Instruction: Generate impression based on findings.

Input: Reason: HCC screening History: Hepatitis C cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Trace perihepatic ascites.There is redemonstration of a lesion within hepatic segment 7 which has not significantly change in size with reference measurements below. The lesion demonstrates increased T2 signal (more pronounced than prior), restricted diffusion, and arterial enhancement without definite washout.There is an additional arterially enhancing lesion more posteriorly within hepatic segment 7 with reference measurements below which demonstrates washout on more delayed images.The hepatic vasculature appears patent. Upper abdominal collateral vessels.Cholelithiasis. No significant biliary ductal dilatation.SPLEEN: The spleen is enlarged and measures up to 20 cm in the craniocaudal dimension. T2 hyperintense lesion within the anterior aspect of the spleen most consistent with hemangioma, not significantly changed.PANCREAS: No significant abnormality noted. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Susceptibility artifact related to IVC filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/16/2016 14:00:00)HEPATIC SEGMENT 7 ANTERIOR LESION: 1.3 x 1.0 cm (Image 154, Series 10); 1.3 x 1.0 cm on prior (7/28/2015) (Image 15, Series 10).HEPATIC SEGMENT 7 POSTERIOR LESION: 0.7 x 0.6 cm (Image 170, Series 10); 0.7 x 0.6 cm on prior (7/28/2015) (Image 27, Series 10).

Output: 1.Hepatic segment 7 arterially enhancing lesion which lacks washout but demonstrates newly increased T2 signal and restricted diffusion and is suspicious but not definitive for early HCC. 2.Additional hepatic segment 7 arterially enhancing 7 mm lesion which newly demonstrates washout and which is suspicious for HCC.3.Cirrhotic liver with sequelae of portal hypertension.


Instruction: Generate impression based on findings.

Input: 32 years old, Female, Reason: assess thyroid for nodules and neck for LNs, previous diagnosis of thyroid nodule at OSH History: lump sensation in throat RIGHT LOBE MEASUREMENTS: 4.0 x 1.7 x 2.0 cmLEFT LOBE MEASUREMENTS: 3.7 x 0.9 x 1.4 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Echogenicity of the right thyroid lobe is normal in appearance. There is a small hypoechoic nodule with some vascular flow which may be solid. There are no calcifications or hypoechoic rim associated with this nodule. The subcentimeter nodules likely not causing patient's reported symptoms.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing left level 2 lymph node measures 0.7 x 0.1 by 0.9 cmOTHER: No significant abnormality noted.

Output: Subcentimeter hypoechoic solid appearing nodule in the right thyroid lobe is indeterminate on this exam although is favored to be benign. No lymphadenopathy as clinically questioned. No specific findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: 63-year-old male with hepatic encephalopathy, right liver lesion. Triple phase MRI abdomen to evaluate right hepatic lesion. Also evaluate for possible portal vein thrombus is possible. Exam limitations related to extensive respiratory motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. In hepatic segment 4A, there is a 2.1 x 2.6 cm T1 hypointense, T2 hyperintense focus demonstrating restricted diffusion (series 10 image 40, series 7 image 13, series 8 image 98). On the postcontrast series, this lesion is isointense to the remaining parenchyma and shows no definite washout. The splenic vein and splenic/SMV confluence are patent. There is marked attenuation of the main portal vein and intrahepatic portal veins with a size discrepancy at the portal confluence. There is intraluminal thrombus at the origin of the main portal vein (series 11 image 272).Few small scattered hepatic cysts. Normally distended gallbladder with nonspecific wall thickening, which could be related to the chronic liver disease. SPLEEN: Splenomegaly measuring 14.5 cm in length. Splenic varices and a splenorenal shunt are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing supraumbilical ventral hernia (series 1 image 13).OTHER: No significant abnormality noted.

Output: 1.In hepatic segment 4A, there is a 2.1 x 2.6 cm lesion demonstrating restricted diffusion. Although no arterial enhancement or washout is seen, this lesion remains suspicious for HCC.2.Marked attenuation of the main and intrahepatic portal veins with size discrepancy at the portal confluence where small intraluminal thrombus is seen. Chronic thrombus is favored.3.Cirrhotic morphology with sequelae of portal hypertension including splenomegaly and collateral varices.


Instruction: Generate impression based on findings.

Input: Cholestasis and pruritus. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. The patient is status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post cholecystectomy without biliary ductal dilatation or other hepatic abnormality.


Instruction: Generate impression based on findings.

Input: Male 30 years old Reason: Assess left testicle for LN and masses History: Small LN in left inguinal area RIGHT TESTIS: Status post right orchiectomyLEFT TESTIS: Left testis measures 4.3 x 3.1 x 2.3 cmRIGHT EPIDIDYMIS: Status post right orchiectomyLEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: There is a small, 1.6 x 0.5 cm lymph node in the left groin at the location where the patient palpates a nodule.

Output: Normal left testis. Status post right orchiectomy. Small left inguinal lymph node.


Instruction: Generate impression based on findings.

Input: T4aN1 squamous cell carcinoma of the left base of the tongue status post induction chemotherapy. There has been interval decrease in size of the infiltrative mass arising from the tongue base, measures up to approximately 30 mm. There is no evidence of significant cervical lymphadenopathy. The thyroid and salivary glands are unremarkable. The osseous structures are grossly intact. The imaged intracranial structures are unremarkable. There is staphylomatous deformity of the globes.

Output: Interval decrease in size of the tongue base squamous cell carcinoma and no significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Reason: please eval for abscess, mass, compression History: pt with severe back pain and ttp Mild levoscoliosis, otherwise alignment is anatomic. Vertebral body heights are intact. Mild disc desiccation at L3-L4. Benign marrow signal. No abnormal enhancement. Normal signal from the distal cord and conus which ends at L1-L2T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Small left neuroforaminal protrusion. Mild ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L4-L5: Mild diffuse disc bulge. Mild ligamentum flavum thickening. Minimal left neural foraminal stenosis. No spinal canal stenosis.L5-S1: Mild diffuse disc bulge. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Small left neural foraminal protrusion at L3-L4 without significant spinal or neural foraminal narrowing at any level.


Instruction: Generate impression based on findings.

Input: Thyroid nodule RIGHT LOBE MEASUREMENTS: 4.2 x 2.0 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.6 x 1.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Several small nodules the largest measuring 1.2 x 0.5 x 0.9 cm located at the lower pole and appearing mostly hypoechoic.LEFT LOBE: Similar to the right several small nodules with largest lower pole measuring 1.2 x 0.7 x 0.9 cm. This nodule also appeared mostly hypoechoic.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small level 2 lymph nodes.OTHER: No significant abnormality noted.

Output: Multiple small bilateral thyroid nodules as described above.


Instruction: Generate impression based on findings.

Input: Female, 71 years old. Reason: r/o growth of nodules History: multinodular goiter RIGHT LOBE MEASUREMENTS: 3.3 x 1.8 x 1.0 cmLEFT LOBE MEASUREMENTS: 3.1 x 1.3 x 1.0 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous echotexture, without focal lesion.LEFT LOBE: A left lower pole solid echogenic nodule measures 1.2 x 0.6 x 1.0 cm, unchanged from prior, mildly heterogeneous, noncalcified, with internal vascularity. The remainder of the left thyroid lobe is heterogeneous, nodular, and vascular, without other focal lesion identified.ISTHMUS: Heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are again identified. A right level 5 lymph node measures 1.0 by 0.8 x 0 .3 cm, with a fatty hilum. A left level 3 lymph node measures 0.5 x 0.2 x 0 .7 cm, with a fatty hilum.OTHER: No significant abnormality noted.

Output: Unchanged size of a left lower pole echogenic thyroid nodule, with redemonstration of a diffusely heterogeneous thyroid gland.


Instruction: Generate impression based on findings.

Input: 5 lumbar vertebral bodies visualized. The last fully formed disc is L5-S1. There is normal alignment of the vertebral bodies with normal marrow signal. No evidence of vertebral body collapse. The conus medullaris ends at the level of L1-L2.T12-L1: No evidence of spinal or neural foraminal compromise.L1-L2: No evidence of spinal or neural foraminal compromise.L2-L3: No evidence of spinal or neural foraminal compromise.L3-L4: There is minimal disc bulge. No evidence of spinal or neural foraminal compromise.L4-L5: There is desiccation of the disc with minimal disc bulge. No evidence of spinal or neural foraminal compromise.L5-S1: No evidence of spinal or neural foraminal compromise.

