Instruction: Generate impression based on findings.

Input: 19-month-old with macrocephaly. History of prior IVH. MRI of the brain appears within normal limits for age. There is mild prominence of the bilateral frontal horns as well as the extra-axial CSF spaces along the bilateral frontal convexities, which is within normal limits for age. No findings to suggest hydrocephalus. No intracranial mass or mass effect is seen. Sulcation and myelination appear within normal limits for age. No focal structural lesions are appreciated. No evidence of acute infarct or hemorrhage. Midline structures including the corpus callosum are normal. Posterior fossa structures also appear within normal limits. Major flow-voids are preserved indicating vascular patency. Paranasal sinuses are partially pneumatized and demonstrate nonspecific opacification of the right maxillary sinus.

Output: MRI of the brain is essentially unremarkable. There is mild prominence of the frontal horns of the lateral ventricles as well as of the extra-axial CSF spaces along the bilateral frontal convexities; these findings however are within normal limits for patient's age.


Instruction: Generate impression based on findings.

Input: Cystic lesion of the pancreas. ABDOMEN:LIVER, BILIARY TRACT: Punctate hepatic cysts noted. No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Evaluation of the pancreas is mildly limited by motion artifact from adjacent bowel. The cystic lesion in the body of the pancreas measures 2.4 x 0.9 cm on MRCP images, previously 2.1 x 1.0 cm. This lesion likely represents a branch type IPMN. No definite solid or enhancing component is noted. There is no main pancreatic ductal dilation.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.

Output: Minimally increased size of the cystic lesion in the pancreas likely representing a branch type IPMN, without suspicious features.


Instruction: Generate impression based on findings.

Input: Endometrial cancer with left iliacus metastasis; restaging The exam is limited by motion artifact.Again seen within the left iliac musculature is a mass reflecting a biopsy proven metastasis. It measures approximately 3 x 2 cm in the greatest transaxial dimensions, essentially unchanged from the exam dated 7/1/2016 but decreased from the exam dated 5/12/2016. There is associated muscular edema and there is abnormal underlying marrow signal reflecting osseous involvement (series 5 image 6). There is heterogeneous enhancement following contrast administration with areas of low signal intensity centrally reflecting necrosis.No additional enhancing foci are identified. Scattered areas of metallic susceptibility reflect artifact reflect prior surgical intervention. The patient is status post hysterectomy.

Output: Unchanged appearance of left iliac/iliacus metastasis.


Instruction: Generate impression based on findings.

Input: Female, 7 months old, submersion injury. Posturing on arrival. Assess for signs of anoxic injury. Bilateral and symmetric linear areas of mildly restricted diffusion are seen at the junction of the medial globus pallidus and posterior limb of the internal capsule.No other areas of restricted diffusion or other parenchymal signal abnormality are detected. Brain morphology is within normal limits. The pattern of white matter myelination is appropriate for age.The pituitary region is unremarkable. The corpus callosum is fully formed and intact. The brainstem, cerebellar vermis and cerebellar hemispheres are within normal limits.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is normal in size and morphology.

Output: 1.Findings suggestive of small areas of ischemic injury involving the junction of the globus pallidus and posterior limb of the internal capsule bilaterally.2.The remainder of the examination is unremarkable.


Instruction: Generate impression based on findings.

Input: 53-year-old male with right calf swelling A marker was placed along the distal fibula at the site of clinical concern. There is underlying edema within the soft tissues extending within the muscle adjacent to the fibula but no cortical erosion or marrow changes to indicate osteomyelitis. No loculated fluid collection. Patchy red marrow signal is noted within bilateral tibias.

Output: Soft tissue abnormality without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: There is vertically oriented longitudinal tearing of the posterior horn of the medial meniscus, with additional horizontal tearing extending to the free edge. An additional obliquely oriented tear traverses the body of the medial meniscus and there is slight medial extrusion of the medial meniscus. There is extensive tearing of the body and posterior horn of the lateral meniscus with much of the posterior horn absent. There is also blunting of the free edge of the body with additional undersurface tearing.ARTICULAR CARTILAGE AND BONE: There is loss of the articular cartilage of the anterior surface of the medial femoral condyle. There is also severe degeneration of the cartilage affecting the lateral compartment with full-thickness cartilage loss along the lateral femoral condyle and lateral tibial plateau posteriorly. Small subchondral cysts are noted in the lateral femoral condyle. The patellofemoral articular cartilage appears intact. Tricompartmental osteophytes are noted. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Extensive tearing of both lateral and medial menisci with cartilage degeneration most notably in the lateral compartment. There is no Baker's cyst.


Instruction: Generate impression based on findings.

Input: Planning for stereotactic brain biopsy. Enhanced head CT:80 cc of Omnipaque 350 is administered for this study.Stealth enhanced head CT for stereotactic brain biopsy protocol is utilized.There is poor visualization of a previously known mass in the inferior fourth ventricle. Compared to priors stealth brain MRI protocol there is no definitive operation interval change. This tumor however it is very poorly defined on this exam and precise measurement is not possible.This is study is otherwise unremarkable.

Output: stealth enhanced head CT for surgical planning. Exam very poorly visualizes patient's known tumor in the inferior fourth ventricle.


Instruction: Generate impression based on findings.

Input: 84-year-old male with critical limb ischemia. Possible TAVR. Please evaluate from arch to toes. History failed transplant kidney.Patient is on hemodialysis per clinical service. VESSELS:SINUS OF VALSALVA: 3.8 X 3.7 X 3.6 cmSINOTUBULAR JUNCTION: 3.3 X 3.3 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 3.6 X 4.0 cmPROXIMAL ARCH: 3.7 X 3.4 cmDISTAL ARCH: 2.7 X 2.6 cmSUPRARENAL ABDOMINAL AORTA: 1.9 X 1.9 cmINFRARENAL ABDOMINAL AORTA: 1.6 X 1.5 cmRIGHT COMMON ILIAC ARTERY: 10 X 9 mmRIGHT EXTERNAL ILIAC ARTERY: 8 X 7 mmRIGHT COMMON FEMORAL ARTERY: 8 X 7 mmLEFT COMMON ILIAC ARTERY: 11 X 9 mmLEFT EXTERNAL ILIAC ARTERY: 8 X 7 mmLEFT COMMON FEMORAL ARTERY: 7 X 7 mmCHEST:LUNGS AND PLEURA: Lower lobe bronchiectasis bilaterally adjacent groundglass opacities (left greater than right), suggesting chronic aspiration and/or infection. No pleural effusions or thickening.Right upper lobe granuloma.MEDIASTINUM AND HILA: Scattered calcified mediastinal lymph nodes reflect previous granulomatous disease.Coronary artery calcifications involving all 3 vessels.Aortic valve calcifications. This exam was not tailored to evaluate aortic valve morphology.Left jugular central venous catheter with tip in distal SVC.CHEST WALL: Gynecomastia. Subacute left sided rib fractures. Presumed bursal fluid about the right shoulder is incompletely evaluated.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: Atrophic end stage kidneys. Failed LLQ renal transplant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:Bladder: Wall thickening.Pelvic kidney: Note is made of a significantly dilated collecting system of the known failed transplant kidney.Extraperitoneal space and lymph nodes: No significant abnormalities.Prostate: No significant abnormalities noted.BONES, SOFT TISSUES: Right hip prosthesis. Lumbar fixation rods and screws. L1 chronic appearing compression fracture.LOWER EXTREMITY RUN-OFF:RIGHT LEG: Mild disease of the common femoral artery with multifocal mild-to-moderate disease of the SFA.Profunda femoris patent but diffusely calcified.Popliteal artery: Multifocal disease with areas of severe narrowing at the level of the knee.Diffuse calcific disease limits evaluation of the runoff vessels. Given this limitation, probable two-vessel runoff to the right foot via anterior tibial and peroneal arteries.Anterior tibial: Multifocal moderate disease.Posterior tibial: Occluded proximally.Peroneal: Occluded proximally with reconstitution via collaterals at the level of the mid-calf.Dorsalis pedis: Patent.LEFT LEG: Severe stenosis of the proximal common femoral artery with multifocal moderate-to-severe disease of the SFA.Profunda femoris patent but diffusely calcified.Popliteal artery: moderate-to-severe disease.Diffuse calcific disease limits evaluation of the runoff vessels. Given this limitation, probable single-vessel runoff to the left foot via a severely diseased anterior tibial artery.Anterior tibial: Multifocal severe disease.Posterior tibial: Occluded.Peroneal: Probable occlusion of the peroneal artery at the midcalf level.Dorsalis pedis: Patent via collateral filling.

