema and enhancement involving the C6 and C7 vertebral bodies. Finding is most likely on a degenerative basis; however, consider correlation with recent PET if one is available to exclude the remote possibility of neoplastic involvement.


Instruction: Generate impression based on findings.

Input: Persistent pancreatic-cutaneous fistula. Evaluate fluid collections. ABDOMEN:LIVER, BILIARY TRACT: Small dependent gallstones within a normally distended gallbladder without evidence of gallbladder inflammation.No suspicious liver lesion. The hepatic vessels are patent. Demonstrated again is significant dilatation of the common bile duct measuring 2.0 cm compared to 1.8 cm previously. It tapers smoothly to the level of the ampulla without a discrete filling defect or mass. There is mild intrahepatic biliary ductal dilatation, appearing similar to the prior study.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: Decreased intrinsic T1 weighted signal intensity of the pancreas. Diffuse irregular beaded dilatation of the pancreatic duct with mild narrowing at the pancreatic body. These findings are compatible with chronic pancreatitis. Demonstrated again is a drain extending from the stomach into the main pancreatic duct.No measurable peripancreatic fluid collection. There is soft tissue infiltration anterior to the pancreatic head extending to the adjacent segment 2 of the liver and anterior abdominal wall which may be the source of the patient's reported persistent pancreatico-cutaneous fistula which is not discretely demonstrated on this study. There are several susceptibility artifacts in this region also limiting evaluation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Tortuous abdominal aorta with infrarenal aneurysmal dilatation measuring up to 2.5 cm in AP dimension with atherosclerotic disease distally.BOWEL, MESENTERY: No evidence of obstruction. Postsurgical changes from gastric bypass with gastrojejunostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Soft tissue infiltration anterior to the pancreatic head extending to the adjacent segment 2 of the liver and anterior abdominal wall which may be the source of the patient's reported persistent pancreatico-cutaneous fistula which is not discretely demonstrated on this study. Susceptibility artifact in this region also limits evaluation. No drainable fluid collection.Persistent significant main biliary ductal dilatation smoothly to the level of the ampulla without a filling defect or mass lesion.Stigmata of chronic pancreatitis with gastropancreatic stent in place. No specific findings of acute pancreatitis.


Instruction: Generate impression based on findings.

Input: 81-year-old male with history of bilateral adrenal hemorrhage and histoplasmosis diagnosed at outside hospital ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense subcentimeter foci in the liver.SPLEEN: Spleen is top normal measuring 14.8 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Enlarged bilateral adrenal gland masses. Intrinsic T1 hyperintensity with central T1 hypointensity within the bilateral adrenal gland masses. The right adrenal gland measures 3.8 x 2.5 cm (series 11, image 167). Left adrenal gland measures 3.7 x 3.2 cm (series 11, image 168). There is no convincing enhancement of these lesions.KIDNEYS, URETERS: There is T2 hyperintense cystic lesions in bilateral kidneys. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: Gastric diverticulum is present.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Status post left hip arthroplasty.OTHER: No significant abnormality noted.

Output: Bilateral T1 hyperintense adrenal gland masses are compatible with provided history of adrenal hemorrhages. Measurements are provided above and an addendum can be issued when comparisons are made available. If no comparisons are available, follow-up is recommended to ensure resolution.


Instruction: Generate impression based on findings.

Input: 50-year-old female with history of ovarian cancer with new cystic mass in the pancreatic head. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum is present.There is a 9 x 7 mm T2 hyperintense focus in the pancreatic head corresponding to that seen on the prior CT. This lesion communicates with the main pancreatic duct, compatible with a side branch IPMN. An additional 5 x 4 mm T2 hyperintense lesion with communication to the main pancreatic duct located closer to the ampulla also likely reflects a side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged right and left cardiophrenic lymph nodes. Reference right cardiophrenic lymph node measures 11 mm in short axis (series 15, image 23).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreatic divisum anatomy. 2.Cystic lesion corresponding to finding reported on prior CT is compatible with a sidebranch IPMN. Additional T2 hyperintense lesion as described above also likely reflects a sidebranch IPMN. Follow-up is recommended to document stability.


Instruction: Generate impression based on findings.

Input: History of right breast cancer status post mastectomy, radiation and chemotherapy now undergoing left prophylactic mastectomy, need to rule out cancer before surgery Status post right mastectomy with a 4 cm seroma cavity in the right lower axillary/subpectoral region. Scattered fibroglandular density seen in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 22-year-old male with finger pain, fever. Evaluate for osteomyelitis Bone marrow signal intensity is within normal limits. There is no cortical destruction or fracture. Alignment is within normal limits. There is no surrounding soft tissue edema or abnormal enhancement. There is no specific evidence of osteomyelitis.

Output: No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 42 year old with dense breasts and strong family history of breast cancer. Prior benign right breast MRI guided biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. A few scattered cysts are again seen. Right great than left high T1 signal proteinaceous fluid again noted in retroareolar ducts. No suspicious enhancement is seen in either breast. Artifact in the right central breast from the biopsy clip is seen.No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemia. Signs and symptoms: AMS and nonverbal. Nonenhanced brain MRI:No convincing evidence of an acute ischemic stroke however diffusion-weighted images demonstrate mild restriction in the large focus of edema and hemorrhage in the left posterior temporal lobe-parietal, posterior pons and left medial aspect of cerebellum on multiple prior exams.A previously known left posterior pontine cavernoma is again identified and measuring approximately 18 x 17 mm in transaxial dimensions. Fourth ventricle is mildly compressed similar to prior exam and in midline.Edematous/hemorrhagic changes in the left posterior temporal and parietal with resultant regional mass effect demonstrate no significant change since prior exam. FLAIR/T2 hyperintensity in the left inferior cerebellum with subtle mass effect on the fourth ventricle remains also similar to prior exam and representing postop change.Normal size of supratentorial ventricular system and trace deviation of midline to the right is identical to prior study.

