Instruction: Generate impression based on findings.

Input: 41 year old female with a history of sickle cell disease, hepatic cirrhosis secondary to blood transfusions referred for cardiac MRI. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 121 ml/m2 (normal range: 65+/-11), the LVEDV is 192 ml (normal range 109+/-23), the LV end systolic volume index is 49 ml/m2 (normal range 18+/-5), the LVESV is 79 ml (normal range 31+/-10), the LV mass index is 48 g/m2 (normal range 67+/-11), and the LV mass is 76 g (normal range 114+/-24). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. T2 Star value for the myocardium = 39.5 ms and T2 star for the liver = 9.4 ms. There is evidence of iron overload in the liver but not in the myocardium. Pre-contrast native T1 myocardial relaxation times normal (1070 ms). Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 118 ml/m2 (normal range 69+/-14), the RVEDV is 188 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThere is a catheter in the SVC. The SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThe course of the trachea is off-midline (previously noted in chest xrays). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with normal systolic function (LVEF 60%).2. The right ventricle is moderately dilated with normal systolic function (RVEF 64%). 3. There is evidence of iron overload in the liver but not in the myocardium (T2 Star value for liver = 9.4 ms; T2 Star value for the myocardium = 39.5 ms).4. Catheter present in SVC .I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon from its attachment at the greater tuberosity. There is approximately 2 cm of proximal retraction of the tendon from its insertion. The tear involves the entire supraspinatus tendon and extends into the anterior fibers of the infraspinatus tendon. The retracted distal fibers of the supraspinatus tendon are tapered, likely reflecting underlying chronic attritional tearing. The supraspinatus muscle is within normal limits. Increased signal within the remaining distal infraspinatus tendon fibers likely reflects additional tendinosis and partial thickness tearing. There is mild atrophy of the infraspinatus muscle. A tiny focus of increased signal at the subscapularis tendon insertion may reflect a small insertional tear, however otherwise the tendon and muscle are unremarkable.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. A small amount of fluid is present in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. A small amount of fluid is present within the joint, without large effusion. Tiny glenohumeral joint osteophytes suggest minimal osteoarthritis. Increased signal intensity within the superior labrum reflects degeneration, without fluid filled tear seen. Small cysts are seen in the lateral humeral head, likely degenerative in etiology.BICEPS TENDON: There is thickening with increased signal intensity of the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular groove, indicating moderate tendinosis. A small amount of fluid around the tendon may reflect tenosynovitis or simply fluid extension from the glenohumeral joint.

Output: Rotator cuff tear and degenerative arthritic changes of the shoulder, as described above.


Instruction: Generate impression based on findings.

Input: Lung cancer with brain metastases. There are postoperative findings related to right suboccipital craniotomy with an unchanged right cerebellar hemisphere surgical cavity. There is mild surrounding T2 hyperintensity surrounding the cavity, as well as mild linear enhancement anteriorly, but no associated nodular enhancement. There has been interval decrease in size of a right middle frontal gyrus cystic lesion with nodular enhancement and susceptibility effect and trace associated vasogenic edema, now measuring 6 x 10 mm, previously 10 x 17 mm. Likewise, there has been interval decrease in size of an intrinsically T1 hyperintense left superior frontal gyrus lesion, which now measures 2 x 3 mm, previously 3 x 4 mm. There is no evidence of 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Interval decrease in size of the bilateral frontal lobe metastases.2. Postsurgical findings in the right cerebellar hemisphere without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with left hemibody numbness. Evaluate for ischemia. Brain:No restricted diffusion is seen. Two or three scattered small foci of parenchymal T2 hyperintensity are nonspecific. No evidence of edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.Cervical spine:Sagittal alignment of the spine 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 throughout with no evidence of any focal lesion. No epidural abnormalities are suspected.C2-3: Right uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: No significant spinal canal or foraminal stenosis. C5-6: Posterior disc-osteophyte complex formation with a small central disc protrusion which mildly contacts the ventral cord but causes no significant generalized canal stenosis. Moderate left foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Relatively mild degenerative findings, most notable at C5-6 where there is a central disc protrusion which does contact the ventral spinal cord but which causes no significant generalized canal stenosis.2.No acute osseous abnormalities are suspected. No focal spinal cord lesions are seen.


Instruction: Generate impression based on findings.

Input: Tongue cancer with PET findings of possible degenerative disk of thoracolumbar spine. Thoracic Spine: There is focal protuberance of the right ligamentum flavum at T3-4 and T10-11 with mild narrowing of the spinal canal, but no spinal cord compression. The rest of the thoracic spinal canal is widely patent. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Lumbar Spine: There are disc protrusions at L2 through S1 with at most mild spinal canal and neural foraminal stenoses at these levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable, aside from degenerative signal alterations. The cauda equina is unremarkable and the lower spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Miscellaneous: There is partially imaged left cervical lymphadenopathy depicted on the localizer images.

Output: 1. No evidence of metastases involving the thoracic or lumbar spine.2. Mild multilevel degenerative spondylosis involving the thoracic and lumbar spine, without evidence of spinal cord and cauda equina compromise.3. Partially imaged left cervical lymphadenopathy related to metastatic tongue cancer. Please refer to the separate neck MRI report for additional details.


Instruction: Generate impression based on findings.

Input: 66 year old man with history of hypertension, hyperlipidemia, and known aortic root dilation who presents for cardiac MRI as part of serial evaluation of aorta dimensions Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 226 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 100 ml (normal range 47+/-19). The LV mass index is 92g/m2, and the LV mass is 185g. There are no regional wall motion abnormalities present. There is a subtle area of epicardial late gadolinium enhancement involving the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 141 ml/m2 (normal range 82+/-16), the RVEDV is 286 ml (normal range 142+/-31), the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9), and the RVESV is 146 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve leaflets are thickened but open widely. There is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root dimensions are as below:Sinus of Valsalva: 42mm x 42mm x 43 mm (9/2013: 43x 41x 42 mm)Sinotubular junction: 41x43 mm (9/2013: 41 x 40 mm)Ascending aorta at level of PA bifurcation: 49 x 50 mm (9/2013: 49 x48 mm)Proximal Arch: 40 x 43mmMid Arch: 33 x 25mm (9/2013: 34 x37 mm)Descending aorta: 32 x 29 mm (9/2013: 29 x31mm)Pulmonary VeinsAll pulmonary veins drain normally into the left atrium. There are three separate ostia of the right sided pulmonary veins.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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 mildly dilated with normal systolic function. The overall LV ejection fraction is 56%, which is unchanged from the previous study.2. The right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 49%, which is improved from the previous study.3. There is subtle area of epicardial late gadolinium enhancement involving the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. The pattern of late gadolinium enhancement likely represents some form of old myocarditis. Although not previously reported, on re-review of the last 2 studies it was present then as well.4. Dilated ascending aorta. Measurements as above. When compared to the 9/5/2013 study on a side-by-side basis with repeated measurements, the ascending aorta is minimally larger. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Flexion/Extension History: Cephalagia There is loss of the normal cervical lordosis. There is preservation of the vertebral body heights and intervertebral disc spaces. No evidence of instability between flexion, neutral and extension. The neural foramina appear patent.