Output: 1. Calcified aortic valve. Ascending aorta measures 3.9 cm (nonorthogonal) at the level of the main pulmonary. Please note that this examination was not tailored for evaluation of aortic valve morphology.2. Diffuse atherosclerotic calcifications of the descending abdominal aorta and iliac vessels, which are otherwise patent.3. Left pelvic kidney with significant dilatation of the collecting system corresponds to known failed renal transplant. Bladder wall thickening is also noted.4. Bibasilar bronchiectasis with adjacent groundglass opacities (left greater than right), suggesting chronic aspiration and/or infection. Given the patient's age this should be followed to resolution to exclude underlying neoplasm, especially if there are no signs or symptoms of infection/aspiration.5. RIGHT LOWER EXTREMITY RUN-OFF: Mild inflow disease with multifocal mild-to-moderate outflow disease involving the superficial femoral artery. There is severe narrowing of the popliteal artery at the level of the knee with probable two-vessel runoff to the right foot via diseased anterior tibial and peroneal arteries.6. LEFT LOWER EXTREMITY RUN-OFF: Focal severe disease of the proximal common femoral artery with multifocal moderate-to-severe disease of the superficial femoral artery. Moderate-to-severe disease of the popliteal artery with probable single-vessel runoff to the left foot via a severely diseased anterior tibial artery.


Instruction: Generate impression based on findings.

Input: Structural abnormality as well as birth HIE: diplegia + right hemiplegia. There is mild volume loss and high T2 signal in the white matter adjacent to the left lateral ventricle, which is asymmetrically enlarged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The cerebellum and brainstem appear unremarkable. 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: Findings suggestive of mild periventricular leukomalacia in the right cerebral hemisphere, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Right upper extremity and left lower extremity weakness. Is there cervical stenosis? Multiple sequences are motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild anterolisthesis of C6 on C7 as seen before. Alignment is otherwise maintained. Bone marrow signal is within normal limits. There is no convincing cord signal abnormality, within the limitations of the motion artifact.Degenerative changes are seen in the cervical spine as described below:C2-3: Small disc disc bulge and uncovertebral osteophytes. No significant compromise to the spinal canal or neural foramina.C3-4: Disc bulge, uncovertebral hypertrophy, and ligamentum flavum thickening contribute to moderate spinal canal stenosis. There is no significant neural foraminal stenosis.C4-5: There is disc bulge eccentric to the right and uncovertebral hypertrophy. There is up to moderate spinal canal stenosis, relatively worse involving the right aspect of the spinal canal. There is moderate right and mild left neural foraminal stenosis.C5-6: There is disc bulge and uncovertebral hypertrophy with mild spinal canal stenosis at this level. There is also mild to moderate right and mild left neural foraminal stenosis.C6-7: There is mild anterolisthesis with disc uncovering and and facet arthropathy. There is no significant spinal canal stenosis. There is mild bilateral neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative changes in the cervical spine with up to moderate spinal canal stenosis at the C3-C4 and right C4-C5 levels. No definite cord signal abnormality is appreciated within the limitations of motion degraded study. Multilevel neural foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: History of metastatic prostate cancer. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal and morphology. Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is a subcentimeter T2 bright focus in the tail the pancreas that may represent a small sidebranch IPMN). The pancreas is otherwise unremarkable. The pancreatic duct is normal in diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts bilaterally measuring up to 13 mm in diameter. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes from ileal conduit formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy. Stable simple cystic collection in the resection cavity. No evidence of local recurrence.BLADDER: Status post cystoprostatectomy. Ileal conduit. Patient with a right lower quadrant ostomy. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes from ileal conduit formation.BONES, SOFT TISSUES: Small T2 bright cystic focus adjacent to the left acetabulum may represent a para labral cyst.OTHER: No significant abnormality noted.

Output: Stable post treatment findings without evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 17 year old male with a history of chest pain and syncope referred for cardiac MRI after echocardiogram noted mild right ventricular dilation/dysfunction. Left VentricleThe left ventricle is normal size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 99ml/m2 (normal range: 74+/-15), the LVEDV is 186 ml (normal range 142+/-34), the LV end systolic volume index is 41ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19), the LV mass index is 64 mg/m2 (normal range 85+/-15), and the LV mass is 120 (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation time is normal (1005 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. No focal right ventricular aneurysms or wall motion abnormalities noted. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 86 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 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. The left ventricle is normal size with normal systolic function (LVEF 58%) without evidence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function (RVEF 53%) without evidence of arrhythmogenic right ventricular cardiomyopathy. 3. Trace pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Breast cancer and brain metastases; s/p SRS to R temporal lesion, L inferior frontal and L cerebellar lesions The dominant part of a left cerebellar mass measures 3.3 x 2.4 cm (series 10 image 23), previously 2.7 x 2.3 cm. There is now new diffusion restriction of the anterior left cerebellar region and increased susceptibility suggestive of hemorrhage. This is superimposed upon an enlarging anterior extending lobule of the tumor, in the area of the previously seen linear extension anterosuperiorly from the dominant component. This lobules now measures 2.1 x 2.1 cm (series 10 image 36). There is increased adjacent FLAIR signal abnormality extending across midline and mass effect.There is linear 7 mm residual enhancing tissue at the location of previous right temporal lobe lesion (series 11 image 18). There is minimal increase in a rounded right occipital intrinsically T1 hyperintense lesion with superimposed enhancement measuring 6 x 7 mm (series 10 image 91), previously 5 x 5 mm. Left frontal lesion is also minimally increased and measures 5 x 4 mm (standard image 105), previously 4 x 4 mm. There are areas of associated FLAIR hyperintensity.There appears to be interval mild global volume loss. No extra-axial fluid collections. Gray-white matter differentiation is preserved. Nonspecific mucosal thickening of the left maxillary sinus.

Output: 1.Increase in size, associated vasogenic edema, and localized mass effect of the left cerebellar metastasis with new hemorrhage anteriorly in an enlarging lobule of the mass.2.Minimally increased subcentimeter metastases, including ones in the left frontal and right occipital lobes.3.Near complete resolution of the right temporal lobe lesion with residual linear enhancing tissue, nonspecific but perhaps related to scarring.4.Findings discussed with Dr. Warnke pager 4244 by Dr. Stephanie Jo at the time of dictation.


Instruction: Generate impression based on findings.

Input: Exam obtained for research purposes only. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not used for clinical purposes.


Instruction: Generate impression based on findings.

Input: 40 year-old male, distention, right lower quadrant pain, flank pain evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable bilateral adrenal mass lesions. Right adrenal mass measures 4.6 x 4 .1-cm on image number 34. Left adrenal mass measures 9.9 x 5.1 cm image number 36.KIDNEYS, URETERS: Right nephrectomy site is clear. Irregular left kidney is unchanged. Possible photocell carcinoma cannot be excluded. Left renal vein is again distended suspicious for tumor thrombus. If there is a clinical concern to evaluate the left renal vein and the left kidney MRI may be helpful.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No change in the right paracolic cutter metastases measuring 5.8 x 2.6 cm image number 71.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Inflammatory changes and small fluid Colette since adjacent to the sigmoid colon consistent with diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Metastatic renal cell cancer. New diverticulitis with small fluid collections in the pelvis.


Instruction: Generate impression based on findings.

Input: 55 years, Male, Reason: Evaluate for posterior fossa contrast enhancement, movement artifact in prior study, history of base of tongue cancer Brain parenchyma appears within normal limits. No intracranial mass or abnormal enhancement is seen in the brain to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Partially empty sella is seen which can be a normal variant. There is a small left maxillary sinus mucus retention cyst and minimal ethmoid mucosal thickening which was present previously. Paranasal sinuses are otherwise clear. There is evidence of prior endoscopic sinonasal surgery. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Brain MRI appears within normal limits. Specifically, no abnormal enhancement or evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 48 years Female (DOB:3/26/1968)Reason: new headaches with position changes please r/o sinus thrombus History: headachesPROVIDER/ATTENDING NAME: JENNIFER M RUSIECKI JENNIFER M RUSIECKI MRI brain:No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a developmental venous anomaly present in the right frontal lobe.The patient status post right parotid surgery.There are several 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.MRV brain:The left sigmoid sinus and left transverse sinus are very small. The left sigmoid groove and left jugular bulb are small. The left transverse sinus is very small.The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.Several periventricular and subcortical white matter lesions are most likely vascular related but are nonspecific. Alternatively examination may include migraines, trauma, vasculitis.2.There is no evidence for venous sinus occlusion. The left transverse sinus appears be hypoplastic and the left sigmoid sinus and the left jugular vein are congenitally small.3.Status post right parotid removal.