Output: 1.No evidence of acute ischemic stroke.2.Patchy foci of restriction in the large region of edematous/ hemorrhagic changes in the left posterior temporal-parietal, posterior pons and left cerebellum are noted.3.Stable focus of edema and hemorrhage in the left posterior temporal/parietal and left cerebellum with resultant associated regional mass effect since prior study.4.Stable cavernoma measuring approximately at 18 x 17 mm transaxial dimensions.5.Stable nondilated supratentorial ventricular system and with trace deviation of midline to the right


Instruction: Generate impression based on findings.

Input: Male, 45 years old, with bladder urgency and up-going toe on the left with left leg cramping. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. No focal lesions are identified. Minimal disc osteophyte formation is seen at C4-5 and C5-6. No significant spinal canal or foraminal stenosis is detected.Thoracic:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The spinal cord demonstrates normal signal intensity and morphology throughout. No focal lesions are appreciated. The intervertebral discs are preserved with no areas of significant spinal canal or foraminal stenosis.

Output: Minimal degenerative findings are seen in the cervical spine. No specific lesions are identified in either the cervical or thoracic spine to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Other headache syndrome [G44.89], Reason for Study: ^Reason: 32F with headaches, sister with recent ruptured brain aneurysm History: headaches No evidence of acute ischemic or hemorrhagic lesion.There is about 5.7 mm downward herniation of cerebellar tonsil through the foramen magnum.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, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.About 5.7 mm downward herniation of cerebellar tonsils indicating possible Chiari I malformation.


Instruction: Generate impression based on findings.

Input: Meningioma, preoperative evaluation. Examination is limited to sequences for operative planning. Again seen are postoperative findings related to parietal craniotomy. As measured before, there is interval increase in size of the posterior falcine meningioma compared to 10/8/2013, which measures 25 x 43 x 28 mm, previously 19 x 34 x 25 mm. However, there is no significant interval change in the extent of confluent T2 hyperintensity in the bilateral posterior cerebral hemisphere white matter consistent with gliosis with possible some vasogenic edema. Encephalomalacia in the left parietal occipital region again seen. Obliteration of the posterior superior sagittal sinus again seen. The ventricles are unchanged in size and configuration without hydrocephalus. There is no midline shift or herniation. The posterior superior sagittal sinus is obliterated. There is a partially-empty sella. Again seen is diffuse right mastoid and right middle ear opacification. Empty sella again seen.

Output: Examination for operative planning demonstrating increase in size of the parasagittal meningioma compared to 10/8/2013 but not significantly changed since 2/9/2015.


Instruction: Generate impression based on findings.

Input: 34-year-old female with history of SDHC dictation. Screening exam. There are subcentimeter benign-appearing lymph nodes scattered about the neck, chest, abdomen, and pelvis. No bulky lymphadenopathy. No evidence of glomus tumor. There is a left maxillary sinus retention cyst. There are postoperative changes in the right neck with carotid artery stent placement. Tiny cysts are present in the breast bilaterally. There is a focus of increased T2 signal abnormality in the left supraclavicular area near the junction of the thoracic duct and left subclavian vein which may represent a dilated thoracic duct. The liver, kidney, pancreas, adrenal glands, gallbladder, uterus, adnexa, bladder, and bowel appear unremarkable. The upper legs appear unremarkable.

Output: No bulky lymphadenopathy in the neck, chest, abdomen, or pelvis. No definite evidence of glomus tumor.


Instruction: Generate impression based on findings.

Input: 63-year-old female with buccal mucosa cancer, compare to previous CHEST:LUNGS AND PLEURA: Stable mild central lobular emphysema and apical scarring. Stable left upper lobe micro-nodule. Mild scarring is identified posteriorly at both bases as well as in the superior segment left lower lobe. No new pulmonary nodules or masses can be identified. Demonstration of a small left pleural effusion/thickening and minimal pleural thickening on the right. MEDIASTINUM AND HILA: New central Port-A-Cath with its tip at the SVC/RA junction. No hilar or mediastinal lymphadenopathy. Coronary calcification is again noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous stable small hypoattenuating lesions, consistent with cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval placement of a G-tubeBONES, SOFT TISSUES: There is new partial collapse of the L4 vertebrae with increased density in the L4 vertebrae. No definite pathologic fracture identified. However MRI of the lumbar spine would be more sensitive.Previously noted small sclerotic lesion in the left iliac crest now demonstrates a radiolucent central portion and well defined peripheral rim that is sclerotic and has a benign appearance.OTHER: No significant abnormality noted

Output: 1. Interval mild pleural thickening/effusion on the left with mild pleural thickening on the right.2. No evidence of metastatic disease.3. Interval placement of a right central Port-A-Cath and NG tube


Instruction: Generate impression based on findings.