Output: No findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Diagnosis: Backache, unspecifiedClinical question: Hx of Infantile cerebral palsy, c/o of several months of whole back pain. Also 2 5x5cm soft tissue lesions in upper back (c/f lipomas)Signs and Symptoms: months of whole back painComments: Pt has a VP shunt Checked annually by. Dr. D. Trim. | Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a high signal focus within the central portions of the spinal cord at the C3-4 level associated with volume loss.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a disk bulge present at this level associated with extruded disk material tracking behind the C3 vertebral body and into the neural foramina. There is bilateral uncovertebral osteophyte formation present as well as end plate osteophyte formation. There is moderate encroachment of the right exiting nerve roots at this level and mild encroachment of the left exiting nerve roots at this level. There is disk dessication and loss of disk space height at this level. Overall there is moderate spinal stenosis at this level.At C4-5 there is loss of disk space height, disk dessication and a disk bulge present at this level. There is bilateral uncovertebral osteophyte formation (right worse than left) present as well as end plate osteophyte formation. There is moderate encroachment of the right exiting nerve roots at this level . Overall there is mild to moderate spinal stenosis at this level.At C5-6 there is loss of disk space height, disk dessication and a disk bulge present at this level. There is bilateral uncovertebral osteophyte formation (left worse than right) present as well as end plate osteophyte formation. There is moderate encroachment of the left exiting nerve roots at this level . Overall there is mild to moderate spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are fatty masses in the subcutaneous tissues of the left mid back at the levels of the spinous processes of T6-T9Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There loss of disk space height and a disk bulge at this level eccentric to the right with mild to moderate encroachment of the nerve roots at the left lateral recess.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.Myelomalacia at the C3-4 level.2.Multilevel degenerative changes are present in the cervical spine with encroachment of the left exiting nerve roots at C5-6, the right exiting nerve roots at C4-5, moderate spinal stenosis at C3-4, and mild to moderate spinal stenosis at C4-5 and C5-6.3.Mild to moderate encroachment of the nerve roots at the left lateral recess at L4-5 due to a disk bulge.4.Lipomas in the in the subcutaneous tissues of the left mid back at the levels of the spinous processes of T6-T9


Instruction: Generate impression based on findings.

Input: Acute myeloid leukemia in relapse, low back pain, urinary retention, evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. There is diffuse T1 hypointensity of the vertebral bodies throughout, which is nonspecific. No destructive bony lesions. There is mild narrowing of the spinal canal at T5-T9 level secondary to prominent epidural fat at these levels. The study is limited for the evaluation of subtle signal abnormality in the spinal cord at this level. No acute cord compression is identified.

Output: No acute cord compression is identified. There is mild narrowing of the spinal canal at T5-T9 level with associated prominent epidural fat at these levels. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Acute mental status change and focal neurologic deficits, left upper extremity greater than right upper extremity. Several sequences are degraded by motion.There is a punctate focus of apparent mild diffusion restriction within the anterior medulla (series 406, image 48). Otherwise, no evidence of territorially restricted diffusion.Prominence of the ventricles and cortical sulci is compatible with mild parenchymal volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There is minimally increased T2/FLAIR signal within the periventricular white matter which is nonspecific. There is curvilinear focus of susceptibility artifact along the anterior left superior frontal sulcus with associated questionably increased FLAIR signal as well as questionable isointense material seen on recent CT which could reflect a trace amount of subarachnoid hemorrhage. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening within the paranasal sinuses as well as small mucous retention cysts within the maxillary sinuses. There is near complete opacification of the bilateral mastoid air cells, middle ear cavities, and right greater than left petrous apices. There is nonspecific asymmetric, subtly increased FLAIR signal within the left lateral suboccipital subcutaneous soft tissues. There is diffusely decreased signal within the visualized osseous structures corresponding to diffuse sclerosis seen on CT.

Output: 1.Punctate focus of restricted diffusion in the anterior medulla which could be artifactual or a tiny acute ischemic infarction, correlate with clinical symptoms.2.Sulcal abnormality perhaps representing trace amount of subarachnoid hemorrhage along the left superior frontal sulcus, correlate with history of trauma.3.Nonspecific opacification of the bilateral mastoid air cells, middle ears, and petrous apices, correlate for otomastoiditis.4.Soft tissue edema within the left lateral suboccipital subcutaneous soft tissues which may simply reflect dependent edema, but recommend correlation with clinical examination to exclude soft tissue infection.5.Diffuse abnormal signal throughout the osseous structures corresponding to diffuse sclerosis on recent CT, which is nonspecific but may be metabolic.6.Minimal nonspecific increased T2/FLAIR signal within the periventricular white matter.


Instruction: Generate impression based on findings.

Input: 56-year-old male. Rule out stroke. Images through posterior fossa are unremarkableimages through the supratentorial brain parenchyma demonstrates no definitive evidence of any hemorrhage, mass-effect, edema, midline shift or hydrocephalus. Focal area of low-attenuation in the periventricular white matter with ex vacuo dilatation of the right lateral ventricle is noted. This has the appearance of an old finding and further evaluation with an MRI is recommended.

Output: No evidence of acute findings. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain Mild joint space narrowing of the right knee. Small joint effusion. Please see recent MRI report for ligament and meniscal injuries. Note is made of left ACL repair.

Output: Joint space narrowing of the right knee with joint effusion. Please see recent MRI report for ligament and meniscal injuries.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disc heights are well-maintained. There is disc dessication at L2-L3 and L3-L4. The marrow signal is heterogeneous with scattered foci of T1 hyperintense signal, which may represent focal fatty replacement or fat-containing hemangiomas. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is a 9 mm right renal cyst incidentally noted.T11-T12: Mild disc bulge and bilateral facet degeneration. No significant spinal canal or foraminal stenosis. T12-L1: Mild disc bulge and bilateral facet degeneration. No significant spinal canal or foraminal stenosis. L1-L2: Disc bulge with annular fissure and superimposed central disc extrusion migrating 8 mm superiorly and bilateral facet degeneration. No significant spinal canal or foraminal stenosis. L2-L3: Disc bulge and bilateral facet degeneration. No significant spinal canal or foraminal stenosis. L3-L4: Disc bulge and bilateral facet degeneration. No significant spinal canal or foraminal stenosis. L4-L5: Disc bulge and bilateral facet degeneration. No significant spinal canal or foraminal stenosis. L5-S1: Disc bulge and bilateral facet degeneration. No significant spinal canal or foraminal stenosis.

Output: 1. Mild degenerative changes of the lumbar spine with mild facet arthrosis at L4-L5, L5-S1 and to a lesser degree more superiorly, which may contribute to low back pain.2. Disc bulge, annular fissure and small superimposed central disc extrusion with 8 mm superior migration at L1-L2 as well as disc bulges in the remaining lumbar levels. No significant spinal canal or foraminal stenosis of the lumbar spine.


Instruction: Generate impression based on findings.

Input: Reason: any paraspinal neurofibromas/ History: man with NF1 who is dropping things and having some change in gait CERVICAL SPINE:Minimal leftward curvature, otherwise alignment is anatomic. Mildly heterogeneous marrow signal, overall not worrisome. Multilevel disc desiccation without significant disc space loss. No abnormal signal within the cord.C2-C3: No spinal or neuroforaminal stenosis.C3-C4: No spinal or neuroforaminal stenosis.C4-C5: Small disc osteophyte complex without spinal or neuroforaminal stenosis.C5-C6: Small disc osteophyte complex without spinal or neuroforaminal stenosis.C7-T1: No spinal or neuroforaminal stenosis.Multiple cutaneous nodules likely represent neurofibromas given history. There is symmetric bilateral multilevel prominent cervical nerve roots within the neural foraminal or just beyond which may be within normal limits. No definite neurofibromas within the cervical spine or deep tissues of the neck.LUMBAR SPINE:There is severe levoscoliosis between L1 and L3 with mild dextroscoliosis of the lower thoracic and upper lumbar spine. There is approximately 1.2 cm of leftward subluxation of L3 relative to L2. No abnormal marrow signal. Multilevel disc desiccation with severe disc space loss at L1-L2 and L2-L3. There is anterior wedging of the L2 vertebral body. No abnormal signal within the cord or conus which ends at approximately L1-L2.T12-L1: Bilateral facet arthropathy. No spinal canal stenosis. No neural foraminal stenosis.L1-L2: Bilateral facet arthropathy. No spinal canal stenosis. No neuroforaminal stenosis.L2-L3: Bilateral facet arthropathy. No spinal canal stenosis. Mild right neuroforaminal stenosis.L3-L4: Bilateral facet arthropathy. No spinal canal stenosis.T2 bright lesion in the left neuroforaminal is suspicious for a neurofibroma. Moderate right neural foraminal stenosis.L4-L5:Bilateral facet arthropathy. No spinal canal stenosis. Mild-to-moderate right neural foraminal stenosis. T2 bright lesion in the right neuroforaminal is suspicious for a neurofibroma. Moderate left neuroforaminal stenosis.L5-S1: Bilateral facet arthropathy. No spinal canal stenosis. Left extraforaminal T2 bright lesion is suspicious for a neurofibroma. Right extraforaminal T2 bright lesion is suspicious for a neurofibroma. Moderate left and mild right neuroforaminal stenosis.Multiple cutaneous nodules are evident and likely represent neurofibromas. Multiple sacral nerve roots are thickened with intermediate T2 signal, likely representing neurofibromas.