Instruction: Generate impression based on findings.

Input: 56-year-old woman with history of breast cancer status post mastectomy, now with a aphasia. In the posterior portion of the left superior temporal sulcus (901/18) there is a round, dural-based extra-axial mass. This mass appears isointense on T1-weighted images, heterogeneously hyperintense on T2-weighted images, and enhances avidly. Additionally, there are punctate foci of susceptibility artifact within the posterior aspect of the mass suggestive of micro-calcification or hemorrhage not visible on the prior CT (702/15). There is slight diffusion restriction in this mass. There is increased T2/FLAIR signal in the adjacent left parietal lobe white matter with sulcal effacement consistent with vasogenic edema. There is slight mass effect on the trigone of the left lateral ventricle, but there is no significant midline shift or evidence of herniation. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. A focus of T2/FLAIR hyperintensity in the subcortical white matter of the left frontal lobe (401/18) is nonspecific and does not enhance. The brain parenchyma is otherwise unremarkable for age. The major flow-voids are preserved.The extracranial soft tissues and the overlying bone appears normal.

Output: 1.Prominent extra-axial mass along the posterior left superior temporal sulcus with local mass effect and extensive associated vasogenic edema with mild localized mass effect. No overlying osseous abnormality. Differential diagnosis would include a meningioma versus solitary dural metastasis.2.Nonspecific, nonenhancing focus of signal abnormality in the subcortical white matter of the left frontal lobe.


Instruction: Generate impression based on findings.

Input: 55-year-old female status post LADD procedure with bouts of chronic pancreatitis ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild irregularity of the mid main pancreatic duct without significant upstream dilation. Decreased compliance within the body and tail of the main pancreatic duct following secretin administration. No evidence of pancreatic divisum. A lobulated T2 hyperintense lesion is noted within the mid pancreatic body favored to represent a sidebranch IPMN (series 4, image 20). There is mild parenchymal atrophy of the distal body and tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Benign cyst in the right interpolar kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical evidence of LADD procedure with small bowel characteristically situated in the right hemiabdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild focal irregularity/stricture of the mid main pancreatic duct with decreased compliance following secretin administration, particularly at level of distal body/tail. There is parenchymal atrophy of the distal body and tail of the pancreas.2.Probable side branch IPMN. 3.Postsurgical changes of a LADD procedure without evidence of small bowel obstruction.


Instruction: Generate impression based on findings.

Input: Pain MENISCI: There is perhaps minimal fraying of the free edge of the body of the medial meniscus, which may be of questionable clinical significance. However, no tear is seen. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The cartilage is within normal limits. No fluid-filled defects are seen. No underlying bone marrow edema is present.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

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


Instruction: Generate impression based on findings.

Input: Left hip pain. Evaluate for occult fracture, metastasis, AVN. There is no evidence of an occult fracture. Subchondral foci of decreased T1 signal along the bilateral superior femoral heads without associated increased T2 signal likely represent bone islands. Bone marrow signal is otherwise within normal limits without abnormal enhancement. A 20 x 9 mm ovoid lesion within the left gluteus medius muscle follows fat on all sequences and is compatible with an intramuscular lipoma.

Output: 1. No evidence of avascular necrosis, fracture, or metastases. 2. Left gluteus medius intramuscular lipoma.


Instruction: Generate impression based on findings.

Input: Ventriculomegaly, 24 weeker with history of RDS, pseudomonas pneumonia and E coli, now with increased ventilator settings over the last week. There is diffuse susceptibility effect and T2 hyperintensity along the margins of the bilateral lateral ventricles, which are diffusely enlarged. There is also a subcentimeter area of encephalomalacia in the right parietal lobe periventricular region. The degree of myelination in the bilateral cerebral hemispheres is likely slightly delayed, even accounting for prematurity. There is no evidence of intracranial tumor or acute infarction. 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: Findings compatible with post-hemorrhagic periventricular leukomalacia with porencephalic cyst formation and cerebral volume loss.


Instruction: Generate impression based on findings.

Input: This is a motion degraded exam. The cervical spine is in normal alignment, with reversal of cervical lordosis which could be positional. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: The T4 vertebral body lesion demonstrates signal characteristics compatible with posttreatment effect. No new lesions in the cervical, thoracic or lumbar spine. Partially visualized left iliac bone lesion. Please refer to MRI pelvis performed on the same date for more details.


Instruction: Generate impression based on findings.

Input: 20 year-old male with history of neurofibromatosis type II status post resection 5 years ago complaining of headache and right leg weakness x 3 weeks. History of prior tumor in brain stem and cervical spinal cord. No mass effect, midline shift, edema, or areas of abnormal contrast enhancement are seen. Presence of contrast reduces sensitivity for intracranial hemorrhage. No gross intracranial hemorrhage is seen. The brainstem is poorly visualized -- if tumor recurrence is a clinical concern, recommend contrast-enhanced MRI.The ventricles and basal cisterns are normal in size and configuration.Within the limits of CT precision, the diameters of the internal auditory canals are unchanged from the study dated 7/9/2006. The known bilateral acoustic neuromas are not visible on the current study.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.No bony lesions of the skull base are seen. A poorly defined sclerotic lesion is present in the frontal bone -- this finding appears stable from the scan dated 7/9/2006. Patient is status post occipital craniotomy.

Output: 1. No acute intracranial process. 2. Multiple abnormalities as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: stroke History: slurred speech MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild 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 demonstrate a mucus retention cyst in the left maxillary sinus and some diffuse mucosal thickening The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are not readily identified. The right vertebral artery is slightly larger than the left vertebral artery .MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for acute ischemic infarction. 2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is no evidence for intracranial cerebrovascular occlusive disease.4.There is no evidence for extracranial carotid or vertebral cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: 52-year-old man with history of excruciating back pain and bilateral sciatica. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L5 on S1; otherwise the alignment is within normal limits. Bone marrow signal is slightly heterogeneous but benign. The L5/S1 disc is desiccated. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: There is a minimal disc bulge. There is also mild prominence of the dorsal epidural fat and minimal narrowing of the spinal canal. Otherwise no significant spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: There is a mild disc bulge with mild right and minimal left neural foraminal stenosis. There is moderate facet arthropathy. No spinal canal stenosis.L5-S1: There is a mild disc bulge with small central protrusion. There is mild right neural foraminal stenosis and mild to moderate left neural foraminal stenosis. No spinal canal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1.Mild multilevel degenerative disease of the lumbar spine without high-grade spinal canal or high-grade neural foraminal stenosis at any level. There is mild right L4-5 and L5-S1 and mild to moderate left L5-S1 neural foraminal stenosis. Additional details as above.2. Moderate facet arthropathy at L4-5 which may also be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus [346.90], Reason for Study: ^Reason: hx of migraines, r/o structural lesion History: hx of migraines No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 66-year-old male with a history of lung cancer status post chemoradiation therapy now experiencing left-sided weakness with an abnormal head CT. As partially imaged on the noncontrast CT performed earlier same day, there are multiple ring-enhancing lesions are seen bilaterally within both supratentorial and supratentorial brain, associated with significant adjacent vasogenic edema, most compatible with metastatic disease. The largest of these lesions is located within the right anterior frontal lobe measuring 3.0 x 2.8 cm in transaxial dimensions with local mass effect resulting in 8 mm right to left midline shift. These include susceptibility hypointensity suggesting a hemorrhagic component. Additionally, there is an enhancing focus within the soft tissues of the scalp overlying the left parietal bone measuring up to 14 mm in maximal dimension. There is also a partially imaged, ill-defined focus of enhancement overlying the right mandible.Elsewhere there are scattered foci of susceptibility compatible with microhemorrhage, unchanged when compared to 2/6/2015. There are no large areas of restricted diffusion to suggest an acute territorial infarction. A chronic right orbital medial blowout fracture is again noted. The paranasal sinuses and mastoid air cells are clear.Redemonstrated are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. Again noted is nonspecific left falcine calcification. There is a left frontal developmental venous anomaly partially displaced by mass effect.