Output: Minimal disc bulge at L3-L4 and L4-L5 with no evidence of spinal stenosis or neural foraminal compromise. Findings are stable since the previous MRI of the lumbar spine.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, with multiple sclerosis and gait problems, follow-up progression. Numerous T2 hyperintense lesions are evident involving the corpus callosum, the periventricular and juxtacortical white matter of the cerebral hemispheres, brainstem and cerebellum. Since the prior examination, numerous lesions have increased in size or have newly developed. The largest progressive lesion is evident in the right frontal juxtacortical white matter and shows marked corresponding T1 hypointensity. The remaining lesions demonstrate mild to moderate T1 hypointensity. No evidence of significant generalized mass effect is seen. Brain parenchymal volume is relatively preserved. No abnormal extra-axial fluid collections are seen. The ventricles remain normal in size and morphology. A mucous retention cyst seen in left maxillary sinus.

Output: Progression of demyelinating disease in the brain.


Instruction: Generate impression based on findings.

Input: Assess extent of resection and 4 vent outflow obstruction status post resection of medulloblastoma. There are interval postoperative findings related to suboccipital craniotomy for partial resection of a fourth ventricular tumor. The residual tumor measures up to approximately 35 mm in width. There is a channel for cerebrospinal fluid to communicate between the upper fourth ventricle and cerebral aqueduct, but the inferior fourth ventricle and outflow pathways remains largely effaced. There is interval insertion of a right transfrontal ventricular catheter that terminates in the right lateral ventricle. There is interval slight decrease in size of the third and lateral ventricles. There is hemorrhage layering within the occipital horns of the bilateral lateral and third ventricles. There are also globular structures with susceptibility effect and mildly high T2 signal in the lateral and third ventricles around the foramina of Monro. There is persistent diffuse periventricular white matter T2 hyperintensity. There are small areas of high T2 signal and restricted diffusion in the medial cerebellum along the surgical approach. There is fluid within the right maxillary sinus.

Output: 1. Interval partial resection of a fourth ventricular tumor and insertion of a right transfrontal ventricular shunt catheter. 2. Interval slight decrease in size of the third and lateral ventricles. 3. Globular structures with susceptibility effect in the lateral and third ventricles around the foramina of Monro may represent blood clots or displaced fragment of hemorrhagic tumor.


Instruction: Generate impression based on findings.

Input: 61 year old with history of ischemic cardiomyopathy admitted with worsening heart failure being worked up for advanced options. Left VentricleThe left ventricle is massively dilated with severely reduced systolic function. The overall LV ejection fraction is 10%, the LV end diastolic volume index is 403 ml/m2 (normal range: 74+/-15), the LVEDV is 678 ml (normal range 142+/-34), the LV end systolic volume index is 363 ml/m2 (normal range 25+/-9), the LVESV is 611 ml (normal range 47+/-19), the LV mass index is 163 g/m2 (normal range 85+/-15), and the LV mass is 275 g (normal range 164+/-36). The left ventricular dysfunction is global with regional variation. There is thinning with dyskinesis of the mid to apical inferior wall and severe hypokinesis of the basal to mid anterior, anteroseptal, and inferoseptal walls. There are two distinct late gadolinium enhancement patterns. The first is transmural late gadolinium enhancement in the mid to apical inferior walls. This finding is most likely due to myocardial infarction and suggests that these segments are not viable. The second is a mid-wall stripe pattern in the interventricular septum. This finding is a non-infarction pattern and suggests a second non-ischemic etiology of the LV dysfunction, in addition to the ischemic etiology. Given the fact that there is also a significant non-ischemic component to the LV dysfunction, it is difficult to predict whether the other myocardial segments are viable. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is moderately dilated with mild-moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 143 ml/m2 (normal range 82+/-16), the RVEDV is 241 ml (normal range 142+/-31), the RV end systolic volume index is 86 ml/m2 (normal range 31+/-9), and the RVESV is 145 ml (normal range 54+/-17).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate-severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern with common origin of right innominate and left common carotid (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC is dilated. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsRenal cyst is noted. 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. Severe LV dilation with severely reduced systolic function (LVEF 10%) with both ischemic and non-ischemic etiologies.2. There is a transmural myocardial infarction involving the mid to apical inferior wall. These segments are not viable.3. There is mid-wall fibrosis involving much of the basal to mid anterior wall and septum. It is unclear whether these segments are viable given the fibrosis is non-ischemic in etiology.4. Moderate RV dilation with mild to moderate RV systolic dysfunction (RVEF 40%.5. Severe left atrial dilation.6. Moderate to severe mitral and tricuspid valve regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 57 year old woman with history of LAD dissection and VF arrest with transient associated LV dysfunction, referred for cardiac MRI for determination of scar burden and LV function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 92 ml/m2 (normal range: 65+/-11), the LVEDV is 152 ml (normal range 109+/-23), the LV end systolic volume index is 40ml/m2 (normal range 18+/-5), the LVESV is 65ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 72 g (normal range 114+/-24). There is thinning of the apical septum. There is persistent dyskinesis of the apical septum and apical anterior segments, similar to the previous study. There is transmural late gadolinium enhancement noted within the dyskinetic segment and consistent with previous infarction. This territory is nonviable. The remaining myocardium appears viable. No LV thrombus is noted. Left AtriumThe left atrium is mildly enlarged. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 172 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly enlarged. 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 are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.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. Normal size left ventricle with normal systolic function (EF 57%). There is persistent dyskinesis of the anteroapical and apical septum. There is transmural late gadolinium enhancement in these segments and thinning of the walls which suggests previous infarction. No LV thrombus is noted. These findings are unchanged when compared to the previous study. 2. Mildly dilated RV with normal systolic function (EF 58%).3. Mild biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: von Hippel-Lindau disease (VHL) with history of brain hemangioblastomas and prior intracranial surgery. Brain: There are postoperative findings related to right retrosigmoid craniotomy with a small extradural fluid along the inferior aspect of the mesh. There is a 3 mm diameter enhancing nodule in the left inferior cerebellar hemisphere with surrounding vasogenic edema. There is linear susceptibility effect along the cerebellar folia diffusely. There is scattered cerebral and pontine white matter punctate and confluent T2 hyperintensity, which may be related to chronic small vessel ischemic disease. There is no evidence of acute infarction. The lateral and third ventricles appear to be disproportionately prominent with respect to the sulci. The orbits are grossly unremarkable. Spine: The spinal cord displays normal signal and morphology. There are posterior disc-osteophyte complexes at C5-6 and C6-7 with mild spinal canal stenosis. There is also degenerative spondylosis at L3-4 and L4-5, where there is essentially mild bilateral neural foraminal and spinal canal stenosis. There is no significant spinal canal stenosis in the rest of the spine. Aside from areas of degenerative bone marrow signal alterations in the cervical and lumbar spine, the vertebral bone marrow signal is unremarkable. There are subcentimeter perineural cysts in the sacral spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The paravertebral soft tissues are unremarkable. There are multiple bilateral renal cysts.

Output: 1. A 3 mm lesion in the left cerebellar hemisphere with surrounding vasogenic edema is compatible with a hemangioblastoma.2. Superficial siderosis involving the cerebellum.3. The lateral and third ventricles appear to be disproportionately prominent with respect to the sulci, which may represent normal pressure hydrocephalus. 4. No evidence of spinal cord lesions.5. Bilateral renal cysts, which can be more thoroughly assessed via dedicated imaging.


Instruction: Generate impression based on findings.