Input: 17 year old male with a history of Tetralogy of Fallot with Pulmonary atresia, status post RV to PA conduit containing a bioprosthetic pulmonary valve, and conduit replacement in 2005. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function, and global hypokinesis. There is diastolic flattening of the interventricular septum. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 179 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. There is an RV to PA conduit anastomosis in the distal anterior wall. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 97ml/m2 (normal range 82+/-16), the RVEDV is 176 (normal range 142+/-31), the RV end systolic volume index is 49ml/m2 (normal range 31+/-9), and the RVESV is 88ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlargedMitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Coronary ArteriesBoth the right and left main coronary arteries originate from a single orifice in the right sinus of Valsalva. The left main courses anterior to the aortic valve and bifurcates to the left anterior descending and circumflex. Distal coronary arteries and posterior descending could not be visualized.Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild aortic regurgitation. The angle of the LVOT and aortic valve is distorted due to the presence of the RV to PA conduit on the right side of the ascending aorta. Aortic valve annulus = 30 x 30 mmAortaThere is a left aortic arch. The aortic root and ascending aorta are moderate-severely dilated and deviated leftward due to the RV to PA conduit.Aortic Sinuses = 42 x 42 x 42 mm (Z-score +4)S-T Junction = 40 x 41 mm (Z-score +4)Ascending Aorta = 42 x 43 mm (Z-score +4)Transverse Arch = 31 x 32mmDescending aorta = 17 x 19 mmTricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitationPulmonic ValveThere is a right ventricle to pulmonary artery conduit in place, containing a bioprosthetic pulmonary valve. The conduit courses from the anterior RV wall, passing to the right of the ascending aorta to the PA anastomosis. There is an elevated trans prosthetic velocity of 2.9 m/s. No other stenosis within the conduit. Moderate pulmonary regurgitation, regurgitant fraction 23%.Pulmonary ArteryRV to PA conduit = 30 x 32 mmRPA = 10 x 13 mmLPA = 9 x 15 mmRPA receives 51% of forward flow, LPA 49%.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function and diastolic flattening of the interventricular septum(LVEF 50%). 2. Normal right ventricular size, with mildly reduced systolic function (RVEF 49%)3. Elevated peak velocity of the valved conduit prothesis, and moderate regurgitation.4. Low-normal branch pulmonary artery dimensions with equal flow.5. Severe aortic root and ascending aorta dilation (see measurements above).6. Mild aortic insufficiency.7. Moderate TR8. Anomalous origin of the left main coronary artery, arising from the right sinus of Valsalva and coursing anterior to the aortic valve.


Instruction: Generate impression based on findings.

Input: Reason: Previous panc duct leak, perihepatic abscess, follow up History: s/p OLT. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of an orthotopic liver transplant. Stable arterioportal shunting in the left lobe of the liver. Interval removal of upper abdominal drain. No evidence of loculated fluid collection.SPLEEN: Splenic infarct has decreased in size with increased scarring. Splenomegaly, unchanged.PANCREAS: Previously seen hemorrhage within the pancreatic tail has also resolved. Mildly dilated pancreatic duct in the tail with focal abrupt termination of dilatation in the pancreatic body. The distal pancreatic duct is minimally visualized within the head. The main pancreatic duct again terminates anterior to the distal common bile duct, suggestive of pancreatic divisum. Normal enhancement of the pancreatic head and uncinate process. Relative decreased enhancement within the body and tail, although improved compared to prior exam when the body was not well visualized. This presumably is related the patient's pancreatic injury. No pancreatic or peripancreatic fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild narrowing of the suprahepatic IVC at the anastomosis is unchanged. BOWEL, MESENTERY: Interval removal of percutaneous gastrostomy tube. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval decrease in ascites.

Output: No abnormal fluid collections. Resolution of pancreatic tail hematoma. Pancreatic duct appearance similar to prior. Decreased enhancement of the pancreatic body and tail, although improved compared to prior, likely representing healing pancreatic injury.


Instruction: Generate impression based on findings.

Input: 25-year-old male with history of neurofibromatosis type I. Lower extremity weakness, rule out axial neurofibromatosis. MRA NECK:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic trunk from the aortic arch. The left vertebral artery also arises from the arch which is a normal variant. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Bilateral vertebral arteries are also normal in course and caliber. No evidence of stenosis, dissection, or vascular malformation. Visualized intracranial circulation appears grossly unremarkable.MRI CERVICAL SPINE:Examination of the cervical spine is limited to post contrast sequences. Precontrast sequences were acquired on 3/1/2016 and reported separately. Cerebellar tonsils are borderline low. Again seen is cervical syrinx extending from the mid C4 to the C6-C7 levels with a fragmented appearance. No abnormal enhancement within the cervical cord or discrete mass within the spinal canal or neural foramina is appreciated. Small foci of T2 hyperintensity and enhancement are seen in the subcutaneous soft tissues consistent with neurofibromas.MRI THORACIC SPINE:There is artifact at the level of the lower thoracic cord which makes assessment slightly difficult. No convincing cord signal abnormality however is appreciated. There is no evidence of syrinx or masses within the thoracic cord. No masses or stenosis involving the thoracic spinal canal or neural foramina. Vertebral body heights and alignment are maintained.Small foci of T2 hyperintensity and enhancement are seen in the subcutaneous soft tissues consistent with neurofibromas.

Output: 1. Post contrast images of the cervical spine demonstrate no abnormal enhancement or masses within the cervical spinal canal or neural foramina.2. Cervical syrinx again seen extending from the mid C4 to the C6-C7 levels. Cerebellar tonsils are borderline low measuring 3 to 4 mm below the foramen magnum.3. No masses within the thoracic spinal canal or neural foramina are appreciated.4. MRA neck demonstrates no evidence of stenosis, dissection, or vascular malformation.


Instruction: Generate impression based on findings.

Input: Clinical question: Left hand numbness and left facial droop. Signs and symptoms: Concern for stroke, history of aneurysm. Nonenhanced brain MRI:No diffusion-weighted abnormalities.No convincing evidence of intracranial hemorrhage however if clinical concern for subarachnoid hemorrhage is high follow-up with head CT is recommended.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination demonstrate normal signal intensity on all MRI sequences and without interval change since prior exam. Ventricular systems remain within normal and mid maintained midline.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits. Mild chronic sinusitis mostly in the ethmoid are noted.Nonenhanced brain MRA:All major intracranial arteries and their branches remain patent and stable since prior exam. There is revisualization of a stable small focus of vascular prominence at the origin of left posterior communicating artery measuring maximum of 2.5 mm in size compared to prior study measurement of 2 mm. The finding could represent an aneurysm or an infundibulum at the origin of left posterior communicating artery.Enhanced neck MRA:The visualized aortic arch and the origin is a major vessels are unremarkable.Unremarkable bilateral vertebral arteries and their origins.Right carotid demonstrate a well-demarcated atherosclerotic plaque at the origin of the right internal carotid without hemodynamically significant stenosis.Unremarkable left common and internal carotid arteries.Unremarkable bilateral external carotid arteries.