Output: 1.Multiple ring-enhancing metastases within both temporal tentorial and supratentorial brain resulting in local mass effect and 8 mm right to left midline shift.2.Enhancing abnormality within the soft tissues overlying the left frontal bone and the right mandible suspicious for cutaneous 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: 54-year-old female with segmentally distributed pleomorphic calcifications in the left breast, biopsy of which proved ADH worrisome for DCIS. The patient presents for technical repeat MRI study. There is scattered fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There is segmental non-mass enhancement at 6:00 - 8:00 position in the left breast, measuring 100 x 41 x 19 mm (AP x ML x CC).Because of the marked parenchymal enhancement, this non-mass enhancement is only seen on ultrafast imaging. A marker clip is identified at posterior lateral and inferior aspect of the lesion.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Suspicious segmental non-mass enhancement in the left breast at 6:00 - 8:00 position. Stereotactic biopsy for calcifications located at 6:00 position (anteromedial from the marker clip) is recommended for tissue diagnosis. Before stereotactic biopsy, ultrasound for left breast can be performed to look for possible target for biopsy.2. No MRI evidence for malignancy in the right breast3. No abnormal lymph nodes in either axillary regionBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 17 years old, with Neurofibromatosis type I, with back pain and multiple intracranial findings of NF1. Brain and orbits:Mild patchy T2 hyperintensity is again seen in the bilateral thalami, as well as questionably in the pons and left basal ganglia, showing no significant interval change. T2 hyperintensity of the medial temporal lobes including the hippocampi is also unchanged. Gyriform cortical T2 hyperintensity within the paramedian posterior left frontal lobe is unchanged as well.No new areas of parenchymal signal abnormality are detected. No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricular system is normal in size and morphology.Redemonstrated is asymmetric thickening of the right optic chiasm and right prechiasmatic optic nerve. The intraorbital optic nerve does not appear to be involved. There is no associated pathologic enhancement. Findings are unchanged.Cervical and thoracic spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen.Visualized spinal cord shows normal signal intensity and morphology throughout. No pathologic intraspinal enhancement is observed.Spinal soft tissues are unremarkable.The intervertebral discs are preserved. No significant bulge or herniation is seen. The spinal canal and neural foramina remain patent.

Output: 1.Stable appearing optic pathway glioma involving the right optic chiasm and right prechiasmatic optic nerve.2.Stable scattered foci of abnormal signal intensity in the brain which are nonspecific but likely related to NF1. No new intracranial lesions are seen.3.Unremarkable evaluation of the cervical and thoracic spine.


Instruction: Generate impression based on findings.

Input: Clinical question:? Cord compression from metastases versus SEA. Signs and symptoms: Back pain and leg weakness worsening. Nonenhanced complete spine MRI: Examination cervical region demonstrate moderate degenerative disk disease and multilevel mild to moderate central spinal stenosis. Note should be made that the examination is performed utilizing cord compression protocol and without dedicated axial images. This flattening deformity of the cord at C3 -- C4 and C5 -- C6 levels without detectable signal abnormality. This appearance is nearly identical to prior study from January of 2015. There is no convincing evidence of metastatic disease of the vertebral column in the cervical region.Examination of the thoracic region demonstrate normal anatomical alignment the vertebral column and without status of the spinal canal or significant neural foraminal compromise. The signal intensity and caliber of the thoracic cord is within normal. The above observations are similar to prior study.Examination of the lumbosacral spine demonstrate degenerative changes of the lower lumber spine with resultant suspected central spinal stenosis at L2 -- L3, L3 -- L4 and L4 -- L5 levels which remain nearly identical to prior exam.Diffuse ill-defined patchy foci of marrow signal changes the vertebral column consistent with known metastatic disease demonstrate no convincing evidence of any significant interval change. There is no evidence of fracture or malalignment and no evidence of perispinal soft tissue masses.There is evidence of mild bilateral pleural effusion.

Output: 1.No evidence of fracture or malalignment.2.Degenerative changes of cervical spine results in central spinal stenosis at multiple levels without significant change since prior exam.3.Degenerative changes of lumbar spine results in multilevel central spinal stenosis without significant change since prior exam.4.No detectable cord signal abnormality at any level.5.Diffuse metastatic lesions without convincing evidence of interval change.


Instruction: Generate impression based on findings.

Input: Per EPIC, history of sinonasal carcinoma status post induction chemotherapy followed by bifrontal anterior fossa skull base approach with frontal bone osteotomy, craniotomy and combined intradural and extradural approach to skull base tumor invading the dura, resection of tumor with complex dural closure with pericranial graft and split bone cranioplasty, microsurgical dissection, harvesting of abdominal fat autograft and insertion of a lumbar subarachnoid drain on March 11, 2010 followed by adjuvant chemoradiation completed July 10, 2010. His course of care has had multiple complications. Patient presents s/p wide local excision of right naso-cutaneous malignant melanoma with skin defect on 6/3/2015 and basal cell carcinoma of the upper lip status post Mohs on 6/9/2015. There is redemonstration of extensive postoperative findings related to skull base surgery, including bilateral frontal craniotomy, resection of the cribriform plate as well as absence of the lamina papyracea, bilateral ethmoids, sphenoid sinus nasal septum and turbinates. There is a persistent rim of tissue in the bilateral maxillary sinuses, stable compared to prior CT from 2014 and slightly improved from MRI of 2012. There is soft tissue thickening subjacent to the frontal craniotomy, which appears increased in size, particularly on the left side compared to CT of 2014 and MRI of 2012. There is heterogeneous tissue or fluid in the sphenoid portion of the operative bed, which shows slightly differing signal characteristics compared to prior MRI of 2012, but is probably stable in extent. Allowing for differences in technique, there are right greater than left anterior frontal foci of T2 hyperintense signal, similar in size compared to to CT of 5/17/2014, although slightly progressed compared to MRI brain dated 9/15/2012. There is a new cystic area associated with the right frontal encephalomalacia. There is mild global parenchymal volume loss, greater than expected for age. There is no evidence of intracranial hemorrhage, or acute infarct. There is no hydrocephalus. There is no midline shift or herniation. There is medial deviation of the bilateral globes.

Output: 1. Extensive postoperative findings related to sinonasal surgery.2. Progressive thickening of ill-defined enhancing tissue subjacent to the frontal craniotomy, increased from MRI of 2012 and CT of 2014. The nature of these changes are of uncertain significance and could represent granulation tissue or inflammatory reaction, but progressive disease is not entirely excluded. 2. Progression of right anterior frontal encephalomalacia, which may be related to treatment effect.


Instruction: Generate impression based on findings.

Input: Generalized enlarged lymph nodes [R59.1] / Fever, unspecified [R50.9], Reason for Study: ^Reason: hearing loss, 72y with recurrent AML, cervical LAD, concern for leukemic involvement vs. Infection History: hearing loss, neutropenic fevers, cervical LAD Diffuse bilateral hemispheric dural enhancements are seen without evidence of small ventricle size or evidence of brainstem sagging.There is no evidence of abnormal brain parenchymal enhancement. No evidence of acute ischemic or hemorrhagic lesion.There are multiple high signal intensities on FLAIR imaging especially on the right globus pallidus and the parietal white matter and left cerebellar hemisphere indicating possible chronic lacunar infarcts.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Right mastoid air cells show opacification.There is developmental venous anomaly on the left cerebellar hemisphere.

Output: 1. Diffuse bihemispheric dural enhancement without evidence of intracranial hypotension. Differential diagnosis include leptomeningeal carcinomatosis, inflammation/infection such as meningitis, post-lumbar puncture or CSF tapping status.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 41-year-old male with bilateral shoulder pain. No improvement with physical therapy and injections. Evaluate for rotator cuff tear. LEFT SHOULDER:ROTATOR CUFF: Mild tendinosis affects the supraspinatus. No full-thickness tear is present.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is severe degeneration and tearing of the inferior and posterior glenoid labrums. There is dysplasia of the posterior glenoid with eccentric position of the humeral head in relation to the glenoid. Moderate osteoarthritis affects the glenohumeral joint with a large osteophyte along the posterior glenoid.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Severe degeneration and tearing of the bilateral posterior and inferior glenoid labrums. 2. Extensive debris within the shoulder joints bilaterally with moderate synovitis.3. No evidence of full-thickness tear of the rotator cuff.