Input: Reason: mildly dilated bile ducts History: severe abd pain ABDOMEN:LIVER, BILIARY TRACT: There is focal ductal dilatation in the right lobe of the liver without definite associated lesion (series 301 image 18), close continued follow-up is recommended.SPLEEN: No significant abnormality noted.PANCREAS: Small peripancreatic nodes noted. The pancreatic duct and parenchyma appear within normal limits.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focal ductal dilatation in the right lobe of the liver without definite associated lesion. This may be due to mild underlying stricture that is not well-visualized, or given patient's age this may be from autoimmune pancreatitis, please correlate with IgG4 levels. Continued close follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 68-year-old female with history of right lumpectomy for invasive ductal carcinoma in 2007. Patient also has history of LCIS and atypical lobular hyperplasia in both breasts, from a needle biopsy the right breast in 2007 and an excisional biopsy of the left breast in 2007. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact is seen in the upper right breast, corresponding to the surgical clips from patient's prior lumpectomy.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are extensive confluent areas of T2 hyperintensity within the supratentorial white matter, most prominent within the parietal and occipital lobes, while also involving the posterior limbs of the internal capsules, the thalami, and basal ganglia. There are additional large patchy areas of T2 hyperintensity within the cerebellar white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.Mildly decreased diffusion within the right thalamus and right occipital lobe may represent acute infarcts. 2.Extensive confluent signal abnormality within the supratentorial and infratentorial white matter as well as the thalami and basal ganglia is non-specific but has an appearance suggestive of posterior reversible encephalopathy syndrome (PRES).


Instruction: Generate impression based on findings.

Input: Male 77 years old Reason: F/U on liver lesion History: None ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is at least 3 hepatic lobe lesions. The 2 left hepatic lobe lesions show peripheral nodular enhancement compatible with hemangiomas. The right hepatic lobe lesion in segment 8 is heterogeneous in T2 signal with peripheral enhancement and more solid fill-in measuring 4.0 x 3.4 cm (image 161 of series 9). The imaging features are suggestive of an atypical hemangioma. No biliary ductal dilatation. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. No hydronephrosis in either kidney.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.Two left hepatic lobe lesions with imaging features most characteristics of hemangiomas.2.Right hepatic lobe lesion has imaging features suggestive of an atypical hemangioma. Follow-up MRI in 12 months is suggested to ensure stability


Instruction: Generate impression based on findings.

Input: Right hemisphere onset epilepsy since childhood. EEG from both Cleveland Clinic and University of Michigan showed sharp waves at right parieto-occipital region. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. On particular, the bilateral hippocampi appear to be intact. There is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No seizure foci are identified, although the sensitivity for subtle cortical malformations may be limited with 1.5 T MRI.


Instruction: Generate impression based on findings.

Input: Seizures, staring spells and developmental delay. There is no evidence of mesial temporal sclerosis, cortical dysplasia or gray matter heterotopia. There is no intracranial hemorrhage, mass, or acute infarct. There are scattered punctate T2 hyperintense foci in the bilateral superior frontal white matter, which are nonspecific but may represent prominent perivascular spaces or gliosis. The brain parenchyma otherwise appears unremarkable.There is mild nonspecific prominence of the ventricles. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the bilateral ethmoid and maxillary sinuses.

Output: No evidence of seizure focus.


Instruction: Generate impression based on findings.

Input: After the radial carpal was accessed and contrast was injected into the joint, there is prompt contrast extravasation into the radioulnar joint compatible with a tear of the triangular fibrocartilage complex. Additionally, contrast extended into the mid carpal bones suspicious for a tear of the lunotriquetral and scapholunate ligaments. Multiple spot images of the right wrist were obtained with the patient and ulnar and radial flexion.Exposure time: Six minutes and 55 seconds.

Output: Successful arthrogram of the right wrist with findings compatible with a tear of the triangular fibrocartilage complex, scapholunate ligament, and lunotriquetral ligament.


Instruction: Generate impression based on findings.

Input: Left breast ADH worrisome for DCIS. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Extensive motion abnormality limits the evaluation, especially given that there is relatively high background enhancement. There is suspicion for non-mass enhancement greater than background in the left central inferior breast. However, confidently clearing the opposite breast is not possible given the motion.

Output: Extensive motion abnormality limits the evaluation, especially given that there is relatively high background enhancement. Therefore, a repeat examination is recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views.


Instruction: Generate impression based on findings.

Input: Clinical question: Chiari malformation, CSF flow study, back pain. Signs and symptoms: As above. Cervical MRI:Examination demonstrates ectopia of cerebellar tonsils of approximately 9 mm with flattening deformity of the inferior poles of the tonsils and consistent with patient's known Chiari malformation. There is normal signal intensity and caliber of the cervical cord and in particular without intravenous syrinx. Signal intensity and alignment of vertebral column is within normal and without spinal stenosis or neural foraminal compromise at any level.CSF flow study demonstrates uncompromised biphasic CSF flow study through the foramen magnum anteriorly. Minimal biphasic flow through the foramen magnum is detected posteriorly and with subtle flow through the fourth ventricle and the aqueduct. 3-D fiesta sequences demonstrate patent aqueduct.Nonenhanced thoracic MRI:There is normal signal intensity and caliber of thoracic cord and in particular without evidence of syrinx. The signal intensity and alignment of vertebral column is unremarkable and without evidence of spinal canal or neural foraminal compromise at any level.Nonenhanced lumbar MRI:Examination demonstrates normal anatomical development of vertebral column with normal signal intensity and alignment. There is normal signal intensity and morphology of the lower most visualized thoracic cord, conus and the cauda equina and normal termination of the cord at L1-L2 level.

Output: 1.Chiari malformation with approximately 9 mm with flattening deformity of cerebellar tonsils as detailed.2.CSF flow study demonstrates uncompromised presence of biphasic flow through the foramen magnum anteriorly. Diminished flow posteriorly through the foramen magnum, fourth ventricle and the aqueduct as detailed.3.Normal signal intensity and caliber of cord without evidence of syrinx and with normal termination at L1-L2 level.4.Unremarkable MRI of the lumbar spine and with normal signal intensity and morphology of conus and cauda equina as detailed.


Instruction: Generate impression based on findings.

Input: 54-year-old male history of newly diagnosed stage IV non-small cell lung carcinoma. Evaluate for metastatic lesions. There are no areas of restricted diffusion to suggest an acute ischemic infarct. There is mildly increased confluent T2/flair signal abnormality within the periventricular white matter, nonspecific. No evidence of acute or chronic intracranial hemorrhage. No abnormal enhancement is appreciated to suggest metastatic disease to the brain. The basal cisterns are intact. The ventricles and sulci are symmetric. The left frontal sinus is opacified. Flow-voids are appreciated in the major intracranial vessels. There is a 3.9 x 1.7 cm T1/T2 bright smoothly marginated ovoid lesion located within the soft tissues of the right occipital scalp which represents a subcutaneous lipoma. The mastoid air cells are unremarkable. The calvarium and remaining soft tissues of the scalp are within normal limits.

Output: 1. No evidence of metastatic disease to brain.2. Mildly increased T2/FLAIR signal abnormality within the periventricular white matter which is nonspecific but likely related to chronic small vessel ischemic disease.3. Left frontal sinus opacification.4. Small lipoma in the right occipital soft tissues.


Instruction: Generate impression based on findings.

Input: Surveillance scan for cancer. History of squamous of carcinoma of the scalp with cervical nodal metastasis. Status post surgery and chemoradiation. Developed recurrence in left cervical lymph nodes. Currently on induction chemotherapy. There are findings related to previous left neck dissection and flap reconstruction. The multilobulated tumor recurrence deep to the flap seen on the previous MRI has regressed in size and is more difficult to discern from the overlying flap. Transaxially, it now measures 28 mm x 9 mm compared to 42 mm x 19 mm previously. Additionally, the metastatic soft tissue nodule superficial to the flap at the level of C6 has also regressed, now measuring up to 15 mm, previously measured 21 mm. There is a smaller soft tissue nodule more superiorly just deep to the posterior edge of the flap, which is also smaller, now measuring up to 9 mm compared to 18 mm previously. Otherwise, there is underlying posttreatment soft tissue thickening but no new mass lesions. There is no new cervical lymph node enlargement.Vascular dilatation at the left carotid bifurcation/bulb is unchanged. The airway is patent. Asymmetry at the level of the larynx remains and is probably in part due to prior medialization laryngoplasty.Well-circumscribed focus of T2-hyperintensity in the left mandibular body has not changed and may represent posttreatment change.Multilevel degenerative cervical spondylosis present is unchanged and results in only mild spinal canal stenosis but left more than right lower cervical neural foraminal stenoses.Included brain shows unchanged right frontal encephalomalacia and brain volume loss. Small retention cysts are present in the right maxillary sinus.

Output: 1.Since the previous MRI from March 2016, there has been further regression of multiple left cervical soft tissue masses, most probably representing lymph node metastases.2.Other posttreatment findings remain unchanged since the prior examination.


Instruction: Generate impression based on findings.