Output: 1.Multiple lesions involving the lower lumbar spine and sacral nerve roots are suspicious for neurofibromas.2.Prominent nerve roots in the cervical spine may be within normal limits for age. No definite cervical neurofibromas.3.Severe scoliosis of the lower lumbar spine with multilevel spondylosis.4.Numerous cutaneous neurofibromas.


Instruction: Generate impression based on findings.

Input: 50 year-old male with history of angiosarcoma diagnosed 12 -- 07 of the face. Status post neck/head radiation and chemotherapy. Please evaluate. Images through the skull base and including cavernous sinuses remain within normal limits. Paranasal sinuses demonstrate a small retention cyst within the dependent portion of left maxillary sinus and otherwise are unremarkable.Minimal soft tissue thickening at the level of the nasal bridge on the left which appears to extend to the eye lid and over the right zygoma Is again identified. In comparison with the prior examination there is evidence of reduction in the volume of this area of increased soft tissue density. After discussion of the findings with the referring physician, Dr.Undevia it is believed to identified findings are likely post therapy changes and less likely residual tumor. Further follow-up exams is recommended. This area can be better evaluated with an MRI exam.No definitive evidence of any additional area of abnormal soft tissue to suggest angiosarcoma is detected. Extensive bilateral calcifications within the pinna remains a stable. These findings are not believed to be angiosarcoma.No evidence of any bony changes with above-described findings. The right globe, retro-orbital fat and extraocular musculature as well as right lacrimal gland remains within normal limits.No evidence of pathologic adenopathy in the neck.CT of brain with infusion.This examination is essentially within normal limits for patient's stated age of 49. No hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. No abnormal enhancement the brain parenchyma or leptomeninges. Calvarium remains intact.

Output: 1.Negative CT of brain with infusion.2.Slight interval reduction in the size of the edematous soft tissue thickening of the right face as detailed above.


Instruction: Generate impression based on findings.

Input: There are scattered T2 hyperintensities in the cerebral white matter representing chronic small vessel ischemic disease. There is no evidence of acute infarction, mass lesions, or intracranial hemorrhage. There is mild diffuse cerebral volume loss. There is fluid in the mastoids, right more than left. There is status post bilateral lens transplant.

Output: 1. No evidence of acute infarction or hemorrhage. 2. Scattered T2 hyperintensities in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.3. Nonspecific effusions in the mastoids, right more than left. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 79-year-old female with history of lung cancer. Evaluate for bone metastases. Multiple low T1 and T2 signal intensity lesions are noted in the bilateral acetabula, pubic symphysis, sacrum, lumbar spine, and at the base of the right greater trochanter. These lesions do not demonstrate significant enhancement and are compatible with sclerotic metastases, much better evaluated on the recent prior CT. The soft tissues of the pelvis are within normal limits. No significant hip joint effusions.

Output: Widespread sclerotic metastases in the pelvis and lower lumbar spine, much better evaluated on the recent prior CT.


Instruction: Generate impression based on findings.

Input: Clinical question: History arachnoid cyst. Evaluate for change in size. Signs and symptoms: None surveillance imaging. Nonenhanced brain MRI:Examination demonstrates normal anatomical development of brain parenchyma.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination for age.There is revisualization of a CSF signal intensity extra-axial fluid in the midline under the tentorium without appreciable change since prior head CT examination from 11-23-14. Finding is believed to represent a normal anatomical variation of CSF space however less likely possibility of a small arachnoid cyst cannot be entirely excluded. This finding on axial T2-weighted images measures at 10 x 12 mm in transaxial dimensions.There is normal visualization of signal void in major intracranial arterial branches.There is unremarkable signal intensity of intracranial venous sinuses.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits.

Output: 1.Unremarkable nonenhanced brain MRI.2.Stable 10 x 12 mm subtentorial midline CSF space prominence likely representing a normal anatomical variation. Remote possibility of a small arachnoid cyst cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: 53 year old man with history of CAD, nonsustained ventricular tachycardia and atrial fibrillation, referred for cardiac MRI to evaluate for scar burden. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 95 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 60 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1129 ms, which is mildly elevated and suggests mild underlying diffuse fibrosis or infiltration. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 238 ml (normal range 142+/-31), the RV end systolic volume index is 51 ml/m2 (normal range 31+/-9), and the RVESV is 112 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (EF 56%). 2. There is no late gadolinium enhancement to suggest the presence of replacement fibrosis or obvious infiltration or inflammation. However the native T1 time is mildly elevated which can indicate a mild diffuse underlying interstitial fibrotic process. 3. The right ventricle is normal in size with normal systolic function (EF 53%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Marty is a 30-year-old female with BRCA1 gene mutation. Family history of breast cancer in mother, maternal grandmother, maternal aunt, paternal grandmother, and two paternal cousins. Personal history of benign left breast biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary 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: right side weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal patchy high signal lesions on bilateral periventricular white matter indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral distal ICAs, ACAs and MCAs. Vertebrobasilar system appears to be normal.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are difficult to evaluate due to signal loss. The signal loss is more likely related to bilateral shoulders and overlapped bilateral jugular veins, not necessarily related to vertebral ostial stenosis.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.2. Normal intracranial and extracranial MRAs.


Instruction: Generate impression based on findings.

Input: Pain In Right Leg [M79.604] / Pain In Left Leg [M79.605] / Malignant neoplasm of unspecified part of left adrenal gland [C74.92], Reason for Study: ^Reason: history of stage 4 neuroblastoma s/p chemo, radiation, transplant For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is, however, multiple cystic lesions likely within the left kidney lower pole measured about 21mm x 18.6mm. Since there is an abdominal MRI performed today, detailed MR characteristics and diagnostic differential diagnosis of this lesion should reference the formal report of the abdominal MRI examination.

Output: 1. Normal lumbar spine MRI2. About 18.6mm x 21mm sized left kidney inferior pole lesion as described above.


Instruction: Generate impression based on findings.

Input: Ms. Horton is a 54 year old female with a personal history of left breast lumpectomy in 2011 for DCIS followed by radiation therapy. Patient is BRCA 2 gene mutation positive. She has no current breast related complaints. Biopsy proven fibroadenoma at the 7:00 position of the right breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally. Post lumpectomy changes are noted in the left medial breast. Susceptibility artifact from surgical clips are also noted. Previously described 6 mm enhancing mass is stable at the 12:00 position of the right breast. The biopsy proven fibroadenoma at the right breast 7:00 position is noted as a benign enhancing focus, also stable from the prior examination.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 56 years, Male, right temporal lobe epilepsy. Surgical candidate. There is T2/FLAIR hyperintensity involving the bilateral hippocampi, right greater than left. Right hippocampal volume is grossly preserved with the left hippocampus slightly smaller than the right.Remainder of the brain parenchyma demonstrates scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. There is mild supra and infratentorial parenchymal volume loss. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: The right hippocampus is slightly larger than the left and demonstrates asymmetric high T2/FLAIR hyperintensity compared to the left. These findings may be a postictal in etiology.