Instruction: Generate impression based on findings.

Input: Cirrhosis with worsening jaundice. Evaluate for biliary dilatation. ABDOMEN:LIVER, BILIARY TRACT: Small nodular liver compatible the history of cirrhosis. There is reticular increased T2 signal throughout the hepatic parenchyma compatible with fibrosis. The hepatic arteries and veins are widely patent. The splenic vein is moderately dilated measuring 17 mm. The extrahepatic and intrahepatic portal vein are diminutive appearing similar to prior. Prominent splenorenal collaterals measuring up to 16 mm.Stable subcentimeter cystic focus in the hepatic dome. No suspicious arterial enhancing lesions.No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 7 mm in diameter.SPLEEN: Splenomegaly with the spleen measuring 17 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent periportal lymph nodes likely reactive in the setting of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination with cirrhotic liver and findings of portal hypertension. No biliary ductal dilatation. No suspicious arterially enhancing lesions. 2.The portal vein remains diminutive which is similar to the prior exam. Ultrasound maybe useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 19 years, Female, Reason: evidence of gallstone pancreatitis History: elevated lipase, N/V. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a segment 3 lesion measuring 2.2 x 2.2 cm which is bright on T2 weighted images, shows diffusion restriction and demonstrates faint enhancement that was not evident on the prior exam. No fat is evident within the lesion.Status post cholecystectomy. Common bile duct is mildly prominent measuring 6 mm. Pancreatic duct appears normal. No evidence of pancreatic divisum.SPLEEN: No significant abnormality noted.PANCREAS: There is diffusion restriction and low T1 signal throughout the pancreas with mild peripancreatic edema, compatible with acute pancreatitis. No focal fluid collections.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral pelvic caliectasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Intrauterine pregnancy seen previously is no longer evident.

Output: 1.Findings compatible with acute pancreatitis.2.Mildly enhancing hepatic lesion may represent a perfusion abnormality or focal nodular hyperplasia, however an adenoma is also a differential consideration. Follow-up MRI in 6 months with FNH protocol is recommended.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. Evaluation is somewhat limited due to differences in technique with regards to prior preoperative exams.Postoperative changes again seen from right frontal craniotomy. There is mild irregular enhancement along the right galea and adjacent musculature. The previously seen large heterogeneously enhancing mass within the sella and suprasellar region on the preoperative MRI is been largely resected. There is irregular intrinsic T1 hyperintensity within the expected location of the anterior superior aspect of the enlarged, with more conspicuous high signal along the adjacent sphenoid region with dropout of signal on fat saturated postcontrast images which may represent an area of fat packing with adjacent postoperative material along the surgical tract which is better delineated on coronal T2-weighted images. There is an area of irregular enhancement identified just anterior to the clivus along the inferior aspect of the enlarged sella, with additional superimposed lacelike enhancement of the area of intrinsic T1 hyperintensity in the expected anterior superior sellar location. Overall, the area of heterogeneous enhancement measures 1.6 cm transverse x 2.1 cm CC x 2.6 cm AP. Overall, the previous extensive mass effect appears resolved. The optic chiasm is now suggested but appears severely thinned. Optic nerves are at the edge of the field-of-view. Visualized flow-voids appear patent.

Output: Postoperative changes following previous large sellar/suprasellar mass resection. Irregular enhancement remaining in the enlarged sella is nonspecific and may in part represent postoperative granulation tissue, although continued follow-up is recommended to evaluate for residual tumor. Overall, resolved extensive mass effect previously seen, with delineation of a very thin optic chiasm.


Instruction: Generate impression based on findings.

Input: Breast and ovarian cancer with intracranial metastases: preoperative planning. There are numerous supratentorial and infratentorial mass lesions with associated vasogenic edema. The largest of these measures up to 4.0 cm in the left frontal lobe and 3.0 cm in the right parietal lobe. There is mild midline shift to the right. The bone marrow of the skull appears heterogeneous. The orbits are grossly unremarkable. There are skin fiducial markers in position.

Output: 1. Preoperative planning for numerous supratentorial and infratentorial metastases with associated vasogenic edema, the largest of which are located in the left frontal and right parietal lobes.2. The bone marrow of the skull appears heterogeneous, which likely also represents metastatic disease.


Instruction: Generate impression based on findings.

Input: 49 year-old female with seizure today, question of new onset. Rule out mass. There is no evidence of intracranial hemorrhage, mass or edema. Hypodensity within the right frontal region including cortical and subcortical regions along the floor of the anterior cranial fossa consistent with encephalomalacia of unknown etiology. If clinically warranted, an MRI may be considered for further evaluation of this region.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The mastoid air cells are normally pneumatized. Limited view of the paranasal sinuses are normally pneumatized.

Output: 1. Low density within the right frontal region, of unknown etiology may be further evaluated with MRI if clinically warranted. 2. No acute abnormalities.


Instruction: Generate impression based on findings.

Input: 69 years, Male, Reason: hx prostatectomy with positive margins in 2007, now with biochemical recurrence, assess for recurrence/mets History: hx prostatectomy with positive margins in 2007, now with biochemical recurrence, assess for recurrence/mets. PELVIS:PROSTATE: Status post prostatectomy. No residual enhancing tissue is present to suggest local recurrence.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 24-year-old female with right knee pain despite PT. Evaluate for meniscal injury, other anatomic cause. Evaluate nonvascular lesion seen adjacent to popliteal vessel (seen on U/L of RLE in 12/14) Note that study is somewhat suboptimal secondary to patient's size.MENISCI: No significant abnormality noted. ARTICULAR CARTILAGE AND BONE: There is marked thinning of the articular cartilage involving the medial and lateral spaces of the patella. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Marked thinning of the articular cartilage involving the medial and lateral spaces of the patella most consistent with chondromalacia patella.2. Findings most consistent with a popliteal cyst.


Instruction: Generate impression based on findings.

Input: High risk patient on study IRB13073B. Status post left lumpectomy in July 2015 at St. Anthony Hospital and radiation therapy presents for follow-up exam There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted in the right breast and moderate parenchyma enhancement is noted in the left breast. Expected post surgical changes with skin thickening and asymmetric parenchymal enhancement in left breast probably due to radiation treatment.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: Clinical question: 45-year-old male with metastatic lung cancer. No known brain metastases. Right facial droop and seventh nerve palsy. Signs and symptoms : Right facial droop. Pre and post enhanced brain MRI:Examination degraded in particular on post enhanced images due to motion artifact.Diffusion-weighted series demonstrate punctate multiple foci of restricted diffusion in bilateral (R>L) inferior cerebellar, left superior cerebellum, right posterior temporal cortex, left basal ganglia/caudate nucleus, right thalamus, right anterior frontal subcortical and cortical and left high convexity anterior frontal and multiple smaller scattered cortical foci in bilateral frontal cortices. Findings are consistent with diffuse small embolic metastatic lesions. None of the lesions demonstrate associated hemorrhagic changes or enhancement.Many of the above detailed ischemic strokes are identified on flair and T2 weighted images. On post enhanced series however there is a single focus of and enhancement measuring approximately 5.8 mm in the left occipital lobe (axial post enhanced series 13 image 15) and highly concerning for a metastatic lesion. There is no associated flair or T2 signal abnormality and no detectable hemorrhagic changes.Calvarium demonstrate no abnormal signal or enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses demonstrate minimal chronic sinus disease the maxillary sinuses.Extensive opacification of right mastoid air cells is noted.

Output: 1.Scattered punctate foci of restricted diffusion in bilateral cerebral and cerebellar hemispheres as detailed. No hemorrhage or enhancement this findings.2.Single ring enhancing lesion measuring 5.8-mm in the left occipital lobe without surrounding edema or hemorrhagic changes and highly concerning for metastatic lesion.3.Unremarkable calvarium and orbits.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.T2 hyperintensity is noted within a left paramedian muscle posteriorly, likely splenius capitis (best seen series 401 image 4, series 501 image 16).C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: UnremarkableC6/7: UnremarkableC7/T1: Unremarkable

Output: 1.T2 hyperintensity is noted within a left paramedian muscle posteriorly, likely splenius capitis (best seen series 401 image 4, series 501 image 16). This appearance is typically secondary to muscular injury.2.No disc herniations or stenoses.


Instruction: Generate impression based on findings.