Input: Right knee pain Open growth plates consistent patient's related age. No underlying discrete osseous abnormality, specifically no fracture malalignment, however a small faint calcific density is projected on the lateral projection at the attachment of the anterior collateral ligament. Although likely old remote injury in the absence of an effusion, internal injury cannot entirely be excluded, consider MRI imaging. Soft tissues are unremarkable.

Output: No definite acute abnormality, however small nonspecific punctate calcification adjacent to the anterior tibial spine may represent a more remote collateral ligament injury in the absence of secondary additional abnormalities. See detail provided


Instruction: Generate impression based on findings.

Input: 67-year-old with strong family history of breast cancer, maternal grandmother, 2 aunts and sister. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable benign enhancing foci in the left breast at the 3 o'clock position. Stable dark T2 signal lesion in the medial right breast with mammographic correlate is consistent with an oil cyst. 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: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:8/4/1947)Reason: evaluate for a pituitary adenoma History: low cortisolPROVIDER/ATTENDING NAME: MELTEM ZEYTINOGLU MELTEM ZEYTINOGLU MRI pituitary:The infundibulum of the pituitary gland is tilted towards the left side. The pituitary gland itself is asymmetric with the left half being larger than the right half. There is a focus of slightly delayed enhancement along the left half of the pituitary gland measuring approximately 3 mm in diameter. No suprasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: Findings are suspicious for small lesion in the left half of the pituitary gland which could represent a pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: 61-year-old female with history of colon cancer and metastasis to the liver. ABDOMEN:LIVER, BILIARY TRACT: Surgical changes from a left hepatectomy. Multiple scattered hepatic cysts. A flash filling hemangioma at the hepatic dome (axial series 11 image 211) is noted along with peripheral nodular enhancement of additional hemangiomas adjacent to the caudate lobe (axial series 11 image 195) and hepatic segment 6/7 (axial series 11 image 183).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T2 hyperintense fat-containing lesions of L1 and L4 vertebral bodies are unchanged and compatible with osseous hemangiomas.OTHER: No significant abnormality noted.

Output: 1.Status post left hepatectomy. No recurrent lesion identified. No evidence for metastatic disease.2.There are 3 hepatic lesions with enhancement characteristics suggestive of hemangiomas.


Instruction: Generate impression based on findings.

Input: 64-year-old man with history of alcoholic cirrhosis, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: There is low signal of the liver parenchyma suggesting iron deposition. The liver is cirrhotic in morphology. Subcentimeter cysts are seen in segments IVb, 5, and 8 of the liver. No suspicious focal enhancing lesion identified. The gallbladder is normal.SPLEEN: The spleen is mildly enlarged.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Left superior pole renal cyst is noted. In the inferior pole of the left kidney (series 8, image 14) there is a round, exophytic T2 hypointense lesion measuring 16 x 15 mm which is incompletely evaluated and not included on the axial sequence field of view.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: There is a moderate hiatal hernia with ascites.BONES, SOFT TISSUES: No significant abnormality noted. Sternotomy sutures noted.OTHER: There is a small amount of ascites.

Output: 1.Cirrhotic liver without suspicious focal lesion.2.Incompletely imaged lesion in the inferior pole the left kidney which can be evaluated with ultrasound as clinically warranted.


Instruction: Generate impression based on findings.

Input: 64-year-old male with shoulder pain. ROTATOR CUFF: There is intermediate signal abnormality and thickening of the supraspinatus tendon consistent with moderate tendinosis. There is linear increased signal abnormality within the distal supraspinatus tendon extending to the level of its insertion on the greater tuberosity consistent with a partial thickness insertional tear of the undersurface fibers involving less than 50% of the tendon width measuring approximately 6 mm in the AP dimension. There is also fraying of the bursal surface fibers of the supraspinatus just proximal to its insertion on the greater tuberosity. The infraspinatus tendon and muscle appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Moderate degenerative changes of the acromioclavicular joint with osteophyte formation along the inferior aspect of the acromion process resulting in mild impression on the superior fibers of the supraspinatus tendon. No significant amount of fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although this examination was not protocoled for evaluation of the glenoid labrum, there is heterogeneity and increased signal abnormality within the superior labrum suggestive of degenerative tearing. Mild degenerative changes affect the glenohumeral joint including subchondral cyst formation within the inferior glenoid. The glenohumeral joint alignment is anatomic.BICEPS TENDON: There is a small amount of circumferential fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the glenohumeral joint. ADDITIONAL

Output: 1. Partial thickness tearing of the rotator cuff without evidence of a full-thickness rotator cuff tear or significant retraction.2. Degenerative osteoarthritic changes of the acromioclavicular and glenohumeral joints.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact.There are unchanged postoperative findings with residual pneumocephalus related to placement of a right frontal approach catheter within a right basal ganglia hematoma. The overall cavity size is unchanged, as is the acute hematoma, currently measuring 52 x 37 mm. There is grossly unchanged surrounding edema. There is again blood layering within both lateral ventricles as well as minimal left parietal subarachnoid hemorrhage. There is unchanged 10 mm leftward midline shift. The ventricles are unchanged in size with questionable mild dilatation of the left lateral ventricle. There is susceptibility effect compatible with chronic microhemorrhage in the left basal ganglia and thalamus. There is no evidence of acute infarct. There are scattered patchy foci of T2 hyperintensity throughout the supratentorial and infratentorial white matter that are most compatible with chronic small vessel ischemic disease. Mild asymmetric T2 hyperintensity within left dentate nucleus is nonspecific but may also represent chronic small vessel ischemic disease. There is mild ectasia of the distal right internal carotid artery. The major cerebral flow voids are intact. There is minimal fluid within the mastoid air cells.

Output: 1.Essentially unchanged postoperative findings related to placement of a catheter within a right basal ganglia acute hematoma with surrounding edema and intraventricular extension. The size of the hematoma and the associated midline shift is unchanged. 2.The ventricles are unchanged in size with questionable mild dilatation of the left lateral ventricle.3.Unchanged mild left parietal subarachnoid hemorrhage.


Instruction: Generate impression based on findings.

Input: 67-year-old male with prostate cancer. PELVIS:PROSTATE: Suboptimal examination secondary to wrap around artifact on post contrast images. Prostate Size: 4.6 x 2.6 x 4.1 cm (TR X AP X CC)Peripheral Zone: There is extensive decreased T2 signal abnormality in the base, mid body, and apex of the peripheral zone of the prostate gland, right greater than left. There is associated restricted diffusion and enhancement on the postcontrast sequences. These findings are suspicious for prostate carcinoma.Seminal Vesicles: There is extension to involve the seminal vesicles bilaterally.Extracapsular Extension: There is apparent extracapsular extension along the left lateral margin of the midbody and apex of the peripheral zone of the prostate gland.BLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings consistent with prostate carcinoma involving the base, mid body and apex of the peripheral zone of the prostate. There is apparent seminal vesicle invasion and extracapsular extension, as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: 45 yo AAF with a 2 cm firm subcutaneous nodule of the L back History: 45 yo AAF with a 2 cm firm subcutaneous nodule of the L back. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Vitamin E capsules are noted along the posterior left lower back denoting the medial and lateral margins of the palpable abnormality. Homogeneous subcutaneous fat underlies the denoted area with no abnormal mass or soft tissue identified. OTHER: Metallic artifact is noted lateral to the left kidney.

Output: No underlying soft tissue mass or finding to explain the patient's palpable abnormality.


Instruction: Generate impression based on findings.

Input: cervicalgia, pain, lumbago Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature centered at C5-6.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge 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.Lumbar 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.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disk dessication at this level.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.There is a Schmorl's node along the superior end-plate of T12.