Instruction: Generate impression based on findings.

Input: 58 year old with biopsy proven DCIS in the left breast, at two sites in upper inner quadrant and lower outer quadrant, presents for MRI evaluation. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Metallic artifacts are identified at anterior 11:00 position and posterior 5:00 position, both from the recent DCIS biopsy.A mild linear enhancement is present in transverse direction at each of the biopsy sites, likely a post biopsy change. No significant enhancing lesion suggesting residual disease is present in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven DCIS in the left breast at two sites. No significant enhancement is present at the site of DCIS biopsy.2. No MRI evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: : Assess for common bile duct stones, pancreatic duct abnormalities, pancreatitis History: 37 y.o. woman with Hx chronic RUQ abd pain S/P cholecystectomy. Admitted to OSH 1 week ago with epigastric pain, Lipase 1700. Abd Ct scan "normal". Question pancreatitis, choledocholithiasis. ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly. Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct is nondistended. No focal pancreatic lesions. Signal intensity within the pancreas is within normal limits. Appropriate response following secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No findings to suggest acute or chronic pancreatitis.2.Biliary system is within normal limits status post cholecystectomy.


Instruction: Generate impression based on findings.

Input: Reason: acute left hip pain History: acute left hip pain There is mild edema and enhancement within the iliopsoas muscle extending from the level of the anterior inferior iliac spine to just proximal to the level of its insertion on the greater tuberosity suggesting a mild strain injury. The tendon of the rectus femoris as well as the rectus femoris muscle appear normal as does the remainder of the musculature of the left hip. There is a trace amount of fluid within the left hip, but no large effusion. Although this examination was not protocoled for detailed evaluation of the acetabular labrum, there is linear abnormal signal intensity traversing the anterior superior labrum suggesting a small tear which is perhaps partial thickness. We see no fluid-filled articular cartilage defects. We see no frank CAM deformity. The bone marrow signal intensity is normal. There is a small amount of free fluid within the pelvis as well as multiple left adnexal cysts which are likely physiologic.

Output: 1. Mild edema of the iliopsoas suggesting a mild strain injury.2. Small anterior superior labral tear.


Instruction: Generate impression based on findings.

Input: History Graves' disease; radioiodine ablation. Hypercalcemia. Evaluate parathyroid glands. RIGHT LOBE MEASUREMENTS: Atrophic measuring 0.9 x 1.6 x 1.7 cmLEFT LOBE MEASUREMENTS: Also atrophic measuring 2.2 x 0.7 x 0.5 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 5 mm nodule near the left thyroid gland could represent a tiny parathyroid but it could also represent a small lymph node. No definite enlarged parathyroid glands identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Atrophic thyroid. No definite parathyroid adenoma identified although there is a subcentimeter nodule on the left which could conceivably represent a small parathyroid gland; correlate with a clear medicine study.


Instruction: Generate impression based on findings.

Input: Left gaze preference, dysarthria, evaluate for ischemic stroke. MRI Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular and subcortical T2 white matter hyperintensity suggestive of chronic small vessel ischemic disease. The brain parenchyma otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right maxillary mucous retention cyst. The orbits and skull are grossly unremarkable. There is a 4 mm thick left frontal scalp lipoma.MRA Brain and Neck: There is no significant steno-occlusive disease involving the major head and neck arteries. There is no evidence of cerebral aneurysms. There is an incompletely evaluated mass that measures at least up to 5 cm within the left thyroid lobe region, which displaces the left carotid vasculature laterally.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of aneurysm, high-grade stenosis, or occlusive thrombus in the major head and neck arteries.3. Partially imaged left thyroid mass.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Sudden visual loss There is restricted diffusion area on the left temporal occipital lobe without evidence of hemorrhage transformation. This lesion indicates acute ischemic infarct.On FLAIR imaging, there is a focal tissue loss on the right frontal lobe middle frontal gyrus and left side pons indicate possible chronic ischemic infarction. High signal intensity on the right insular subcortical white matter on FLAIR images also indicates chronic ischemic lacunae.In addition, there are multiple scattered high signal intensities on centrum semiovale and periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.There is a 9.5 mm sized relatively well circumscribed cystic lesion on the posterior pharyngeal mucosa in between longus coli muscle indicate Thornwaldt's cyst.

Output: 1. Acute ischemic infarction without hemorrhagic transformation on the left temporo-occipital lobe.2. Multi focal chronic ischemic infarctions with underlying non specific small vessel disease.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for osteomyelitis History: left shoulder pain for 3 weeks post deep flu shot injection over lateral deltoid that may have penetrated bone. There is increased T2 and intermediate signal within the subdeltoid bursa with enhancement following gadolinium administration, consistent with subdeltoid bursitis. The underlying bone marrow signal is normal. The supraspinatus, infraspinous, teres minor, and subscapularis tendons are intact without evidence of tearing. The biceps tendon is intact. The glenoid labrum appears normal. There is a tiny amount of fluid within the joint .

Output: Findings consistent with subdeltoid bursitis.


Instruction: Generate impression based on findings.

Input: Patient with an acute hemoglobin drop and right lower extremity sarcoma. Please evaluate for hematoma.IMAGE ACQUISITIONS: CT of the right thigh without contrast enhancement; transverse, coronal, and sagittal views are provided CT of the right thigh without contrast enhancement again shows a large heterogeneous mass within the posterior thigh, which appears comparable to that seen on the MRI from June. Centrally, the mass is of prominently low density, which likely represents a combination of blood, fluid and/or necrosis. The periphery of the mass is isodense to muscle. Although the previous MRI showed findings consistent with internal hemorrhage, there are no specific findings on this exam showing new hemorrhage or hematoma. However, acute extravasation cannot be assessed in the absence of contrast enhancement. The right sacroiliac joint is fused as seen previously.

Output: There is a large soft tissue sarcoma which is comparable in appearance to the previous MRI study. The heterogeneous appearance may be due to internal hemorrhage as seen on the previous MRI; however, the possibility of acute extravasation cannot be determined in the absence of contrast.


Instruction: Generate impression based on findings.

Input: Reason: please eval for potential seizure focus History: new onset right sided seizure There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is increased T2 signal in the periatrial white matter bilaterally which likely represents terminal myelination and prominent perivascular spaces. Otherwise, the brain parenchyma is normal for age. 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. Hippocampi are symmetric without abnormal signal or evidence of atrophy. Midline structures are intact. No heterotopic gray matter.

Output: No underlying structural abnormalities to explain patient's seizures.


Instruction: Generate impression based on findings.

Input: Knee pain. Question of chondromalacia. MENISCI: There is minimal intrasubstance degeneration within the posterior horn of the medial meniscus, however, no discrete tear is identified. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of articular cartilage of the weight-bearing portion of the medial femoral condyle without focal chondral defect. The lateral femoral condyle articular cartilage is intact. There is a focal near full thickness to full thickness degeneration of the articular cartilage of the median ridge of the patella with underlying increased T2 signal compatible with bone edema. There is also generalized thinning of the superior medial and lateral patellar facet articular cartilage. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Chondromalacia of the patellar articular cartilage with underlying bone edema as described above.


Instruction: Generate impression based on findings.

Input: Male; 71 years old. Reason: rule out renal recurrence or metastasis History: hx of renal cell carcinoma sp partial nephrectomy 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: Status post left partial nephrectomy with lower pole fat stranding compatible with post surgical change and similar to prior study. No specific evidence of recurrence.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: Partial left nephrectomy with stable lower pole postsurgical changes. No specific evidence of recurrence.


Instruction: Generate impression based on findings.