Input: Right upper extremity weakness. The imaged are degraded by patient motion. There is high T2 signal and mild swelling of the left medial temporal lobe and basal ganglia without restricted diffusion. There are otherwise multiple scattered areas of cerebral and pontine white matter T2 hyperintensity. There are bilateral cerebral convexity subdural effusions, which measures up to 4 mm in thickness. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Sequelae of maxillofacial trauma are better delineated on the prior CTs.

Output: 1. High T2 signal and mild swelling of the left medial temporal lobe and basal ganglia without restricted diffusion may represent traumatic brain injury, subacute infarction superimposed upon a background of chronic small vessel ischemic disease, and less likely neoplasm, although the assessment is limited by patient motion and the lack of intravenous contrast. Otherwise, no evidence of acute infarction. Nevertheless, follow up with a brain MRI with contrast is recommended.2. Small bilateral cerebral convexity subdural hygromas.3. Sequelae of maxillofacial trauma are better delineated on the prior CTs.


Instruction: Generate impression based on findings.

Input: Reason: evidence for median neuropathy, likely in forearm, recent liver transplant History: left arm numbness and tingling There is no abnormal soft tissue mass or other deformity affecting the median nerve along its course. The appearance of the carpal tunnel is normal. No soft tissue abnormalities or atrophy is evident. The osseous structures of the forearm appear within normal limits.

Output: No abnormalities are identified to account for the patient's left arm numbness/tingling.


Instruction: Generate impression based on findings.

Input: Reason: osteomyelitis of left foot? History: diabetic foot infection, high CRP Note is made of soft tissue irregularity along the plantar aspect of the distal phalanx of the great toe consistent with the stated history of ulceration. There is increased signal abnormality on fluid sensitive sequences within the subcutaneous tissue along the plantar aspect of the distal phalanx of the great toe indicating a cellulitis. There is extension of this enhancing signal abnormality to the plantar aspect of the distal tuft of the distal phalanx of the great toe. There is associated increased bone marrow signal abnormality on fluid sensitive sequences and decreased signal abnormality on T1-weighted images consistent with osteomyelitis of the tuft of the distal phalanx of the great toe. There is increased signal abnormality in the base of the distal phalanx and proximal phalanx of the great toe without corresponding decreased T1 signal abnormality likely reflecting reactive osteitis rather than osteomyelitis. The first metatarsal bone marrow signal is within normal limits. There is nonspecific increased signal abnormality within the plantar musculature of the foot which can be seen in diabetic patients. There is a small amount of fluid within the first MTP joint which may reflect a synovitis. There is no focal fluid collection to suggest abscess formation.

Output: Findings consistent with osteomyelitis of the distal phalanx of the great toe. Other findings as described.


Instruction: Generate impression based on findings.

Input: 68 year old with history of ischemic cardiomyopathy with biventricular pacing/ICD presenting for cardiac evaluation as part of workup for advanced options. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 175 ml/m2 (normal range: 74+/-15), the LVEDV is 320 ml (normal range 142+/-34), the LV end systolic volume index is 124 ml/m2 (normal range 25+/-9), the LVESV is 228 ml (normal range 47+/-19), the LV mass index is 110 g/m2 (normal range 85+/-15), and the LV mass is 201 g (normal range 164+/-36). There is global hypokinesis with additional akinesis in the mid to basal inferior and inferolateral wall. There is correlating transmural (>50%) late gadolinium enhancement mid to basal inferolateral wall in a pattern consistent with myocardial infarction. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 112 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 137 ml (normal range 54+/-17).Right AtriumThe right atrium is grossly normal in size.Aortic ValveThe aortic valve opens widely and there is trace significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation. The degree of regurgitation is difficult to quantify due to the artifact. Pulmonic ValveNot well seen. Tricuspid ValveNot well seen. AortaNot well seen.Pulmonary VeinsNot well seen. Pulmonary ArteryNot well seen. Venous AnatomyNot well seen. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%. There akinesis in the mid to basal inferior and inferolateral wall. There is correlating transmural (>50%) late gadolinium enhancement mid to basal inferolateral wall in a pattern consistent with myocardial infarction. No MRI evidence to support the diagnosis of cardiac amyloidosis. 2. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%. 3. Severe left atrial enlargement. 4. At least moderate mitral regurgitation. 5. Marked bilateral pleural effusion.


Instruction: Generate impression based on findings.

Input: 23-year-old male with a history of a injury to the left ankle presents with chronic left ankle pain. TENDONS: The Achilles tendon is intact. LIGAMENTS: The lateral collateral ligament complex of the ankle is intact.ARTICULAR SURFACES AND BONE: No significant abnormality noted. No abnormal bone marrow signal.ADDITIONAL

Output: No specific findings to account for the patient's chronic left ankle pain.


Instruction: Generate impression based on findings.

Input: 67 year-old with multiple myeloma and history of compression fractures. Cervical spine:The vertebral body heights are preserved. Alignment is anatomic. No compression deformity is evident. There is diffuse loss of vertebral disc signal compatible desiccation as well as loss of disc height at C6-7. The bone marrow is heterogeneous throughout which is nonspecific but compatible with the history of myeloma. No abnormal enhancement.C2-C3: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C3-C4: Trace disc osteophyte complex. No significant neural foraminal or spinal canal stenosis.C4-C5: Small disc osteophyte complex asymmetric to the right and uncovertebral joint hypertrophy. Mild right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.C5-C6: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.C6-C7: Moderate disc osteophyte complex with a superimposed left paracentral disc protrusion and uncovertebral joint hypertrophy. Mild left neural foraminal stenosis. No significant spinal canal or right neural foraminal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.Thoracic spine:There are mild anterior wedging deformities at T7, T8, and T9 with approximately 25% loss of anterior vertebral body height. This creates an exaggeration of the thoracic kyphosis. Additional central endplate compression deformity of the T3 and T12 vertebral body accounting for approximately 20% of the vertebral body height. Alignment is maintained. Mild diffuse loss of intervertebral disc height and signal compatible with degeneration. This is associated with multiple Schmorl's nodes in the lower thoracic spine The bone marrow is diffusely heterogeneous throughout which is nonspecific but can be seen in myeloma. No abnormal enhancing lesions. Note is made of several mildly prominent mediastinal and retroperitoneal lymph nodes seen better on recent PET scan. No significant disc bulges, spinal canal stenosis, or neural foraminal narrowing in the thoracic spine.Lumbar Spine:There are 5 true lumbar type vertebral bodies with an additional transitional vertebra which for the purpose of this exam will be labeled S1. Post surgical changes from L3-4 interbody fusion and posterior stabilization. Metallic artifact mildly limits evaluation at this level. The vertebral body heights are maintained. Alignment is anatomic. The bone marrow is diffusely heterogeneous throughout with more focal lesions in the iliac bones compatible with the history of myeloma. There is a more focal high T1 and high T2 focus in the L1 vertebral body which suppresses on the STIR images compatible with an intraosseous hemangioma. There is diffuse loss of intervertebral disc signal compatible with desiccation and degeneration. Large aortocaval lymph node measuring 2.3 cm in diameter as seen on prior PET scan. No abnormal enhancement.T12-L1: No disc bulge, neural foraminal stenosis, or spinal stenosis.L1-L2: Trace disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge slightly asymmetric to the left. Hypertrophy of the ligamentum flavum. Mild left neural foraminal stenosis.L3-L4: Postsurgical changes from posterior spinal fusion. Enhancing granulation tissue fills the neural foramen. There is moderate residual right neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis.L4-L5: Mild diffuse disc bulge. Mild hypertrophy of the ligamentum flavum. No significant neural foraminal or spinal canal stenosis.L5-S1: Mild diffuse disc bulge. Mild hypertrophy of the ligamentum flavum. No significant neural foraminal or spinal canal stenosis.