Output: 1.Minimal degenerative changes are present in the cervical spine.2.There are minor degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 23 year old female patient with seizure like episodes. History of bipolar type I as well as anxiety disorder. There is asymmetrically slight vertical alignment of the right collateral sulcus and a globular morphology of the right hippocampus, but the internal architecture and signal is not grossly abnormal and there is no significant hippocampal atrophy. The brain parenchyma otherwise appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact, including a fetal origin of the right posterior cerebral artery. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Apparent mild malrotation of the right hippocampus, but no evidence of tumor or mesial temporal sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Possible intracranial hemorrhage. Headache. Patient has a brain tumor .50-year-old female The patient is status post recent left-sided temporal craniotomy. Postsurgical changes include intracranial air and a left-sided subdural collection.A small 8mm hemorrhagic focus is present along the left temporal lobe at the superior margin of the patient's tumor bed. A hypodense focus is present in the left temporal lobe measuring 25 x 20 mm axial dimensions presumably related to the patient's known left sided brain tumor.A focus of encephalomalacia is present in the left parietal lobe extending to the left the occipital lobe and the left posterior temporal lobe. This has been present on previous exams and has not changed substantially in essence it represents a fluid filled the cavity and is best to assess bone MRI..It corresponds to a previous tumor bed identified on the 6/19/06 MRI exam

Output: 1.The patient is status post a left temporal lobe surgery . Residual tumor cannot be assessed on this exam. MRI is more accurate in assessing residual tumor than CT. there is a small focus of hemorrhage in the tumor bed as described above.2.Encephalomalacia and gliosis adjacent to previous surgical site in the left posterior temporal lobe and adjacent to left parietal and occipital lobes as described above.3.Postsurgical changes at the craniotomy site.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, left sideClinical question: r/i disc herniationSigns and Symptoms: progressive low back back with tingling down L leg 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 is a right lateral recess broad-based disc protrusion which displaces the nerve roots of the right lateral recess and partially effaces the fat at the right lateral recess. Disc material extends into the inferior aspect of the right neural foramen at this level. The exiting nerve roots within the neural foramina are surrounded by fat. There are endplate reactive changes present at this level which are predominantly high signal on T2-weighted imaging and low signal on T1-weighted imaging which are located along the right half of the endplates of the L4-5 disc space.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: There is a right lateral recess disc protrusion present at L4-5 associated with some subacute inflammatory changes at the adjacent endplates which encroaches mildly on the nerve roots of the right lateral recess at this level. Please note that this does not match the reported history of left sided sciatica


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cauda equina. Signs and symptoms: Back pain, lumbar pain, urinary incontinence. Non-enhanced total spine MRI:This examination is performed as a work compression protocol and no axial images were acquired. Images through the cervical region on sagittal plane demonstrate normal anatomical alignment and signal intensity of the vertebral column. Degenerative changes results in multilevel mild central spinal stenosis without significant change since prior exam from 2014. There is a small focus of T2 hyperintensity likely representing myelomalacia in the right aspect of cord at C4 -- C5 level without interval change since prior exam from 2014.Images through the thoracic region demonstrate normal signal intensity and alignment the vertebral column. There is mild exaggeration of thoracic kyphosis similar to prior exam.There is normal signal intensity and caliber of the cord and without evidence of any mass effect on the cord.Sagittal images through the lumbosacral spine demonstrate and post operative changes of posterior laminectomy at L3 and L4 levels. There is no evidence of spinal canal compromise at any level and no evidence of mass effect on the cauda equina or conus.

Output: No evidence of cord compression. Revisualization of a small focus of cord T2 hyperintensity likely myelomalacia in the right side of the cord at C4 -- C5 without change since 2014 exam.


Instruction: Generate impression based on findings.

Input: Subarachnoid hemorrhage [430], Reason for Study: ^Reason: ICP/SAH History: HA/syncope, history of recent anticoagulation and head trauma. There is right temporal ICH measured about 13.6mm x 43.6mm x 24mm with surrounding edema.Main portion of the ICH shows high signal intensity on T1 weighted image indicating subacute hemorrhage.Central portion of the ICH shows low signal intensity areas which could represent deoxyhemoglobin or could include vascular signal voids.There are also bihemispheric parietal and occipital subarachnoid signal voids on gradient echo images and high signal intensities on FLAIR images indicating subarachnoid blood products. In addition, there is focal susceptibility artifacts on the right lateral ventricle occipital horn indicating possible intraventricular hemorrhage.Considering the patient's history of recent anticoagulation and head trauma, above described findings can be understood. However, etiology of unusual location ICH should include arteriovenous malformation and dural arteriovenous shunting. Therefore, diagnostic angiography can be considered for further imaging valuation.The ventricles, sulci and cisterns are symmetric. There is no restricted diffusion indicating acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No intracranial arterial luminal stenosis. No intracranial arterial aneurysm.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate intra dural sinus filling defects on the right transverse sinus and sigmoid sinus indicating intra dural thrombosis. Superior sagittal sinus and left transverse sinus and left sigmoid sinus appear to be patent. However, forward flow through the right transverse sinus and sigmoid sinus appear to be maintained. Deep venous system including straight sinus as well as bilateral internal cerebral veins were patent. Vein of Galen was not clearly visualized on this scan, however, since there is no evidence of venous congestive encephalopathy of deep structures, it could well be an artifactual.

Output: 1. Right temporal ICH, bilateral parietal and occipital SAH and right lateral ventricle occipital horn focal IVH as described above.2. Right transverse sinus and sigmoid sinus intraluminal filling defects but maintaining forward flow.3. No intracranial arterial aneurysm, no evidence of intracranial arterial luminal stenosis.4. Possibility of brain AVM or DAVF cannot be excluded with MRI and MRA. If indicated, diagnostic catheter angiography can be considered.


Instruction: Generate impression based on findings.

Input: 11-year-old male with mosaic neurofibromatosis and bilateral optic nerve gliomas s/p chemotherapy experiencing visual loss, right eye, unchanged from prior Redemonstrated is an oval T2/FLAIR hyperintense lesion along the right optic tract, extending inferiorly into the mesial right temporal lobe, unchanged in appearance on noncontrast techniques. There has been interval resolution of previously demonstrated enhancement.As before, there is a nonenhancing T2/FLAIR hyperintense and T1 hypointense lesion in the left optic chiasm/hypothalamus which has not significantly changed since prior exam.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of new pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Smaller foci of T2/FLAIR hyperintensity along the more posterior portions of the bilateral optic tracts are again noted, unchanged in appearance.Redemonstrated is an oval mildly peripherally enhancing right orbital segment optic nerve lesion with central cystic appearance, unchanged in appearance. Orbital structures are otherwise unremarkable. As before, there is mild scattered mucosal thickening within the paranasal sinuses without air-fluid level. Mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: 1.Redemonstrated is an oval T2/FLAIR hyperintense lesion along the right optic tract, extending inferiorly into the mesial right temporal lobe, unchanged in appearance on noncontrast techniques, although there has been interval resolution of previously demonstrated enhancement.2.Other presumed bilateral optic pathway gliomas are stable.


Instruction: Generate impression based on findings.

Input: Right facial weakness and pronator drift, as well as headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brainstem and cerebellum appear unremarkable. There are mild scattered cerebral white matter T2 hyperintense foci bilaterally. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: No evidence of intracranial mass or infarct.


Instruction: Generate impression based on findings.

Input: Newly diagnosed base of tongue cancer. There appears to be an ill-defined lesion in the left tongue base that measures up to approximately 10 to 15 mm, although precise measurement is limited by the il-defined nature of the lesion. There does not appear to be extension into the oral tongue, glossotonsillar sulcus, masticator space, or parapharyngeal space. There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The osseous structures are grossly intact. The imaged intracranial structures are unremarkable.

Output: An ill-defined lesion in the left tongue base is compatible with invasive squamous cell carcinoma. No evidence of significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate growth of meningioma. Signs and symptoms: Recurrent meningioma. Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a new falcine meningioma in the posterior frontal and parietal region since prior exam. The tumor expands bilaterally from the falx and measures at 42 x 26 mm in transaxial dimensions and 34 mm in craniocaudad axis and reaches the inferior edge of the falx. Additionally there is a second new meningioma in the high convexity right posterior parietal and along the right lateral aspect of falx measuring approximately at 15 x 25 x 29 mm in size. This mass is immediately anterior to the edge of the craniotomy flap from prior surgery.Small loculated foci of dural based enhancement along the most posterior left lateral aspect of the falx suspected of residual meningioma on prior exam demonstrates significant interval increase size. This finding on prior exam measured approximately at 7 x 12 mm however on current study the tumor has dramatically increased in size and measures at least at 60 x 28 mm in transaxial dimensions. This finding extends anteriorly and projects into the quadrigeminal plate cistern and posterior 3rd ventricle. This tumor is inseparable from the straight sinus and the vein of Galen which are highly suspected to be encased by tumor. This tumor also minimally extends along the superior medial aspect of bilateral tentorial leaves (L>R). Constellation of above new findings results in new bilateral hemispheric vasogenic edema in bilateral posterior frontal and parietal lobes.Moderately enlarged supratentorial ventricular system with maintained midline demonstrate no significant interval change.