Input: Sinus symptoms: Lower extremity weakness, recent fall. Clinical question: Evaluate for fracture. Non-enhanced CT brain:There is no evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Findings consistent with small vessel disease of indeterminate age are noted.Calvarium is intact. Limited view of paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable. No abnormality of the scalp is thickened.Nonenhanced CT of thoracic spine:Examination demonstrate a fracture along the horizontal plane bisecting the 10th vertebral body into superior and inferior halves fracture extends posteriorly and extends across the right pedicle and right pars inter-articularis. On the left fracture also extends across the left pedicle and left pars inter-articularis. There is also fracture of the spinous process of T10. There is evidence of slight retrolisthesis of the inferior half of T10 fracture vertebrae and lower thoracic spine in respect to the upper half of fracture T10 vertebrae. This subluxation result in mass effect and deformity of the cord both anteriorly and posteriorly and the AP diameter of the canal at this level measures 6-mm. axial images demonstrate bilateral pleural effusion which may represent hemorrhage. This finding is significantly more pronounced on the right. There is no definite evidence of paraspinal hemorrhage or edema or mass. Follow-up with an MRI is recommended for further assessment in particular of the cord.There is no definitive evidence of fracture at other levels. The alignment of the spine a bulb and below the fracture remains unremarkable.Heavy calcification of the interspinous ligament throughout the thoracic spine.Nonenhanced CT of lumbar spine:There is no evidence of fracture or subluxation. Extensive degenerative disk disease with large omental hypertrophic spurs and bulging disks results in multilevel height is suspected central spinal stenosis. These findings are more pronounced at L2 -- L3 and L4 -- L5 levels. I suspect multilevel neural foramina compromise also.

Output: 1.Negative CT of brain for post traumatic findings. Small vessel disease of indeterminate age.2.A linear fracture in horizontal plane bisects the T10 vertebral body in superior and inferior halves. The fracture extends to bilateral T10 pedicles and bilateral pars inter-articularis and spinous process.3.There is slight retrolisthesis of the lower T10 vertebral body in respect to the upper. There is resultant 6 mm central spinal stenosis.4.Extensive degenerative changes of thoracic spine and heavy calcification of interspinous ligament5.no evidence of fracture or subluxation in the lumbar spine.6.Extensive degenerative disk disease with multi-level central spinal stenosis and lumbar spine. I suspect that multilevel neural foramina compromise.


Instruction: Generate impression based on findings.

Input: Right arm and leg weakness, numbness, and pain. Brain MRI: There are several small areas of encephalomalacia in the bilateral basal ganglia and pons. There are also scattered foci of high T2 signal in the cerebral white matter. There are scattered foci of supratentorial and infratentorial susceptibility effect, which may represent chronic microhemorrhages. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary sinus. There is a subcentimeter probable Thornwaldt cyst.Brain MRA: There is vertebrobasilar dolichoectasia. Otherwise, there is no evidence of significant steno-occlusive lesions or cerebral aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. Multiple chronic infarcts and small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions in the head and neck.


Instruction: Generate impression based on findings.

Input: 85 year-old female with right frontal bony expansile mass seen on MRI. Focal lesion in the right frontal bone adjacent to the frontal sinus demonstrates internal groundglass opacity and is associated with mass effect but no significant edema on the underlying frontal lobe. These findings are consistent with a focus of fibrous dysplasia. No additional lesions are seen within the calvarium.Mild scattered hypodensities within the subcortical white matter consistent with small vessel ischemic disease, unchanged since prior MRI. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Focal fibrous dysplasia in the right frontal bone. Otherwise, stable small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Recent posterior fossa tumor resection. There are postsurgical changes of a left retrosigmoid suboccipital craniectomy for posterior fossa tumor resection, with a small amount of extra-axial fluid deep tot he craniotomy flap. There is an enhancing nodular lesion with measuring approximately 15 mm in diameter in the posterior left cerebellomedullary angle cistern region, along the lateral aspect of the fourth ventricle. There is also a 12 mm diameter nodular enhancing lesion more anteriorly in the left cerebellomedullary angle cistern region. There is extensive encephalomalacia in the left cerebellar hemisphere and middle cerebellar peduncle and what may represent a small amount of acute ischemia in the left cerebellar hemisphere. There is no midline shift or herniation. The third and lateral ventricles are not enlarged. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are skin fiducial markers.

Output: Recent postoperative findings with evidence of residual tumor in the left cerebellomedullary angle cistern region.


Instruction: Generate impression based on findings.

Input: 44-year-old male with right upper quadrant pain, persistent. Assess for masses or other lesions. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: 15 cm diameter hypodensity at the hepatic dome on axial image 15 of series 3 is indeterminate. This may represent a hemangioma, but further characterization would require dedicated hepatic CT or MRI examination. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Fat-containing inguinal hernias bilaterally. There are some inflammatory changes in the left inguinal canal involving fat within the hernia.

Output: Small amount of fat inflammatory change in left inguinal fat.1.5 cm diameter hepatic dome lesion is indeterminate.Otherwise negative.


Instruction: Generate impression based on findings.

Input: Patient with history of multiple sclerosis presenting with left leg weakness. Brain: Again noted is a moderate burden of periventricular and subcortical white matter T2/FLAIR hyperintense lesions, consistent with patient's known demyelinating disease and unchanged as compared to the prior exam. Multiple of these lesions are associated with marked T1 hypointensity, similar to prior exam. Additional lesions in the corpus callosum and left cerebral hemispheres are unchanged. No abnormal enhancement is noted within the lesions. No intracranial hemorrhage identified. The ventricles and basal cisterns are normal in size and configuration. Brain volume is within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Postoperative changes of previous sinus surgery are noted. Cervical spine:FLAIR signal abnormalities are noted within the anterior and posterior aspect of the spinal cord at the C2 level, along with right posterior aspect of the cord at the C6 level, suggestive of demyelinating disease. No associated enhancement is identified. A couple of additional small lesions may be present but are equivocal.Alignment is anatomic. Vertebral body heights are preserved. There is a central disc osteophyte complex at the level of C6-C7, resulting in mild spinal canal stenosis and foraminal narrowing. Additionally, small disc osteophyte complexes are present at the C4-C5 level with mild foraminal narrowing as well as mild foraminal narrowing at the C3-C4 level are seen. Facet joints are hypertrophied at multiple levels.Thoracic spine:Image quality is reduced by patient motion. Given these limitations, no definite cord abnormalities are identified. Alignment is anatomic. Vertebral body is intervertebral disc spaces are preserved. No disc herniations or spinal canal stenoses are identified. Incidental note is made of the T9 vertebral body hemangioma.

Output: 1. Multiple periventricular and subcortical white matter T2/FLAIR hyperintense lesions with no contrast enhancement, compatible with patient's known history of demyelinating disease, stable as compared to prior exam.2.2 to 3 areas of cord signal abnormality in the cervical spinal cord, suggestive of demyelinating disease with no associated enhancement.3.Thoracic spine images are degraded by patient motion. Given these limitations, no definite thoracic spinal cord abnormalities are identified.


Instruction: Generate impression based on findings.

Input: Ms.JILL CHAVIN, 55 years old, submitted outside study for review. An enhancing focus was noted in the left breast on screening MRI, which was subsequently biopsied.Images performed at Northwestern Memorial Hospital submitted for review: MR directed breast biopsy 12/24/2015, postprocedural mammogram 12/24/2015, diagnostic breast MR 12/18/2015, diagnostic mammogram 4/15/2015, and screening mammogram 4/9/2015.Images submitted for comparison:Screening mammogram 4/9/2014, screening mammogram 4/16/2013, screening MR breast 10/28/2013. SCREENING MAMMOGRAM 4/9/2015: Two standard views of both breasts were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. Patient was recalled for focal asymmetries in the right breast at outside hospital.Right unilateral diagnostic MAMMOGRAM 4/17/2015: Two standard views as well as spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. SCREENING BREAST MRI 12/18/2015: Outside hospital MRI with contrast was uploaded on Dyna CAD for further interpretation. There is a new enhancing focus in the left breast at the 5:00 position, mid to anterior depth, measuring approximately 4 mm in maximal diameter. No additional abnormal enhancement is evident in either breast. Stable bilateral small enhancing foci elsewhere noted. No axillary or internal mammary lymphadenopathy is seen.MR BIOPSY OF THE LEFT BREAST BREAST 12/24/2015: Previously identified enhancing focus in the left breast 5:00 position, anterior to mid depth is the target for the biopsy. Targeting appears appropriate.LEFT UNILATERAL POST PROCEDURE MAMMOGRAM (10/19/2015): A cylindrical clip is placed in the left breast at the 5:00 position, anterior to mid depth.PER OUTSIDE PATHOLOGY:A. the left breast breast lesion, 5:00 position; MR guided core needle biopsy:- Breast tissue with focal atypical ductal hyperplasia, usual ductal hyperplasia, columnar cell change, sclerosing adenosis, fibroadenomatous changes, and rare microcalcifications.