Output: 1.Nonenhanced brain MRI demonstrate no detectable acute intracranial process. Stable and unremarkable exam otherwise.2.Nonenhanced brain MRA demonstrate no evidence of vascular lumen compromise or stenosis. Focus of vascular prominence at the origin of the left posterior communicating artery representing an infundibulum or an aneurysm is again noted. It measures 2.5 mm compared to prior study measurement of 2 mm. This minimal difference is likely technique related however less likely possibility of true interval increased size cannot be completely excluded.3.Enhanced neck MRA demonstrates a small well-demarcated smooth atherosclerotic plaque at the origin of right internal carotid artery without hemodynamically significant stenosis and unremarkable otherwise.


Instruction: Generate impression based on findings.

Input: Male; 42 years old. Reason: VHL, s/p bilateral adrenalectomy for pheochromocytoma and history of paraganglioma. Abdomen:LIVER, BILIARY TRACT: Scattered subcentimeter cysts but no suspicious liver lesions. No biliary ductal dilatation. Hepatic vasculature patent. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post bilateral adrenalectomy. KIDNEYS, URETERS: Bilateral simple renal cysts. Subcentimeter T1 hyperintense and T2 hypointense lesion in the left lower pole is consistent with hemorrhagic cyst, unchanged (series 1001, image 58). RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal adenopathy. Nonenhancing T2 hyperintense lesion in the left retroperitoneum measures 1.1 x 0.8 cm, previously 1.0 x 0.7 cm (series 601, image 27). T2 hyperintense, enhancing lesion in the midline about 2 cm inferior to the aortic bifurcation measures 1.2 x 1.0 cm, previously 1.2 x 0.9 cm (series 1601, image 98). Imaging findings are consistent with paraganglioma. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T2 hyperintense enhancing extraaxial lesions are again noted along the nerve roots of the lumbar spine. The largest of these measures 1.4 x 1.3 cm at the level of L1, previously 1.0 x 0.9 cm (series 1104, image 289). OTHER: No significant abnormality noted.Pelvis:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T2 hyperintense enhancing extraaxial lesions are again noted along the nerve roots of the lumbar spine. The largest of these measures 1.4 x 1.3 cm at the level of L1, previously 1.0 x 0.9 cm (series 1104, image 289). OTHER: No significant abnormality noted.

Output: 1.No significant interval change in paraganglioma just inferior to the aortic bifurcation and left retroperitoneal non-enhancing reference lesion. Please see measurements above. 2.Mild interval increase in size of largest extra-axial enhancing lesion at the level of the L1 nerve root, compatible with hemangioblastoma. Additional smaller hemangioblastomas are also again seen. 3.No new sites of disease identified in the abdomen/pelvis.


Instruction: Generate impression based on findings.

Input: History of right ear tumor. There is avid nodular enhancement centered in the right geniculate ganglion with extension along the tympanic segment of the facial nerve, which measures up to 8 mm. The bilateral internal auditory canals and labyrinthine structures otherwise appear unremarkable. There are secretions and/or mucosal thickening in the bilateral mastoid air cells. There is a T1 hyperintense and T2 hypointense nodule within the pituitary gland that measures up to 9 mm. The cerebellar tonsils are mildly low-lying, which is unchanged. There is no evidence of intracranial hemorrhage or acute cerebral infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There are also secretions and mucosal thickening throughout the left maxillary sinus and left anterior ethmoid air cells. There is prominence of the adenoids and an enlarged left lateral node of Rouviere that measures up to 9 mm in short axis. There are bilateral lens implants. The orbits otherwise appear unremarkable.

Output: 1. Nodular enhancement centered in the right geniculate ganglion with extension along the tympanic segment of the facial nerve measuring up to 8 mm likely represents a facial nerve schwannoma and appears unchanged since 2007. 2. A pituitary lesion measuring up to 9 mm likely represents a Rathke cleft cyst and appears unchanged since 2007.3. Left ostiomeatal unit inflammatory changes.4. Secretions and/or mucosal thickening in the bilateral mastoid air cells may represent mastoiditis. 5. Nonspecific prominence of the adenoids and an enlarged left lateral node of Rouviere that measures up to 9 mm in short axis. Although this appears unchanged since 2007, further evaluation via endoscopy may be useful. 6. Unchanged mildly cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: 54-year-old woman with left breast cancer (biopsy proven invasive ductal carcinoma) presents for wire localization for surgery. Of note, an area anterior to the biopsy-proven cancer was biopsied via MRI guidance with benign concordant pathology results. On review of the prior studies, there is a biopsy-proven invasive ductal carcinoma in the left breast outer lower quadrant posterior depth. Of note, an additional suspicious area anterior to the biopsy-proven cancer was biopsied via MRI guidance with benign pathology. There was suboptimal visualization of the target on the mammographic views. Therefore, the procedure was converted to an ultrasound-guided localization.Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 22 x 16 x 19 mm at the 4 o’clock position with increased vascularity, 5 cm from the nipple. The lesion was readily visible. The procedure, risks including bleeding, mis-targeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, a 7 cm Kopans needle was placed through the lesion approximately 2cm deep to the center of the target. A spring wire was then deployed. Two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. The procedure was performed by Dr. Udoji. Dr. Abe was present during the procedure at all times. Orthogonal digital specimen radiographs revealed the mass and clip and spring wire to be within the specimen and discussed with Dr. Jaskowiak.