Output: 1.Significant interval progression of disease since prior study.2.Large new meningiomas along the falx as detailed/measurement above.3.Significant interval increase small foci of residual meningioma in the left occipital region with anterior extension into the quadrigeminal plate cistern, posterior third ventricle and with encasement of the straight sinus and the vein of Galien as detailed/measurement above.4.Interval new foci of vasogenic edema secondary to an above-mentioned tumors in bilateral posterior frontal and parietal lobes.5.Stable moderately enlarged supratentorial ventricular system with maintained midline.


Instruction: Generate impression based on findings.

Input: Female 37 years old with chronic neurologic condition, found to have sacral decubitus ulcer, assess for osteomyelitis There is ulceration of the soft tissues posterior and distal to the sacrum with signal abnormality extending from the skin to the fifth sacral segment, compatible with an ulcer and surrounding inflammation. Abnormal signal intensity with associated enhancement in the fifth sacral segment and inferior half of the fourth sacral segment is compatible with osteomyelitis. The upper coccyx is not visualized, which may reflect complete destruction due to infection or possibly prior surgery. A portion of the distal coccyx is noted inferior and anterior to S5, with abnormal signal intensity and enhancement suggestive of osteomyelitis.Additional ulceration below the left ischium is seen, with focal signal abnormality within the underlying bone, also suspicious for osteomyelitis.A collection of nonenhancing tissue with surrounding rim enhancement is noted along the right greater trochanter with adjacent soft tissue inflammation. We cannot tell whether this extends to the skin surface. This may represent additional ulceration or bursitis, however we cannot exclude the possibility of an abscess. Mild edema is noted in the underlying greater trochanter on T2 fat saturated images, however the bone marrow signal intensity on T1 images is preserved, suggestive of osteitis rather than osteomyelitis.A small amount of fluid is noted in both hips. The sacroiliac joints appear normal. A Foley catheter is visualized within a distended bladder.

Output: 1. Posterior soft tissue ulcers as described above, with osteomyelitis of the sacrum, coccyx, and left ischium.2. Collection of nonenhancing tissue with surrounding rim enhancement along the right greater trochanter, which may represent additional ulceration or bursitis, however we cannot exclude the possibility of an abscess. Signal abnormality in the underlying greater trochanter is suggestive of osteitis rather than osteomyelitis.


Instruction: Generate impression based on findings.

Input: 89 years Female (DOB:3/1/1927)Reason: r/o stroke History: left upper extremity weaknessPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with craniopharyngioma, presenting with vision loss, preoperative planning for tumor resection. A cystic and solid, partially enhancing suprasellar mass is redemonstrated measuring 43 x 31 mm in the axial plane. This compares to 37 x 27 mm on the prior MRI. Interval increase in size represents growth of both the cystic and solid components.This lesion fills the suprasellar cistern from the level of the sella to the floor of the third ventricle into which it protrudes. The optic apparatus is markedly displaced by this process. The cerebral peduncles are splayed.Redemonstrated is evidence of a right fronto-parieto-temporal craniotomy. Encephalomalacia of a small part of the right frontal lobe is unchanged.No new lesions are seen. No abnormal extra axial fluid collections are detected. The ventricular system remains within normal limits for size and morphology. A developmental venous anomaly is noted incidentally within the pons.

Output: Interval increase in the size of both the cystic and solid components of a large suprasellar lesion.


Instruction: Generate impression based on findings.

Input: 26 years, Male, multifocal lesions in the left hemisphere with vasogenic edema. First-time seizure. There is an intensely enhancing T2 hypointense mass involving the left cingulate gyrus and callosal body measuring approximately 4.6 x 2.4 x 1.7 cm in the AP, transverse, and craniocaudal dimensions. There is an additional left parietal mass more posteriorly involving the precuneus which measures approximately 12 x 15 x 14 mm. There is surrounding vasogenic edema as well as local mass effect. Mild edema extends across the corpus callosum. No associated hemorrhage aside from a punctate focus of susceptibility involving the left frontal lesion which may represent microhemorrhage. There is associated mild restricted diffusion. Additionally, there are small foci of FLAIR hyperintensity involving the left frontal subcortical white matter, in the right posterior frontal lobe, right parietal lobe, as well as in the right periatrial white matter; there is mild restricted diffusion associated with these lesions without appreciable enhancement.Mass effect includes downward displacement of the corpus callosum and lateral ventricles. No significant midline shift at the level of the foramen of Monro. No uncal herniation. No hydrocephalus. There is mild, nonspecific prominence of the nasopharyngeal lymphoid tissue. There is a small right maxillary mucus retention cyst. Calvarium and extracranial soft tissues are otherwise unremarkable.

Output: Enhancing masses in the left frontal and parietal lobes with multiple additional smaller nonenhancing lesions in the bilateral frontal and parietal lobes with mild restricted diffusion. Findings are most favored to represent lymphoma, with tumefactive demyelination a less likely possibility.


Instruction: Generate impression based on findings.

Input: 25 year old with history of chest pain and newly diagnosed left ventricular systolic dysfunction. Left VentricleSevere LV dilation when adjusted for body surface area (mildly dilated based on absolute volume) with mildly reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 109 ml/m2 (normal range: 65+/-11), the LVEDV is 166 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 82 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 90 g (normal range 114+/-24). The systolic dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 91 ml/m2 (normal range 69+/-14), the RVEDV is 139 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 55 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 with evidence of mitral valve prolapse and bileaflet billowing. Trace 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. Normal origin of the coronary arteries.Shunts No evidence of atrial septal defect or ventricular septal defect.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trace pericardial effusion.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. Severe LV dilation when adjusted for body surface area (mildly dilated based on absolute volume) with mildly reduced systolic function (LVEF 51%). No evidence of underlying myocardial fibrosis, infiltration, and inflammation.2. Normal RV size and systolic function (RVEF 60%).3. Mild left atrial dilation.4. Mitral valve prolapse with bileaflet billowing.5. No evidence of cardiac shunt. Normal coronary origins.


Instruction: Generate impression based on findings.

Input: Female 81 years old with a cystic pancreas mass. Revaluate for change in size in 1 year. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour. Mild atrophy of the right hepatic lobe appears similar to the previous exam. There is diffuse loss of signal on out of phase imaging indicating hepatic steatosis. No suspicious hepatic lesion. No intra or extrahepatic biliary ductal dilatation. There is unchanged thrombosis of the right portal vein branch with multiple collateral. The left and main portal veins are patent. Narrowing of the portal vein and the portal splenic confluence is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is atrophic. The duct is not dilated. There are innumerable cystic lesions, some of which appear to communicate with the pancreatic duct, are seen throughout the pancreas as on the previous exam. No nodularity, enhancement or restricted diffusion within the cysts to suggest malignancy. The reference pancreatic tail lesion measures 1.6 x 1.3 cm (series 9, image 50).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right lower pole renal cyst.RETROPERITONEUM, LYMPH NODES: Tortuous aorta.BOWEL, MESENTERY: Extensive sigmoid colon diverticulosis.BONES, SOFT TISSUES: Lower thoracic spine anterior wedge deformity is unchanged.OTHER: No significant abnormality noted.

Output: Numerous cystic pancreatic lesions most suggestive of IPMNs are not significantly changed.


Instruction: Generate impression based on findings.

Input: 61 years, Male, episodic left-sided tonic spasms of the face, arm, and leg right frontal cortex lesion seen on outside MRI.. There is an approximately 20 x 15 x 20 mm enhancing mass with associated expansion of the cortex of the posterior aspect of the right superior frontal gyrus abutting the falx. Previously enhancing nodule in this region measured 9 x 6 x 6 mm. Restricted diffusion was noted previously corresponding to the area which is now enhancing, with current study demonstrating more peripheral restricted diffusion. There is suggestion of increased central necrosis. There is also increase in adjacent leptomeningeal enhancement along the right paracentral lobule. There is associated mild vasogenic edema which is not significantly changed. There is minimal susceptibility within this lesion may represent minimal blood products or mineralization. No other mass or abnormal parenchymal or meningeal enhancement is appreciated elsewhere in the brain. Prominent perivascular spaces are incidentally noted in the left subinsular region and left temporal stem. No hydrocephalus or extra-axial collections. No evidence of midline shift or herniation. Calvarium and extra cranial soft tissues are unremarkable.