Output: Enhancing focus in the left breast at the 5:00 position compatible with biopsy proven atypical ductal hyperplasia.Clip in appropriate location.Surgical consultation and pathology review is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: s/p osteo and chronic pain History: chronic pain Osseous alignment is anatomic. The bone marrow signal characteristics are normal. Mild heterogeneity of the first metatarsal on several sequences is likely due to incomplete fat suppression. There is small joint effusion, but synovium appears normal without thickening or enhancement. No abnormal enhancing structure is identified. Muscles appear normal. Achilles tendon is intact.

Output: Normal examination without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: There are two punctate foci of restricted diffusion in the right superior frontal gyrus and left inferior frontal gyrus. There is diffuse global volume loss that is more focally pronounced in the bilateral hippocampi, greater on the right. There are scattered predominantly subcortical white matter T2 signal abnormalities, with lesser degree of periventricular white matter involvement, along with symmetric involvement of the bilateral external capsules and subinsular white matter. There is no associated susceptibility abnormality. There is unchanged volume loss in the anterior temporal lobes bilaterally with ex vacuo dilatation of the temporal horns. There is a partial empty sella. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.Two punctate subcortical foci of restricted diffusion in the left inferior frontal gyrus and the right superior frontal gyrus superimposed upon a background of extensive predominantly peripheral subcortical white matter T2 signal abnormalities likely represent acute upon chronic microembolic disease. Therefore, cardiac and cerebrovascular imaging may be useful. A variant of CADASIL and metastatic lesions given the history of colon cancer are perhaps less likely. Nevertheless, further evaluation with contrast enhanced MRI can also be considered for the evaluation of metastatic disease, if clinically indicated.2.Global volume loss that is most pronounced in the hippocampi supports the clinical suspicion of Alzheimer's disease.


Instruction: Generate impression based on findings.

Input: Multiple previous surgeries. Knee pain. Evaluate menisci. MENISCI: The body of the medial meniscus is attenuated, likely reflecting prior meniscectomy. There is an oblique tear through the posterior horn of the medial meniscus with partial extension into the posterior root. The lateral meniscus is unremarkable. ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: There is a 6 mm ganglion within the ACL graft. The ACL graft fibers are intact, however there is increased signal and ligament thickening in the mid substance of the ACL, likely representing fibrosis. No ACL tear is seen. The PCL and collateral ligaments are within normal limits.EXTENSOR MECHANISM: Postsurgical changes are noted in the patellar tendon. Otherwise the extensor mechanism is intact.ADDITIONAL

Output: 1. Findings compatible with fibrosis of the mid ACL, without tear.2. Partial meniscectomy of the medial meniscus with a residual or recurrent tear of the posterior horn.


Instruction: Generate impression based on findings.

Input: Reason: r/o CCM History: tremors The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a small focus of susceptibility effect adjacent to the left medial longitudinal fasciculus which is unchanged compared to the prior exam. There is associated contrast enhancement which is stable compared to the prior exam. There is redemonstration of adjacent draining veins.A stellate focus of susceptibility is present the periventricular white matter adjacent to the frontal horn of the left lateral ventricle which is associated with developmental venous anomaly. It is also stable compared to the previous exam. There is associated enhancement.A small developmental venous anomaly is present along the inferior aspect of the left cerebral hemisphere.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A small left pontine hemorrhagic lesion is stable compared to the prior exam. One possibility is that this represents capillary telangiectasia.2.Left frontal periventricular white matter lesion most likely represents developmental venous anomaly associated with capillary telangiectasia.


Instruction: Generate impression based on findings.

Input: 25-year-old female with diagnosis of Li-Fraumeni syndrome (P 53 mutation) and high risk for breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, limiting the sensitivity of MRI.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Parenchymal enhancement limits sensitivity of the MRI. Given these limitations, no MRI evidence for malignancy. Annual screening with MRI is recommended. BIRADS: 1 - Negative.RECOMMENDATION: G - Ductography/MRI/Etc.


Instruction: Generate impression based on findings.

Input: Male, 26 years old, with history of low-grade astrocytoma, interval scan to Evidence of right temporal lobe resection is again seen. The surgical cavity is stable in size and morphology. Mild parenchymal T2 hyperintensity surrounding the cavity is unchanged in extent. No pathologic enhancement is seen within or around the resection bed.A few scattered foci of nonspecific T2 hyperintensity are demonstrated in cerebral hemispheres, including within the posterior left thalamus. These have not significantly changed and there are no new parenchymal lesions. Diffusion weighted images are unremarkable. A presumed arachnoid cyst along the left operculum is unchanged. Ventricular size and morphology are stable.

Output: 1. No evidence of recurrent tumor.2. Stable presumed arachnoid cyst along the left operculum.


Instruction: Generate impression based on findings.

Input: Reason: Labrum Tear History: Pain ROTATOR CUFF: There is thickening and increased signal and undersurface fraying of the distal supraspinatus tendon without discrete tear. The supraspinatous muscle is within normal limits. The remainder of the musculature and tendons of the rotator cuff are unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Gadolinium is seen extending into the superior labrum and tracking laterally consistent with a SLAP tear (series 5, image 11).There is a focal defect in the glenoid articular cartilage, (series 3, image 18).BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.SLAP tear, as above.2.Tendinosis and undersurface fraying of the distal supraspinatus tendon without discrete tear.3.Focal defect in the articular cartilage along the posterior glenoid.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: evaluate for meniscal disease History: right knee pain + Mcmurray MENISCI: There is maceration of the posterior horn of the medial meniscus with tearing which has both vertical and radial components. The lateral meniscus is normal in signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: There is near full thickness loss of the cartilage overlying the medial tibial condyle and medial femoral condyle. There is marrow edema within the medial tibial condyle subjacent to the posterior horn of the medial meniscus and presumably secondary to above described complex tearing. There is diffuse mild thinning of the patellar cartilage with a focal partial thickness defect in the medial patellar facet. There is mild edema of the underlying patella.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tearing of the posterior horn of the medial meniscus with near full thickness loss of the cartilage overlying the medial femoral condyle and medial tibial condyle.2. Focal partial-thickness defect of the medial patellar facet cartilage.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Desmoid tumor of right mandible status post chemotherapy. Stable x 7 years. Surveillance exam. There appears to be mild residual cortical thinning along the lingual aspect of the posterior body of the mandible on the right side. The mandible otherwise appears to be intact and there is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The orbits and imaged intracranial structures are unremarkable.

Output: No evidence of recurrent tumor in the right mandible.


Instruction: Generate impression based on findings.

Input: Clinical question: r/o acute abnormalities. Signs and Symptoms: new onset ataxia in setting of etoh abuse Nonenhanced brain MRI:Only a single sagittal T1 localizer image acquired. Patient was unable to continue with the exam and moved out of the scanner and examination was terminated.The acquired sagittal T1-weighted series demonstrating no acute intracranial process.

Output: Examination was aborted by the patient due to inability to continue after acquisition of a single sagittal T1-weighted sequence.


Instruction: Generate impression based on findings.