Output: 1. Diffusely heterogeneous bone marrow signal with some areas of more geographic patchy low T1 signal compatible with the history of multiple myeloma.2. Compression deformities involving the T3, T7, T8, T9, and T12 vertebral bodies with a maximum of 25% loss of intervertebral disc height. No associated compromise of the spinal canal3. Multilevel spondylitic changes which are most notably at L3-4 where there is moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke, Parkinson's plus. Signs and symptoms: Rigidity L>R. Pre and post enhanced brain MRI:Negative diffusion weighted series.There is mild prominence of cerebellar vermian folia for patient's stated age 67. Correlate with history and risk factors.Examination otherwise demonstrate normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits including axial fat sat post enhanced series.Unremarkable calvarium and soft tissues of the scalp.Normal pneumatization signal pattern normal paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: 1.Negative diffusion-weighted series.2.Mild prominence of the vermian folia for patient's stated age and otherwise unremarkable pre and post enhanced brain MRI.3.Unremarkable orbits, calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Reason: Eval for abscess vs fistula History: History of perirectal abscess with fistula PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction, abnormal mucosal enhancement, or bowel wall thickening.BONES, SOFT TISSUES: Approximately 20 x 12 mm rim-enhancing collection in the right posterior buttock in the subcutaneous tissue (series 1201 and image 41). Underlying muscle appears normal without sinus tract or fistulization. There are faint linear enhancement along the medial left thigh extending from the anus (series 1201 and image 43-48) at the previous site of perirectal abscess. OTHER: Bilateral hydrocele.

Output: 1. Rim-Enhancing collection in the posterior right buttock subcutaneous tissue without fistulization.2. Faint linear enhancement along the medial left thigh at the previous site of perirectal abscess. This is not typical of abscess but cannot rule out developing inflammation. Please correlate with physical exam.


Instruction: Generate impression based on findings.

Input: headache, chronic migraine with acute worsening. No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Male 58 years old with 4 cm fungating mass 10 cm from anal verge on colonoscopy, pathology confirms rectal adenocarcinoma. Assess for depth and lymph node involvement. Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: There is a lesion within the right prostate involving the right peripheral zone measuring 7 x 6 mm (image 36/series 4) which is dark on T2 and ADC.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: There are a few enhancing lymph nodes measuring up to 5 mm (image 147 and 150/series 10011).Lymph nodes outside the mesorectal fascia: No abnormal appearing lymph nodes.BOWEL, MESENTERY: Rectal Tumor:Size: 2.3 x 1.0 x 4.3 cm (image 51/series 4; image 27/series 7)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensity. There is intermediate signal intensity extending into the fat posterior to the rectal wall.Tumor location: Upper thrid of the rectum involving the posterior rectal wall with its inferior margin approximately 8 cm from the verge.Circumference of the rectum involved: 180 degrees posteriorly.Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Not involved.MRI T-stage: T3b - Tumor invades 0.5cm to 1cm into perirectal fat or extramural.Node Distance to Mesorectal Fascia: 4 mm (image 49/series 12).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Predominantly solid tumor in the upper third of the rectum involving the posterior rectal wall has evidence of invasion into the perirectal fat. There are abnormally enhancing lymph nodes within the mesial rectal fascia suspicious for metastasis.2.A lesion within the right peripheral zone is suspicious for prostate carcinoma.


Instruction: Generate impression based on findings.

Input: Female 73 years old Reason: osteomyelitis? History: sacral decubitus ulcer with stool The bones appear demineralized. Evaluation of the lower sacrum and coccyx is limited on the AP view due to overlying stool. There is ulceration of the soft tissue which appears to extend to the coccyx. We see no definite osteolysis. If there is strong clinical concern for osteomyelitis MRI may be considered.Degenerative disc disease of the lower lumbar spine.

Output: Limited study showing soft tissue ulceration and gas density extending to the coccyx. We see no gross bone destruction. If there strong clinical concern for osteomyelitis, MRI may be considered.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness, concern for cord compression. Compared to 12/29/2014, there is interval increase in destructive changes at the C6-C7 disc level including the adjacent C6 and C7 vertebral bodies with loss of vertebral body height. T2 hyperintensity involving the disc space and bone marrow compatible with edema is stable to minimally increased in the interval. There is a dorsally projecting osteophyte/osseous retropulsion which results in flattening of the cord which is worse since prior. There is also increased T2 hyperintensity in the cord compatible with edema. There is mild edema involving the prevertebral soft tissues which appears overall decreased since 12/29/2014, but is slightly increased at the C6-C7 level.There is T2 hyperintensity in the ventral epidural space extending from C5 to C7 which is favored to represent engorged epidural venous plexus.Diffuse low T1 and T2 bone marrow signal may be related to renal osteodystrophy and/or chronic anemia. Individual levels as below:C2/3: Minimal posterior osteophyte disc complex without spinal canal or neural foraminal stenosis.C3/4: Posterior osteophyte complex causes anterior cord flattening, worse in the midline, without resulting intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is moderate spinal canal stenosis and mild bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex causes anterior cord flattening, worse in the midline, without resulting intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy, ligamentum flavum thickening, and mild right facet hypertrophy. There is moderate spinal canal stenosis and mild to moderate bilateral neuroforaminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild to moderate spinal canal stenosis. There is moderate to severe left neural foraminal and moderate right neural foraminal stenosis.C6/7: See above. There is severe spinal canal stenosis at this level which has progressed with also new T2 cord signal abnormality. There is severe right and moderate to severe left neural foraminal stenosis..C7/T1: No significant spinal canal or neural foraminal stenosis.

Output: 1. Examination is compared to 12/29/2014. Again seen are endplate destructive changes with edema centered at the C6-C7 level with interval worsening of height loss of the C5 and C6 vertebral bodies and worsened osseous retropulsion. Associated spinal canal stenosis has also worsened and is now severe. There is also new T2 hyperintensity in the cord at the C5-C6 level likely representing edema related to compression. Extent of osseous destruction and retropulsion may better assessed on CT.2. T2 hyperintensity involving the subligamentous anterior epidural space from C5 to C7 is favored to represent engorged venous plexus. Epidural abscess seems less likely based on the morphology although postcontrast images would be helpful. Differentials for the above destructive process include dialysis-related spondyloarthropathy and chronic infection.3. Multilevel cervical spinal canal stenosis and neural foraminal stenosis at additional levels is similar to prior and detailed above.


Instruction: Generate impression based on findings.

Input: History of perirectal mass with sciatica and pelvic fluid collection. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter within a collapsed bladder. In the vesicouterine pouch there is a heterogeneous complex fluid collection with irregular peripheral thick-walled enhancement with restricted diffusion compatible with an abscess measuring 4.8 x 4.1 cm (series 1101/71).LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In the presacral space there is a bilobed cystic lesion measuring 4.5 x 3.9 cm (series 1101/60) demonstrating thin peripheral enhancement. More superiorly and to the right of midline involving the right piriformis muscle there is a 1.6 x 1.3 cm fluid collection with extensive peripheral enhancement and soft tissue edema which extends into the sacral neuroforamen. There is presacral edema.BONES, SOFT TISSUES: Large right-sided Tarlov cysts.OTHER: No significant abnormality noted.

Output: 1. Vesicouterine pouch complex 4.8 cm abscess. 2. 1.6 cm fluid collection in the right piriformis muscle with extensive surrounding inflammatory enhancement and edema. An underlying mass lesion cannot be excluded.3. Inferior presacral cystic lesion measuring 4.5 x 3.9 cm also likely represents an infected fluid collection.


Instruction: Generate impression based on findings.

Input: 76 year old female with a personal history of right lumpectomy and radiation therapy for invasive lobular carcinoma in 1999. Prior benign left breast biopsy in 1985, and surgical removal of scar tissue from the left breast in July 2010. No current breast complaints. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.Volume loss of the right breast with stable postoperative deformity and scarring is unchanged.A few small metallic artifacts are seen in the right breast and right axilla, from the surgical clips of the prior surgery.Stable duct ectasia is present in the left retroareolar area.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: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Left clavicle fibromyxoid sarcoma: 3 month post op follow up. There are postoperative findings related to left clavicle sarcoma resection. There is diffuse edema and enhancement in the soft tissues surrounding the reconstructed left clavicle, with ill-defined soft tissue partially surrounding the underlying neurovascular bundle. Assessment of the bone marrow of the reconstructed left clavicle is limited due to the presence of metal hardware artifact. The regional lymph nodes do not appear to be particularly enlarged. There is a cystic right thyroid nodule that measures up to 12 mm.

Output: Extensive post-treatment findings in the left brachial plexus region, including what may represent granulation and scar tissue, although a small amount of residual tumor cannot be entirely excluded. Follow up with PET may be useful.


Instruction: Generate impression based on findings.