Output: There is an enhancing mass involving the posterior aspect of the superior frontal gyrus which compared to 12/31/2015 demonstrates increased enhancement and central necrosis. There is also new adjacent leptomeningeal enhancement. Relatively mild surrounding edema is not significantly changed. Differentials include high-grade glioma, atypical infection, and less likely metastatic disease.


Instruction: Generate impression based on findings.

Input: Chronic lymphocytic thyroiditisEXAMINATION: Sonogram thyroid 5/26/2016 RIGHT LOBE MEASUREMENTS: 3.5 x 1.4 x 1.2 cmLEFT LOBE MEASUREMENTS: 3.8 x 1.5 x 1.4 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous echotexture without focal lesion.LEFT LOBE: Diffusely heterogeneous echotexture without focal lesion.ISTHMUS: Diffusely heterogeneous echotexture without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Enlarged hypervascular right level 2 lymph node measures 3.3 x 1.7 x 1.1 cm.Enlarged left level 2 lymph node conglomerate measures 1.7 x 1.0 x 3.8 cm. Other benign appearing subcentimeter lymph nodes or possibly parathyroid glands are noted throughout the left and right neck.OTHER: No significant abnormality noted.

Output: 1. Heterogeneous thyroid without focal lesion.2. Bilateral cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for change in mass. Signs and symptoms: Near syncope. Nonenhanced head CT:In comparison with prior examination there is further interval increase in the size of the right temporal horn and trigone of right lateral ventricle.There is interval improvement of postoperative changes and including complete absorption of air from surgical site. Diffuse area of low attenuation of white matter in the right posterior temporal and parietal lobe is grossly similar to prior exam. There is also overall less mass-effect and decrease in the midline shift. The midline shift at the level of the septum pellucidum on the current exam measures 6.4-mm wide on the prior exam measured 11.2. Recommend further follow-up with an MRI for better evaluation of residual tumor. There is a small linear increased density in the right parafalcine location adjacent to the surgical cavity which may represent small amount of blood. Possibly tumor calcification at the surgical site cannot be entirely ruled out. The only available exam is from 12 -- 23 -- 10 and there are no more recent exams for comparison.

Output: 1.Interval increase in the size of right temporal horn believed to represent entrapped right temporal horn.2.Interval improvement in postop changes.3.Overall there is less mass-effect on the current exam than prior study however 6.4-mm midline shift to the left at the level of septum pellucidum is still present.4.Diffuse area of low attenuation in the right posterior temporal, occipital and parietal likely represent patient's known tumor. This finding is associated with effacement of cortical sulci.5.recommend MRI examination for better evaluation.


Instruction: Generate impression based on findings.

Input: Seizure and right-sided weakness and numbness. There is no evidence of intracranial hemorrhage or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. In particular, the hippocampi are unremarkable, and there is no evidence of heterotopia. There is a cyst that measures up to 9 mm between the adenohypophysis and neurohypophysis. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of potential seizure foci. 2. Subcentimeter pars intermedia cyst.


Instruction: Generate impression based on findings.

Input: There is multilevel degenerative spondylosis with a disc-osteophyte complex at C3-4 with mild right neural foraminal stenosis and mild spinal canal stenosis. In addition, there is a posterior disc-osteophyte complex with mild spinal canal narrowing and bilateral moderate neural foraminal stenosis. There is also a a disc-osteophyte complex at C6-7 with a superimposed right paracentral disc extrusion that encroaches into the right neural foramen and mild indents the spinal cord. However, there is no abnormal spinal cord signal. The vertebral body and disc heights are preserved. There is no pathological enhancement.

Output: 1. Mild degenerative cervical spondylosis with a disc-osteophyte complex at C3-4 that results in mild right neural foraminal stenosis and mild spinal canal stenosis, a posterior disc-osteophyte complex with mild spinal canal narrowing and bilateral moderate neural foraminal stenosis, and at C6-7 with a disc-osteophyte complex superimposed right paracentral disc extrusion that encroaches into the right neural foramen and mild indents the spinal cord. 2. No evidence of cervical spine metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: White spot in left cerebellum: headaches. There is interval increase in size of a patchy T2 hyperintense lesion, now measuring up to 9 x 12 mm, previously 7 x 10 mm. There is no longer associated enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Slight interval increase in size of the left cerebellar hemisphere lesion, but no residual enhancement.


Instruction: Generate impression based on findings.

Input: History of sarcoidosis and rheumatoid arthritis with left eye pain and headache. Evaluate for neurosarcoid involvement, mass, blood, or other. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There are no areas of abnormal signal or pathological enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Previously seen Tornwaldt's cyst is no longer appreciated. Limited evaluation of the orbits is unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage, mass effect, or acute infarct.2.No abnormal intracranial enhancing lesion to suggest active neurosarcoid.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60-year-old female patient with history of VHL disease and pre-existing renal lesion. Evaluate for new lesions and growth of pre-existing lesions in comparison to most recent scan. Note that examination is limited by patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: No intrahepatic lesions. No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic lesion seen. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a cyst in the midpole of the left kidney that measures 1.1 x 0.9 cm (series 6 image 29), unchanged. Again seen is a thin septation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes from right breast implant with a small amount of surrounding fluid.OTHER: No significant abnormality noted.

Output: 1.Small left renal complex cyst is unchanged.2.No new lesions in the kidneys, liver or pancreas.


Instruction: Generate impression based on findings.

Input: Further evaluate pituitary lesion with hypermetabolic activity on PET. There is a hypoenhancing lesion in the left pituitary gland that measures up to 10 mm. There is no mass effect upon the optic apparatus or cavernous sinus. There is minimal deviation of the pituitary infundibulum to the right. The cavernous carotid artery flow voids are intact. There are minimal scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute infarction. The ventricles and basal cisterns are normal in size and configuration. There is mucosal thickening within the maxillary sinuses.

Output: A hypoenhancing lesion in the left pituitary gland that measures up to 10 mm likely represents an adenoma, which can display marked hypermetabolism on 18FDG-PET.


Instruction: Generate impression based on findings.

Input: Male 61 years old Reason: screening for prostate cancer History: elevated PSA, negative TRUS biopsy Feb 2014 PELVIS:PROSTATE:Prostate Size: The prostate gland measures 6.3 x 4.5 x 5.8 cm.Peripheral Zone: There is a 0.4 x 0.3 cm focus of hypointense T2 signal which is dark on ADC map (series 804, image 144). This is located at the apex in the midline posteriorly and is suspicious for a small focus of prostatic adenocarcinoma. A rounded area of T2 hypointense signal projecting into the right peripheral zone at the base appears to arise from the central zone and may represent an area of benign prostatic hypertrophy. Intrinsic T1 hyperintensity throughout the left peripheral zone suggestive of hemorrhage.Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No significant abnormality noted.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: 1.The prostate gland is enlarged. Tiny focus of signal abnormality at the apex in the midline posteriorly is suspicious for a small focus of prostatic adenocarcinoma.


Instruction: Generate impression based on findings.

Input: History of gallbladder cancer with involvement of the liver, evaluate for response to treatment. ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of a previously described heterogeneous mass extending along the hepatic hilum involving segment 5/8 and to lesser extent segment 4A which also involves the superior aspect of the gallbladder wall. The mass demonstrates heterogeneous enhancement as well as internal cystic areas. There is associated subcapsular retraction. The superiormost component of the mass measures approximately 3.6 x 5.7 cm (3/16), unchanged since 3/8/2016 CT when allowing for differences in modality. The mass mildly compresses the main portal and right portal vein, unchanged from prior and without evidence of invasion/thrombosis.Cholelithiasis with several large cholesterol gallstones measuring over 2 cm and with gallstones in the gallbladder neck. Mild diffuse intrahepatic biliary ductal dilatation appearing similar to recent CT. There is mildly increased enhancement as well as thickening along the central intrahepatic bile ducts. No extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts which lack suspicious features.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.Mass involving the hepatic hilum and gallbladder, cholangiocarcinoma slightly favored over gallbladder carcinoma.2.Cholelithiasis. Mild intrahepatic biliary ductal dilatation appearing similar to prior.


Instruction: Generate impression based on findings.