Output: Successful ultrasound guided needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: There is widening of the scapholunate interval, but no intra-articular contrast is identified within the radiocarpal joint to confirm ligamentous injury/disruption, despite maneuvering. A nondisplaced fracture along the distal articular surface of the radius is better seen on subsequent MRI. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 58 seconds

Output: 1. Successful fluoroscopic guided injection of dilute gadolinium for subsequent MRI arthrogram examination. Slight widening of the scapholunate interval without contrast extension into the radiocarpal joint to indicate a tear. Please see subsequent MRI arthrogram examination report for additional details.2. Nondisplaced fracture of the distal radial epiphysis extending to the articular surface.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:1/2/1944)Reason: stroke evaluation History: dysarthriaPROVIDER/ATTENDING NAME: CHRISTINE A BABCOCK BETTY C SOLIVEN MRI of the brainNo diffusion weighted abnormalities are appreciated.There is an extra-axial mass present along the planum sphenoidale measuring 23 mm in width, 16 mm superior-inferior dimension and 21 mm AP dimension which previously measured similar dimensions.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a focus of encephalomalacia present in the inferior aspect of the left cerebellar hemisphere along the left posterior inferior cerebellar artery territory. The intracranial portion of the left vertebral artery flow-void is absent.Small foci of encephalomalacia are present along the right inferior parietal lobule.Normal vascular flow voids are present in the distal carotid and right 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.There is redemonstration of a small right calvarial osteoma.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 70% stenosis along the left M1 segment along the midportion of the M1 segment one centimeter proximal to the bifurcation. There is also stenosis at the origin of the superior division of the left middle cerebral artery.There is 50% stenosis present along the distal right M1 segment proximal to the bifurcation of the right middle cerebral artery.There is a high-grade stenosis present at the proximal portion of the left A1 segment.There is a 60% stenosis present in the right P2 PCA segmentThere is a stenosis present along the proximal portion of the superior division of the left middle cerebral arteryNo flow is identified in the distal left vertebral artery.The anterior communicating artery is small. The right posterior communicating artery is not readily identified. There is an infundibulum at the origin of the left posterior communicating artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. There is an approximately 67% stenosis at the left subclavian artery proximal to the origin of the left vertebral artery On the basis of NASCET criteria there is 80% stenosis at the origin of the right internal carotid artery. There is an approximately 67% stenosis at the origin of the right vertebral artery. There is a high grade stenosis of the origin of the left vertebral artery as well as in the midportion of the left vertebral artery.

Output: 1.There is 80% stenosis at the origin of the right internal carotid artery. 2.There is an approximately 67% stenosis at the origin of the right vertebral artery. 3.There is an approximately 67% stenosis at the left subclavian artery proximal to the origin of the left vertebral artery 4.There is a high grade stenosis of the origin of the left vertebral artery associated with tandem stenosis along the midportion of the cervical right vertebral artery and occlusion of the distal left vertebral artery.5.70% stenosis along the left M1 segment proximal to the MCA bifurcation.6.There is 50% stenosis present along the distal right M1 segment proximal to the bifurcation.7.There is a high-grade stenosis present at the proximal portion of the left A1 segment.8.High grade stenosis along the superior division of the left MCA.9.High-grade stenosis along the left A1 segment of the anterior cerebral artery associated with a hypoplastic right A1 segment.10.There is a 60% stenosis present in the right P2 PCA segment11.Stable meningioma along the planum sphenoidale.12.There are small chronic phase foci of infarction along the left cerebellar hemisphere and right parietal lobe13.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 62-year-old female with HCV cirrhosis with segment 5 hepatic lesion measuring 12 x 10 mm. Evaluate for change in size. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology including left hepatic lobe and caudate lobe hypertrophy as well as fissural prominence.There is a segment 5 hepatic lesion demonstrating T2 intermediate, T1 hypointense, avid arterial enhancement and rapid washout. This lesion demonstrates signal dropout on out of phase images and measures 12 x 10 mm, unchanged.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology with a stable segment 5 lesion, most compatible with fat containing hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: Left lower quadrant pain, thought to be from ovarian cyst but cyst now resolved and still with persistent pain ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal T2 hyperintense focus, likely a cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Physiologic follicles seen in both ovaries, including dominant follicle on right side measuring up to 1.8 cm. Minimal fat stranding near junction of sigmoid colon and left ovary, nonspecific. Intrauterine device present. Visualized junctional zone normal in size, no evidence of adenomyosis. Nabothian cyst formation. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered sigmoid colon diverticula without definite evidence of acute diverticulitis. BONES, SOFT TISSUES: Visualized bone marrow signal within normal limits. OTHER: Small pelvic free fluid, likely physiologic.

Output: 1. Physiologic ovarian follicles. 2. Sigmoid colon diverticulosis.


Instruction: Generate impression based on findings.

Input: Multiple meningiomas and left vestibular schwannoma: dizziness. There are postoperative findings related to right frontal craniotomy. There is no evidence of recurrent tumor in this region There is no significant interval change in the multiple dural-based enhancing lesions, including a dominant right superior parietal convexity mass that measures up to 25 mm. Likewise, there is no significant interval change in the enhancing left internal auditory canal tumor, which measures up to 8 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the multiple intracranial meningiomas and subcentimeter probable left vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Ms. Shea is a 52 year old female presenting for further evaluation of a high probability benign finding in the left breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild to moderate background parenchymal enhancement is noted bilaterally.There are several benign morphology enhancing foci seen in the left breast, predominantly in the outer left breast. The superior one of which contains a fatty hila and is compatible with a benign intramammary lymph node (confirmed on OSH US performed on 08/22/2016). No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Several high probability benign enhancing foci in the left breast, one of which represents a benign intramammary lymph node. A short term 6 month follow-up MRI along with a left unilateral diagnostic mammogram is recommended in order to ensure stability of these findings. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3A - Followup at Short Interval (Within 6 Months).