Input: 64-year-old male presenting with confusion and altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Abdominal pain and elevated LFTs. Evaluate pancreatic anatomy and ductal anatomy. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly with the liver measuring 19.6 cm in length. No focal hepatic lesion. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Extensive soft tissue edema throughout the upper abdomen, particularly affecting the pancreatic parenchyma, presumably reflects the patient's anasarca and prior pancreatitis. Evaluation of the mid and distal pancreatic duct is limited by the extensive adjacent edema, however the proximal duct is nondilated and has normal course and morphology. No focal peripancreatic fluid collections are evident.ADRENAL GLANDS: Mild nonspecific nodularity of the left adrenal gland.KIDNEYS, URETERS: Atrophic kidneys with subcentimeter foci of increased T2 signal like representing small cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse mesenteric edema as well as moderate volume ascites.BONES, SOFT TISSUES: Diffuse soft tissue edema compatible with anasarca.OTHER: Partially imaged cardiomegaly.

Output: 1.Limited examination as patient could not tolerate full exam. Diffuse edema throughout the upper abdomen but particularly affecting the pancreas compatible with the history of pancreatitis. No evidence of complication on this noncontrast exam.2.Limited evaluation of the pancreatic duct as described, however the proximal duct is not dilated and has normal morphology.3.Moderate ascites appearing similar to prior.4.Atrophic kidneys bilaterally.5.Partially visualized cardiomegaly.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: ischemic stroke History: as above There is no evidence of acute ischemic lesion on the scan.There are however multifocal susceptibility lesions involving left side insular cortex, basal ganglia, posterior temporal lobe, left thalamus and the left cerebellar hemisphere. Among them, left thalamus lesion measured about 9.5 mm with periportal T2 low signal intensity lesions indicating hemosiderin deposition. Constellation of these findings suggest a possible cavernous malformations.There is no evidence of associated developmental venous anomaly on this scan.Scattered bihemispheric periventricular and centrum semiovale T2/flair high signal intensity lesions are seen. These lesions are nonspecific but may indicate related to small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic lesion.2. Multifocal susceptibility lesions with the largest lesion on the left thalamus, differential diagnosis include cavernous malformations, prior multifocal hemorrhages, parenchymal mineralizations.3. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 60-year-old male with history of multiple myeloma, with newly diagnosed FDG avid lesion in the left femur. There is extensive abnormal low T1 signal within the distal right femoral diaphysis, spanning approximately 17 cm in length, with associated increased T2 signal and enhancement. There is marked cortical thickening adjacent to this lesion with associated endosteal scalloping. Increased T2 signal is noted about the periphery of the associated outer cortex.

Output: Enhancing lesion in the distal left femoral diaphysis with associated cortical thickening and endosteal scalloping consistent with the patient's known history of multiple myeloma, although other differential considerations such as metastatic carcinoma are possible.


Instruction: Generate impression based on findings.

Input: 25-year-old male. History of testicular cancer. Evaluate for mets. Lack of intravenous contrast limits evaluation for solid organ and bowel pathologyABDOMEN:LIVER, BILIARY TRACT: Stable hepatic cyst. No suspicious hepatic mass.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 lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease within limits of noncontrast exam.


Instruction: Generate impression based on findings.

Input: 46 show man with dental x-rays showing "left maxillary cyst." Patient is status post left upper molar extraction about one year ago -- since that time swelling in left cheek. Patient appears to be status post left temporal craniectomy and mastoidectomy with a large defect in the tectum of the petrous bone. There is inferior herniation of the temporal lobe through this bony defect to the expected level of the external auditory canal and middle ear. The inner ear structures are visualized and appear grossly normal. Middle ear structures are not visible and the external auditory canal is not visible. There is soft tissue density present in the expected position of the external auditory canal. Correlate with physical examination and medical history and consider evaluation with MRI.The left maxillary sinus is completely opacified and expanded with bony remodeling extending anteriorly into the soft tissues of the left cheek, medially into the left nasal cavity, inferiorly into the left alveolar process of the maxilla and posteriorly into the pterygopalatine fossa. The left ostiomeatal unit is not visible. The bony floor of the left orbit has normal contour and the orbital contents have normal appearance. This lesion is consistent with a mucocele.There is minimal mucosal thickening in the inferior portion of the right maxillary sinus. The right ostiomeatal unit is not clearly seen to be patent on this study. The frontal sinuses, ethmoid air cells, and sphenoid sinuses are normal in appearance. The right orbit is unremarkable. Limited examination of the soft tissues of the face is normal.The right mastoid air cells and middle ear cavity has normal CT appearance. The right external auditory canal is not clearly patent on this study, however, this may be due to soft tissue compression by the InstaTrak device.

Output: 1. Expansile lesion in the left maxillary sinus causing extensive bony remodeling. The appearance of this lesion is consistent with a mucocele. 2. Postsurgical changes of left temporal craniectomy and mastoidectomy with absence of middle ear structures and EAC. Inferior herniation of temporal lobe through bony defect and soft tissue at expected position of the external auditory canal. Consider evaluation with MRI.The ordering physician was not available by pager at the time of study interpretation and no additional contact information was available.


Instruction: Generate impression based on findings.

Input: Lateral hip pain The left ischiofemoral space is markedly narrowed (4 mm) with edema and tiny foci of fluid within the intervening soft tissues. These changes contact the anterior margin of the sciatic nerve and there is fatty atrophy of the quadratus femoris. Additionally, there is tendinosis and partial tearing of the hamstring tendons at their origin of the ischium which is of uncertain clinical significance. Mild edema is also noted lateral to the greater tuberosity which may reflect a component of mild inflammation but is commonly seen in asymptomatic patients. Evaluation of the acetabular labrum is limited given the lack of intra-articular contrast however there is a band of intermediate signal intensity traversing the anterior labrum, suspicious for tear. Minimal osteoarthritis of the left hip is noted.There are similar findings of ischiofemoral impingement on the right with similar degeneration and partial tearing of the hamstrings at the origin of the ischium. Similar increased signal is noted along the greater tuberosity which again could be of no clinical significance.Mild degenerative arthritis of the pubic symphysis is noted and there is severe degenerative disc disease of the lumbar spine.

Output: 1. Imaging features of bilateral ischiofemoral impingement.2. Although evaluation of the hip joint is limited by lack of intra-articular contrast, there is suspected tearing of the anterior labrum.3. Mild edema along the lateral aspect of the greater tuberosity bilaterally which is of uncertain clinical significance.4. Degeneration and partial tearing of the hamstrings tendons at their origins which again is of questionable clinical significance.5. Degenerative arthritis of the lower lumbar spine with additional findings described above.


Instruction: Generate impression based on findings.

Input: Male, 13 years old, with complex partial seizures and EEG. Evaluate for focal abnormality which might cause seizure. Parenchymal morphology and signal characteristics are within normal limits. No focal lesion, edema or mass effect is detected. Within the limitations of moderate motion artifact, no evidence of any dysplasia or migrational anomaly is seen, and the mesial temporal lobe structures are symmetric and intact. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.

Output: Given moderate motion artifact on some sequences, the evaluation is unremarkable with no specific findings seen to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Hypothalamic hamartoma and gelastic seizures; planning for laser ablation. There has been continued evolution of the signal characteristics of the laser ablation zone within the exophytic hypothalamic hamartoma, which has again decreased slightly in size. There is concentric enhancement at the ablation site in the left lateral aspect of the lesion. The optic apparatus demonstrates normal signal characteristics. There is a non-enhancing T2 hyperintense focus in the region of the right anterior frontal lobe subcortical white matter that measures up to 12 mm, which has gradually increased in size. There is no evidence of acute cerebral infarction or hemorrhage. The ventricles are unchanged in size. There are findings related to prior frontal craniotomy and transcallosal surgery. There are small retained secretions within the left sphenoid and ethmoid sinuses. There is a small amount of persistent high T2 signal within the right mastoid tip air cells.