Input: 69-year-old female with right ear hearing loss and vertigo. Brain MRI:There is no evidence of acute infarct. Multiple foci of susceptibility in a predominately peripheral distribution in the bilateral cerebral hemispheres have corresponding peripheral enhancement measuring less than 1 cm, and correspond to calcifications seen on prior CT, although a few foci are seen along the deep gray nuclei particularly including the right caudate and right thalamus. There is no significant surrounding FLAIR signal abnormality or restricted diffusion. 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. A few small lymph nodes are seen in the right posterior cervical scalp which may be reactive. Incidental empty sella is noted.Brain IACs:Limited study since the 3D T2 sequence is of a large field of view. Additional sequences are also limited by motion. There is prominent fluid involving the right mastoid air cells and extending into the middle ear cavity. The left mastoid air cells and IACs are unremarkable. The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are grossly normal. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.

Output: 1.Multifocal, multiple small ring-enhancing supratentorial parenchymal lesions with susceptibility that correspond with round coarse calcification seen on the prior CT. Findings are suspicious for either the late granular nodular stage of neurocysticercosis, or early nodular calcified stage given the coinciding enhancement and calcification pattern. No surrounding parenchymal edema.2.Prominent fluid involving the right mastoid air cells and right middle ear cavity, which is nonspecific. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction. History of stroke and left-sided weakness. There is no evidence of restricted diffusion to suggest acute ischemia. There are punctate foci of susceptibility effect in the right Heschl gyrus and right occipital lobe. There are scattered periventricular and subcortical white matter hyperintensities, particularly in the right parietal periventricular white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening.

Output: 1.No evidence of acute infarct or intracranial hemorrhage.2. Nonspecific signal abnormality in the cerebral white matter, particularly in the right parietal periventricular region, which may represent small vessel ischemic changes, among other potential etiologies.3. Punctate foci of susceptibility effect in the right Heschl gyrus and right occipital lobe are also nonspecific, but may represent chronic microhemorrhages.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 5 years old, with seizure-like activity, history of seizures, strong family history of neurofibromatosis. The parenchymal morphology and signal characteristics are within normal limits. No evidence of edema or mass effect is seen. No restricted diffusion or pathologic enhancement is noted.The pattern of white matter myelination is mature. The pituitary region is within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology.

Output: Unremarkable evaluation of the brain. No stigmata of neurofibromatosis or any other specific findings are seen to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: 78-year-old man with history of bladder cancer status post cystectomy, now with left renal mass on CT. ABDOMEN:LIVER, BILIARY TRACT: There is slight loss of parenchymal signal on opposed phase imaging. Multiple hepatic cysts are noted. The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: Spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: There is new, nodular thickening of the lateral limb of the left adrenal gland (series 13, image 40) measuring 18 x 12 mm. The signal characteristics of this nodule are similar to those of the left renal mass described below.KIDNEYS, URETERS: In the inferior pole of the left kidney, there is a 38 x 24 mm lesion extending from the renal collecting system to the posterior cortex (series 13, image 32). The hilar portion of this lesion has a rim of high T1 signal on precontrast images (series 12, image 32) and the remainder of the lesion demonstrates only mild enhancement.A punctate T1 hyperintense cyst is seen in the inferior pole of the left kidney, likely hemorrhagic.There is a right inferior pole renal cyst, otherwise the right kidney is normal.RETROPERITONEUM, LYMPH NODES: There is a 14 x 11 mm left para-aortic lymph node (series 12, image 39) with diffusion restriction.BOWEL, MESENTERY: There is at least a small hiatal hernia. Postoperative findings are noted with a right lower abdominal ostomy.BONES, SOFT TISSUES: Probable hemangiomas in L1 and L2.OTHER: Partially imaged right-sided ostomy (patient status post cystectomy).

Output: 1.Tumor involving left inferior pole renal collecting system and cortex. Imaging appearance suspicious for papillary urothelial carcinoma arising from collecting system and extending into renal parenchyma, with internal hemorrhage.2.Present on 10/6/15 CT imaging left adrenal nodule and retroperitoneal lymph node suspicious for metastatic disease.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55], Reason for Study: ^Reason: Evaluate for cerebral ischemia, stroke or TIA History: Acute RLE weakness No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered high signal intensity on FLAIR/T2 images on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for lesion. Signs and symptoms: Seizures. Nonenhanced CT of brain:Large area of right cerebellar encephalomalacia is again identified as was noted on prior MRI examinations.Focal area of encephalomalacia in the left frontal lobe and left basal ganglial is consistent with old stroke and remains stable.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.

Output: No evidence of acute new findings since prior study. Multiple areas of encephalomalacia likely old strokes in the right cerebellum and the left frontal lobe/basal ganglia is again identified.


Instruction: Generate impression based on findings.

Input: 21-year-old female patient with history of PSC with evidence of mild progression on last MRCP dated 5/2015. ABDOMEN:LIVER, BILIARY TRACT: Irregularity of the intrahepatic and extrahepatic biliary ducts compatible with patient's history of PSC, stable. Intrahepatic and extra hepatic biliary ductal dilatation is similar compared to prior examination. The common bile duct measures up to 11 mm. No focal hepatic lesion or dominant biliary stricture.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic inflammation, pancreatic mass or pancreatic ductal dilatation.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.Biliary ductal irregularity and dilatation appear similar compared to prior MRCP, compatible with history of PSC.2.No focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: Reason: Eval GBM. \R\1mo s/p RT/TMZ. History: GBM.. Resected 4/28/2015 radiation therapy completed one month ago. There are postsurgical changes of a right parietal craniotomy and resection of a right posterior frontal GBM. The resection cavity itself is decreased in size measuring 1.4 x 0.7 cm, previously 2.1 x 1.7 cm. FLAIR hyperintensity surrounding the resection cavity is mildly increased. Nodular enhancement surrounding the resection cavity is increased since the prior exam, particularly along the inferior margin. This region restricts on diffusion-weighted sequences, similar to the prior exam.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Postsurgical changes of GBM resection with increased nodular enhancement surrounding the collapsed resection cavity. Given history of recent radiation, this may represent posttreatment changes, however close interval follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 19-year-old male with instability and pain of the left shoulder. Evaluate for labral tear (Bankart). ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid is identified within the subacromial subdeltoid bursa. No intra-articular contrast is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is linear branching signal abnormality traversing the posterior glenoid labrum at the 9:00 position indicating a tear.BICEPS TENDON: The tendon of long head of the biceps appears intact. ADDITIONAL

Output: 1. Tearing of the posterior glenoid labrum as described above.2. Os acromiale.


Instruction: Generate impression based on findings.

Input: Neck pain with left hand numbness. There is multilevel degenerative cervical spondylosis with associated bone marrow signal alterations. At C2-3, there is no significant spinal canal or neural foraminal narrowing. At C3-4, there is a small posterior disc-osteophyte complex with minimal narrowing of the spinal canal, but no significant neural foraminal narrowing. At C4-5, there is a disc-osteophyte complex that abuts the spinal cord and there is severe left and mild right neural foraminal narrowing. At C5-6, there is a posterior disc-osteophyte complex with mild narrowing of the spinal canal and there is severe left and mild right neural foraminal narrowing. At C6-7, there is posterior disc-osteophyte complex with mild narrowing of the spinal canal and there is severe left and mild right neural foraminal narrowing. At C7-T1, there is no significant significant spinal canal or neural foraminal narrowing. There are posterior disc-osteophyte complexes at T1-2 and T2-3 that do not indent the spinal cord, but there is associated neural foraminal stenosis bilaterally, which is otherwise incompletely characterized on this dedicated cervical spine MRI. Aside from prominent degenerative endplate irregularities in the C3 vertebra, the vertebral body heights are essentially preserved. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative cervical spondylosis, which is most pronounced at C4 through C7, with severe left neural foraminal narrowing at these levels.


Instruction: Generate impression based on findings.

Input: There is ill-defined, very mild/equivocal increased STIR signal within the cervical spinal cord. The morphology and signal intensity of the spinal cord is otherwise within normal limits. The spinal canal is patent without acute cord compression. Mild scattered degenerative disc disease is present. No worrisome bone marrow lesions are identified.

Output: 1.No acute cord compression. 2.Equivocal increased STIR signal within the cervical spinal cord which may be artifactual. Dedicated segment-specific MRI can be considered as clinically warranted.