Instruction: Generate impression based on findings.

Input: 54 year old woman with a strong family history of breast cancer, including her mother at age 82, a maternal aunt at age 60, and a maternal cousin. She presents today for routine screening MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Ms. Sain is a 74 year old female presenting with bilateral indeterminate masses (which will be subsequently biopsied on same day as her MRI). She presents for an MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Numerous enhancing foci are seen in both breasts, compatible with moderate-marked background parenchymal enhancement, limiting the sensitivity of this examination.There is clumped non-mass enhancement identified throughout the entire superior left breast, spanning approximately 8.7 x 5.2 x 4.7 cm (AP x ML x SI). The enhancement extends up to the left nipple base. This corresponds in extent and distribution to the mammographically detected mass/calcifications in the left breast. In the right upper outer breast, there is a round enhancing mass identified measuring approximately 0.7 x 0.5 x 0.5 cm. This corresponds to the sonographically detected mass seen in the right breast 11:00 location. In addition, there are numerous enhancing foci seen scattered throughout the right breast. Some of these likely correspond to the sonographically detected simple cysts/complex cysts/ectatic ducts. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 8.7 cm span of clumped non-mass enhancement in the left superior breast, corresponding to the mammographically detected mass/calcifications in the left breast. A two site biopsy will be performed later today for further evaluation.(2) 0.7 cm enhancing mass in the right upper outer breast, corresponding to the sonographically detected mass. An US-guided biopsy will be performed later today for further evaluation.(3) Numerous enhancing foci scattered throughout the right breast, some of which may represent the sonographically detected simple cysts/complex cysts/ectatic ducts. A short term 6 month MRI follow-up is recommended to ensure stability of these findings. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with apparent focal gyral thickening in the high convexity right posterior frontal region on a prior CT from 2014. The suspected area of cortical thickening seen on prior CT along the high right frontal vertex appears to reflect slight crowding of otherwise normal-appearing cerebral gyri. There is no differential signal intensity or pathologic enhancement to suggest an underlying mass lesion.Elsewhere, moderately extensive scattered patchy foci of T2 hyperintensity are seen within the white matter of the cerebral hemispheres without edema or mass effect. A small chronic appearing focus of encephalomalacia is seen within the superior left cerebellum. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is detected. The ventricles are normal in size and morphology. No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen.

Output: 1.The suspected area of cortical thickening seen on prior CT along the high right frontal vertex appears to represent slight crowding of normal cerebral gyri, likely an anatomic variation.2.No intracranial mass or any other acute intracranial findings are seen. There is evidence of moderately advanced chronic microvascular ischemic disease, as well as a small chronic infarct of the left superior cerebellum.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, status post fall with abnormal finding on CT. Assess for infarct. No evidence of restricted diffusion is seen. No areas of significant parenchymal signal abnormality, edema or mass effect are detected. A few scattered foci of T2 hyperintensity within the cerebral white matter are nonspecific. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology. Marrow signal characteristics are unremarkable. A chronic deformity of the right lamina papyracea is demonstrated.

Output: 1.No evidence of any acute intracranial abnormality.2.In particular, there is no clear lesion to correlate with the finding on prior CT.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with thoracic pain with fractures of T4, T5 and T6. Severe comminuted fracturing of the T5 vertebral body is demonstrated. Fracture fragments have been displaced laterally on both sides. There is complete loss of height anteriorly, and approximately 40% loss of height posteriorly.There is a small fracture of the anterior/inferior aspect of the T4 vertebral body. There is also a severe comminuted compression fracture of the T6 vertebral body. A fracture line is seen traversing the spinous process of T4 and to some degree the lamina, but the fracture fragments are not significantly displaced. At T5, the pars interarticularis on the right is fractured. A lucency is also evident within the left T7 pedicle which does not appear to be traumatic in nature and may simply represent fatty deposition or perhaps a hemangioma. There is, however, lucency through the right T6, T7 and T8 transverse processes compatible with fractures. As a result, there is a focal kyphotic angulation of the thoracic spine centered at the T4 through T6 region. The fractured vertebral bodies show mild retropulsion of vertebral body material, mostly at T5 and T6. This does not appear to significantly compromise the spinal canal, though MRI would provide a better assessment.Elsewhere, the bony spinal canal does not appear to be significantly compromised, though CT is insensitive for soft tissue encroachment. Likewise, except at the fractured levels, the bony neural foramina are preserved. At the level of fracturing, there is narrowing of the T5-6 and T6-7 neural foramina.Numerous rib fractures are identified involving at least T1 through T8 on the right and T1 through T6 on the left. These are at variable stages of repair given the presence of callus formation at some fracture sites.Bilateral small pleural effusions are seen.

Output: 1. Vertebral body fractures involving T4, T5 and T6, most severely affecting T5, with mild retropulsion of vertebral body material.2. Posterior element and/or transverse process fractures involving T4 through T8 as discussed above.3. Numerous bilateral rib fractures.


Instruction: Generate impression based on findings.

Input: Lung cancer with EGFR mutation, on therapy, status post resection and RT. There are stable postoperative findings and encephalomalacia in the right superior temporal gyrus extending into the superior marginal gyrus adjacent and an unchanged focus of T1 hyperintensity and susceptibility effect in the right temporal lobe related to chronic blood products. There is unchanged diffuse cerebral white matter T2 hyperintensity. There is a developmental venous anomaly in the left superior frontal gyrus. Otherwise, there is no evidence of abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with evidence of diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits and scalp soft tissues appear unchanged. There are left maxillary sinus retention cysts. There is a small amount of fluid within the left mastoid air cells.