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


Instruction: Generate impression based on findings.

Input: 44-year-old male status with bilateral DBS insertion. Interval placement of bifrontal DBS electrodes entering the frontal bones bilaterally and terminating in the region of the cerebral peduncles bilaterally. Foci of pneumocephalus are consistent with the patient's history of recent DBS insertion. There is no evidence of postoperative hemorrhage or hematoma formation. There is no evidence of intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. Redemonstration of posterior fossa arachnoid cyst better demonstrated on recent MRI examination.Bilateral bifrontal bone burr holes. The calvaria and skull base are otherwise radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.

Output: 1. Expected postoperative changes from interval placement of bilateral DBS electrodes without evidence of complication.2. Posterior fossa arachnoid cyst, unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stroke. Signs and symptoms: Left-sided weakness, left facial droop. Nonenhanced CT of brain:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Paucity of cortical sulci is within normal for patient stated age. Ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Considering provided clinical data recommend further follow-up with an MRI examination since subtle findings of early acute stroke can be missed on non-infused head CT.Calvarium is intact.Visualized mastoid air cells and paranasal sinuses demonstrate extensive opacification.

Output: 1.No evidence of acute intracranial findings. Considering provided clinical data follow-up with an MRI is recommended to exclude early onset of acute stroke.2.Unremarkable CT examination of brain without contrast.3.Extensive opacification of visualized paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: headache.dizzy, no proprioception History: headache,dizzy, no proprioception Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. There are mucosal thickening on bilateral ethmoid sinuses (left worse than right).Brain MRAMotion artifacts degraded exam quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate bilateral fetal PCAs and normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.For more definitive evaluation of intracranial arterial aneurysm or significant (more than 50%) luminal stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 10% luminal stenosis at the level of the right carotid bulb. Otherwise normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral internal/external carotid, and vertebral arteries. Vertebrobasilar system appears to be smaller in lumen size, however, given circumstances of bilateral fetal PCAs, this should be interpreted as a normal disposition of posterior fossa circulation.

Output: 1. Normal brain MRI2. Normal brain MRA3. Minimal luminal stenosis (about 10%) of the right carotid bulb, otherwise unremarkable Neck MRA


Instruction: Generate impression based on findings.

Input: Reason: R knee pain and swelling History: limited ROM Condylar indentation on the lateral view. There is a trace joint effusion. No acute malalignment. If continued pain consider MRI.

Output: Condylar indentation on the lateral view. If continued pain consider orthopedic consultation and knee MRI.Findings discussed with ER charge nurse.


Instruction: Generate impression based on findings.

Input: 47-year-old female patient with traumatic structural injury. ACETABULAR LABRUM: The acetabular labrum appears grossly intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. SOFT TISSUES: There is mild increased T2 signal within the tendinous insertion of the right gluteus minimus muscle compatible with tendinopathy. A small amount of fluid is also noted about the greater trochanter.ADDITIONAL

Output: Right gluteus minimus tendinopathy and a small amount of fluid about the greater trochanter which may reflect a trochanteric bursitis.


Instruction: Generate impression based on findings.

Input: Constipation, rule out tethered cord Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the lower L1 level. Prone images are motion degraded but do suggest appropriate ventral motion of the conus and cauda equina nerve roots. No evidence of filar lipoma or other lesions within the lumbar spinal canal.No significant disc disease. There is diffuse congenital narrowing of the lumbar spinal canal. There is otherwise no significant spinal canal or neural foraminal stenosis at any level. Paraspinous soft tissues are within normal limits.

Output: 1. No findings to suggest tethered cord.2. Lumbar spinal canal appears narrow on a congenital basis but demonstrates no significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with suspicious breast mass and right axillary lesions presents for for research MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast: There is a heterogeneous lobulated mass in the right breast 12:00 position involving the nipple, morphology and enhancement characteristics highly suspicious for malignancy. The mass measures 4.6 x 4.6 x 5.7 cm (AP x TV x CC). There is associated neovascularity, nipple retraction and periareolar skin thickening up to 7 mm. Additionally, there are benign morphology mildly enhancing masses (three in the lateral breast and one in the medial breast, posterior depth) which are stable when allowing for differences between MRI and mammograms when comparing to an old mammogram from 2010. There is an abnormal size and morphology right axilla lymph node measuring 3.1 x 1.9 x 1.9 cm, highly suspicious for malignancy. There is a small subpectoral node measuring up to 6 mm that has no clear fatty hilum, indeterminate.Left Breast: A few scattered benign enhancing foci are seen. There is no discretely enhancing mass, suspicious morphology or foci of suspicious enhancement. There are a few mildly prominent indeterminate left axillary lymph nodes that maintain fatty hila but have some cortical thickening. A left axilla ultrasound should be considered.

Output: (1) Heterogeneously enhancing right upper outer quadrant mass highly suspicious for malignancy, and measuring up to 5.7 cm in craniocaudal dimension. An ultrasound-guided biopsy with clip placement was performed for this mass today. (2) Abnormal morphology right axilla lymph node measuring up to 3.1 cm. An ultrasound-guided biopsy with clip placement was performed for this today as well. (3) A few mildly prominent indeterminate left axilla lymph nodes with mild cortical thickening up to 6 mm for which left axilla ultrasound should be considered for further evaluation. (4) Small right subpectoral lymph node. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female 67 years old patient has bilateral inguinal pain BONE MARROW: Scattered foci of marrow edema involving the right femoral head, acetabulum bilaterally. No acute fracture is evident.SOFT TISSUES: Mild global muscle atrophy. JOINTS: Severe osteoarthritis affects the left hip joint with osteophytes and intra-articular loose bodies located posteriorly. The left hip labrum appears torn. There is a small left hip effusion.Severe osteoarthritis affects the right hip joint with bone on bone apposition. The right hip labrum appears torn.Severe degenerative changes affect the lower lumbar spine with endplate changes at L4-L5 and L5-S1. There is a disk bulge at the L5-S1 disk space.ADDITIONAL

Output: Severe bilateral hip osteoarthritis, left worse than right. Lower lumbar spine degenerative changes, partially imaged


Instruction: Generate impression based on findings.

Input: History of 3+3 left lateral and medial base prostate cancer diagnosed in 2011 currently on active surveillance. PELVIS:PROSTATE:Prostate Size: 3.7 x 6.0 x 5.3 cmPeripheral Zone: Ill-defined focus of T2 weighted hypointensity in the left base/mid gland (series 801/15) with associated restricted diffusion measuring approximately 7 x 6 mm (series 904/284) which is suspicious for the patient's site of adenocarcinoma.Nonspecific punctate peripheral zone 4 mm focus of T2 weighted hyperintensity and restricted diffusion near the junction with central zone.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 7 mm peripheral zone focus in the left mid-gland/base is suspicious for prostatic adenocarcinoma.Additional non-specific punctate focus near junction of central zone as above.


Instruction: Generate impression based on findings.

Input: 79 years Female (DOB:3/12/1936)Reason: stroke evaluation History: L sided clumsiness/weaknessPROVIDER/ATTENDING NAME: MURRAY J KEENE MURRAY J KEENE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of encephalomalacia involving the medial aspect of the left occipital lobe which involves left lingual gyrus and left cuneus and part of the left fusiform gyrus. It is associated with ex vacuo effect along the left lateral ventricle.There is no evidence for diffusion restriction on the current exam.A punctate hypointense focus is present along the inferior aspect and posterior aspect of the right thalamus. There are punctate foci of signal hyperintensity on T2 imaging in the right thalamus and the basal ganglia bilaterallyThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is no evidence for acute cerebral ischemic infarction.2.There is encephalomalacia involving much of the left occipital lobe which is probably related to prior vascular event.3.Small lesions in the basal ganglia and right thalamus are likely related to prior lacunar infarcts.4.Findings suggest a microhemorrhage in the right thalamus which in isolation is of unknown clinical significance.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.