Output: Stable post-treatment findings in the brain without evidence of recurrent intracranial metastases.


Instruction: Generate impression based on findings.

Input: 90 years Male (DOB:12/14/1925)Reason: eval for tia/stroke History: left facial droopPROVIDER/ATTENDING NAME: DAVID HOWES KEEGAN CHECKETT MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some patchy T2 and FLAIR signal hyperintense lesions are present in the brainstem.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an opacity in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is larger than the left A1 segment. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is mild narrowing of the proximal basilar arteryMRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for acute cerebral ischemic infarction.2.No evidence for significant intracranial cerebrovascular occlusive disease3.There is no evidence for extracranial cerebrovascular occlusive disease4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.5.Patchy lesions in the brainstem are likely vascular related as well and most likely chronic in nature.


Instruction: Generate impression based on findings.

Input: Hypothyroid, adrenal insufficiency, hypo-PTH. The pituitary gland is not enlarged and there is no evidence of sellar or suprasellar mass lesions. A small posterior pituitary bright spot is apparent. The pituitary infundibulum is slightly wide, but otherwise intact and situated in the midline. The optic apparatus, regional internal carotid artery flow voids, and cavernous sinuses are intact. There is diffuse, thin, smooth dural hyperenhancement, along with trace diffuse subdural effusions. The imaged portions of the brain parenchyma are unremarkable.

Output: 1. No evidence of pituitary tumor.2. Diffuse, thin, smooth dural hyperenhancement, along with trace diffuse subdural effusions is nonspecific, but may be related to intracranial hypotension, for example.


Instruction: Generate impression based on findings.

Input: Clinical question: Cord compression. Signs and symptoms: RLE numbness/weakness. Pre-and post-enhanced lumbar MRI:There is normal anatomical alignment of the vertebral column however with straightening of the lumbar lordosis.Lower most visualized thoracic spine demonstrate mild central spinal stenosis at T10 -- T11 secondary to ligamentum flavum hypertrophy changes posteriorly. There is no detectable signal abnormality in the cord and no axial images of the sella were acquiredT12 -- L1 demonstrate mild degenerative changes and unremarkable otherwise.L1 -- L2 demonstrate mild disk disease and mild to moderate ligamentum flavum hypertrophy no central spinal stenosis or neural foraminal compromise. Incidental note at this level is made of partially visualized very large left renal cyst. This finding was present on prior MRI exam from 2008. Due to lack of complete visualization of the lesion precise comparison cannot be made however in this limited view the cyst appear grossly stable.L2 -- L3 demonstrate mild disk disease, shallow broad-based bulging disk and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in moderate central spinal stenosis and bilateral (left greater than right)-year-old foraminal compromise.L3 -- L4 demonstrate mild to moderate disk disease, subtle loss of disk height, broad-based bulging disk, moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophy changes. There is resultant significant central spinal stenosis and moderate (left greater than right) neuroforaminal compromise.L4 --L5 demonstrate mild disk disease and loss of disk height, broad-based bulging disk, moderate to significant bilateral ligamentum flavum hypertrophy and mild bilateral facet disease. Constellation of changes results in significant central spinal stenosis and moderate bilateral neural foraminal compromise.L5 -- S1 demonstrate mild degenerative disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy, mild facet disease and including bilateral facet diffusion. There is no central spinal stenosis. Moderate right neural foraminal compromise secondary to degenerative changes however is identified.Compared to prior exam from 2008 there is progression of the degenerative changes and progression of multilevel central spinal stenosis as detailed above.Post-enhanced images demonstrate expected subtle enhancement of hypertrophic changes of facets and ligamentum flavum and subtly of the endplates. No abnormal enhancement of the cord, conus or cauda equina.

Output: 1.No acute findings.2.Mild to moderate disease and moderate hypertrophic changes of posterior elements throughout the lumbar spine results in central spinal stenosis at L2 -- L3, L3 -- L4 and L4 -- L5 levels.3.Multilevel bilateral neural foraminal compromise as detailed per above. Please see detailed report.4.Progression of disease since prior exam from 2008 and progression of spinal stenosis.5.No concerning abnormal enhancement on post infused images.


Instruction: Generate impression based on findings.

Input: Clinical question: Subarachnoid hemorrhage. Signs and symptoms: Same. Non-infused head CT:As was noted on multiple prior head CTs a large hematoma in the interhemispheric fissure with associated mass effect on lateral ventricles is again identified. The largest transverse axes measurement of hematoma is 29.9-mm which is similar to prior study.The lateral ventricles are shunted and remains stable in their normal size. No change in the position of the right-sided ventricular catheter with the tip in the right frontal horn of lateral ventricle.Examination demonstrates a well demarcated foci of low attenuation of cortex and subcortical white matter of right frontal and parietal lobes along its interhemispheric aspect consistent with ischemic strokes. These findings are best appreciated on axial image 30. The new area of ischemic stroke in the right frontal lobe measures approximately 11.4 x 19.2-mm and the right posterior parietal cortical stroke measures 13.4 x 25.8 mm. the stroke in the right parietal lobe extends inferiorly to involve the singlet gyrus.There is generalized paucity of cortical sulci in bilateral cerebral hemisphere and with suspected interval worsening suggestive of cerebral edema and possible additional nondetectable on this exam cortical strokes. MRI can further delineate the extent of cortical strokes.Residual blood in the subarachnoid space is again identified. There is no suggestion of any additional subarachnoid hemorrhage since prior study.

Output: 1.No evidence of new hemorrhage since prior study.2.Foci of ischemic cortical stroke in the right frontal and parietal lobes with no evidence of hemorrhage.3.Suspected further effacement of cortical sulci in bilateral cerebral hemispheres as detailed.4.The stable size of hematoma in the interhemispheric fissure since prior study.5.Stable size and right-sided ventricular catheter since prior exam.


Instruction: Generate impression based on findings.

Input: History of spinal stenosis in the cervical region. Per Epic note: several months of increasing right lower extremity pain and weakness especially while driving for long hours. There are postoperative findings related to anterior cervical discectomy and fusion from C6 to T1. At C5-6, there is an eccentric right disc-osteophyte complex that results in moderate-to-severe right neural foraminal stenosis, but no significant spinal canal stenosis. At C6-7, there is bilateral facet and uncovertebral joint hypertrophy with perhaps mild-to-moderate bilateral neural foraminal stenoses. At C7-T1, there is bilateral facet and uncovertebral joint hypertrophy with perhaps minimal bilateral neural foraminal stenoses. There is no significant spinal canal or neural foraminal stenosis at the other levels of the cervical spine. The cervical spinal cord displays normal signal characteristics and morphology. The cervical spinal column alignment is near-anatomic. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to anterior cervical discectomy and fusion from C6 to T1.2. At C5-6, there is an eccentric right disc-osteophyte complex that results in moderate-to-severe right neural foraminal stenosis, but no significant spinal canal stenosis. 3. At C6-7, there is bilateral facet and uncovertebral joint hypertrophy with perhaps mild-to-moderate bilateral neural foraminal stenoses. 4. At C7-T1, there is bilateral facet and uncovertebral joint hypertrophy with perhaps minimal bilateral neural foraminal stenoses.


Instruction: Generate impression based on findings.

Input: 5-week-old male with apparent life threatening episode and reported cyanosis. Rule out bleed or skull fracture. There is no evidence of intracranial hemorrhage, mass or midline shift. Hypodensity in the subcortical white matter along the convexities and in the frontal and parietal regions bilaterally is slightly lower T1 signal than expected for unmyelinated parenchyma and could represent gliosis from prior ischemia. An MRI is recommended for better visualization of these areas, if clinically indicated.The ventricles and basal cisterns are normal in size and configuration for the patient's age.The calvaria and skull base are radiographically normal without evidence of fracture.

Output: Subcortical white matter hypodensity in the frontal and parietal regions bilaterally shows lower T1 signal than expected for unmyelinated parenchyma. An MRI is recommended for better visualization of these areas, as clinically indicated.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:6/5/1961)Reason: Re-evaluate disease status following additional therapy; History: compare to previous scan and provide bi-dimensional measurements per RECIST 1.1PROVIDER/ATTENDING NAME: JASON JOHN LUKE JASON JOHN LUKE On susceptibility imaging there are multiple subcortical punctate foci of signal loss present in both hemispheres. Additionally there are punctate foci of signal loss in the basal ganglia and left internal capsule as well as subcortical white matter of the cerebellar hemispheres bilaterally. Many of these lesions can also be seen on the T2 and FLAIR images. In particular one located in the right caudate nucleus has evolved and is relatively stable compared to the 3/4/2016 exam.The patient is status post right-sided parietal craniotomy. There is encephalomalacia present along the right inferior parietal lobule extending to the right temporal lobe associated with susceptibility effect.There is redemonstration of diffuse periventricular and subcortical white matter confluent signal changes which were also present on the previous exams to a similar extent.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.There are multiple hemorrhagic type lesions scattered throughout the brain which appear relatively stable compared to the exam from March. The patient is known to have metastatic melanoma to the brain.2.Extensive and diffuse white matter signal changes have been present on prior exams and are most likely treatment related.


Instruction: Generate impression based on findings.

Input: Clinical question: Pituitary mass. Signs and symptoms: Pituitary mass. Pre- and postenhanced brain MRI: Examination demonstrated a pituitary macroadenoma on the left and with extension into the left cavernous sinus and subtle extension across the midline to the right. There is subtle elevation of pituitary secondary to macroadenoma however without extension into the basal cistern similar to prior exam. The macroadenoma measures approximately 19 mm in longest transverse axis at 19 mm on coronal postenhanced series compared to prior study measurement of 21.2 mm. The cranial cephalad axis of adenoma measures at 10.6 mm compared to prior study measurement of 10.7 mm. The pituitary gland and stalk are deviated to the right and without change since prior exam. There is no convincing evidence of any appreciable interval change in size, morphology or the signal intensity of this lesion since prior exam.Pre and postcontrast enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate normal anatomical development and the signal intensity of brain parenchyma on all MRI images. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium and orbits without abnormal enhancement.

Output: 1.Stable pituitary macroadenoma in the sella on the left, extension into left cavernous sinus since prior study.2.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Left 3rd, 4th and 6th nerve palsy. CT evidence of suprasellar mass. Fiducial markers were attached on the scalp for the purpose of Stealth guidance.There is expansile suprasellar mass (24mm x 34mm x 34mm) which shows slightly inhomogenous iso signal intensity with brain parenchyme on T1 weighted images and slightly high signal intensity on T2 weighted images. On Gad enhancement, there are nodular and linear enhancements especially superior and central part of the mass indicating inhomogenous enhancement. Considering signal voids on Gradient echo images within the center of the mass, the inhomogenous enhancement pattern indicates intra tumoral hemorrhage with some edema.The mass displaces optic chiasm superiorly and extending toward left side cavernous sinus especially middle and posterior aspect displacing cavernous sinus segment of the left ICA laterally indicating possible left cavernous sinus invasion. However, left side cavernous itself shows thin but normal enhancement indicating cavernous sinus itself is patent without evidence of engorged left supra-ophthalmic vein.The differential diagnosis include pituitary macroadenoma with intratumoral hemorrhage most likely, the possibility of craniopharyngioma, meningioma or metastasis is less likely.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Suprasellar mass with inhomogeneous enhancement with possible left cavernous sinus invasion, the likely diagnosis would be pituitary macroadenoma as described above.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.