Input: Male; 69 years old. Reason: eval biliary system, assess hepatic vessel patency History: s/p OLT March 2014 with increasing AP ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant. Scattered focal and more geographic areas of arterial hyperenhancement in the right hepatic lobe without corresponding signal abnormality on remaining sequences, most likely due to transient arterial hepatic differences. No suspicious hepatic lesions. Mild central intrahepatic biliary ductal dilation. Patent choledochojejunostomy. Remnant common bile duct noted. Absent gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ventral abdominal wall hernia containing bowel loops without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild central intrahepatic biliary ductal dilation with patent choledochojejunostomy..


Instruction: Generate impression based on findings.

Input: There are 3 intracranial metastases. The largest measures 10 x 9 mm, contains minimal intrinsic T1 hyperintensity and susceptibility effect compatible with hemorrhage, and is located within the medial right frontal lobe anteriorly (superior frontal gyrus). There is mild edema associated with this lesion. In addition, there is a 4 x 6 mm enhancing lesion within the left frontal lobe (left middle frontal gyrus) and a 4 x 4 mm lesion within the right occipital lobe without significant edema. There is no midline shift or herniation. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. Bone marrow signal is heterogeneous is nonspecific; no discrete destructive osseous lesions.

Output: Three enhancing lesions involving the bilateral frontal lobes and right occipital lobe consistent with metastases. There is minimal hemorrhage and edema associated with the right frontal lesion without midline shift or herniation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Sanchez is a 47-year-old woman with biopsy-proven invasive ductal carcinoma of the right breast metastatic to right axillary lymph node. She presents today for an MR-directed ultrasound for additional lesions seen bilaterally on same day MRI. LEFT BREAST: A targeted grayscale and color Doppler left breast ultrasound was performed for the area of concern as directed by MRI in the left upper outer breast. In the left breast 1:00 position, approximately 2 cm from the nipple, there is an oval hypoechoic mass measuring 0.4 x 0.3 x 0.8 cm (CC by AP by TV). A vessel is seen draping over the mass. Internal vascularity is present. This correlates in location and appearance with the MR-detected finding. An ultrasound guided biopsy is recommended.RIGHT BREAST AND AXILLA: A targeted grayscale and color Doppler right breast ultrasound was performed for the area of concern as directed by MRI in the right upper outer breast. In the right breast 10:00 position, approximately 3 cm from the nipple, (located inferior to the index biopsy-proven cancer) there is a 0.4 x 0.3 x 0.5 cm hypoechoic mass with indistinct margins. This correlates in location and appearance with the MR detected finding. An ultrasound guided biopsy is recommended.Targeted grayscale and color Doppler of the right axilla was also performed. There is an abnormal morphology lymph node in the right axilla measuring approximately 3.3 x 0.9 x 2.3 cm, correlating with findings on outside ultrasound 7/27/2015 and consistent with the biopsy-proven metastatic lymph node.

Output: (1) Bilateral suspicious breast masses identified on ultrasound, corresponding to the MR-detected findings. An ultrasound-guided biopsy is recommended for both lesions for further evaluation.(2) Known biopsy-proven metastatic lymph node in the right axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Male; 69 years old. Reason: Hx of lung CA, f/u on chest CT findings History: none ABDOMEN:LIVER, BILIARY TRACT: Three small lesions in the inferior right hepatic lobe are suspicious for metastases and detailed below.18 x 9 mm slightly T2 hyperintense lesion with increased early enhancement and washout on delayed phase (series 12/63). This lesion appears new since CT dated 1/23/15.11 x 14 mm partially exophytic lesion with slight T2 hyperintensity and increased peripheral enhancement. This lesion appears new since CT dated 1/23/15.13 x 10 mm slightly T2 hyperintense lesion with increased early enhancement and washout on delayed phase (series 12/55).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Posttreatment changes in the chest, partially visualized.

Output: Three small lesions in the inferior right hepatic lobe suspicious for metastases.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of right shoulder pain. Evaluate for rotator cuff pathology. ROTATOR CUFF: There is a full thickness tearing of the anterior fibers of the supraspinatus tendon over a width of approximately 7 mm in the background of moderate to severe tendinosis. Posteriorly, there is partial thickness tearing . There is minimal retraction of the tendon. There is moderate to severe tendinosis of the infraspinatus with partial thickness tearing. There is moderate to severe tendinosis of the subscapularis with moderate fraying. The teres minor muscle and tendon are unremarkable.SUPRASPINATUS OUTLET: Moderate to severe degenerative disease affects the acromioclavicular joint with a small subacromial osteophyte that impinges the subjacent rotator cuff. There is no fluid in the subacromial or subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is extensive glenohumeral articular cartilage loss with near bone-on-bone apposition. There is degenerative tearing of the glenoid labrum.BICEPS TENDON: There is moderate tendinosis of the biceps tendon with partial thickness tearing just superior to where it enters the bicipital groove.ADDITIONAL

Output: 1.Full thickness tear of the anterior fibers of the supraspinatus.2.Moderate to severe tendinosis of the remaining rotator cuff with partial thickness tearing as above.3.Degenerative arthritic changes as above.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with right-sided weakness. Evaluate for acute stroke. A linear focus of restricted diffusion is seen within the left posterior limb of the internal capsule and posterior putamen. No other restricted diffusion is seen.Mild T2 hyperintensity is seen corresponding to the lesion above. Additional scattered small foci of periventricular and subcortical T2 hyperintensity are noted.No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.Please note that susceptibility weighted images were not obtained due to early termination of the examination due to patient discomfort. Therefore, the ability to detect small quantities of hemorrhage is diminished.

Output: Small acute infarct involving the posterior limb of the left internal capsule and the adjacent left posterior putamen.


Instruction: Generate impression based on findings.

Input: Thyroid cancer. Head CT:Nonspecific cerebral white matter hypoattenuation is compatible with small vessel ischemic changes. There is no evidence of intracranial mass, hemorrhage or infarction. No enhancing abnormality is seen. Neck CT:There is a large, irregular, heterogeneous mass at the thyroid bed, measuring 44 x 34-cm (series 4, image 56). There is likely involvement of the bilateral sternocleidomastoid muscles. The mass invades the trachea and extends to the right tracheo-esophageal groove, likely also involving the esophagus. There are satellite lesions in the right sternocleidomastoid muscle.A necrotic nodule measuring 13 x 16-mm (image 52, series 4) is seen, consistent with right level 6 adenopathy. There is extracapsular extension, and partial encasement of the right carotid artery.There is prominent soft tissues thickening along the tectorial membrane at C1 and C2 levels of uncertain etiology. Nonspecific lucent lesions are seen in C2 vertebra. MRI of cervical spine is recommended to exclude neoplasm. Degenerative disease of the cervical spine is seen, with disk osteophyte complex at C4 - C5 level, causing spinal canal stenosis. Severe neural foramina narrowing is also seen at multiple levels.

Output: 1. Large, necrotic mass in thyroid bed, with involvement of bilateral sternocleidomastoid muscles, and invasion of the trachea. There is also likely involvement of the esophagus.2. Right level 6 adenopathy with extracapsular extension and partial encasement of right carotid artery.3. Nonspecific vague lucent lesions in C2 vertebra, with soft tissue thickening along tectorial membrane. Correlation with MRI is recommended.4. Degenerative disease of cervical spine, resulting in spinal canal stenosis and foraminal stenosis..


Instruction: Generate impression based on findings.

Input: Diagnosis: Stable burst fracture of t11-T12 vertebra, initial encounter for closed fractureClinical question: Bone biopsy, h/o pulmonary nodules, concern for metsSigns and Symptoms: t6 fractureComments: DIET RESTRICTION: NPO after midnight. Must have radiologist approval. | Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the T11 vertebral lesion. Post procedure images do not identify any complications.

Output: T11 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis. The cytologist reports that carcinoma is present on the touch preps.


Instruction: Generate impression based on findings.

Input: Focal left hand dystonia. Asymmetric reflexes. There are multiple punctate T2-hyperintense, non-diffusion restricted foci in the frontoparietal white-matter that are nonspecific but most probably reflect chronic microvascular ischemia. There is no mass effect or space-occupying brain lesion. There is no midline shift. Gray-white differentiation is preserved. There is mild brain volume loss manifested by expansion of the ventricles and CSF-containing spaces above and below the tentorium. There is no intracranial hemorrhage by susceptibility weighted imaging. The intradural right vertebral artery does not show the expected flow-void which may reflect slow flow or thrombosis. Major intracranial vascular flow voids are preserved, otherwise.The mastoid air cells are clear. There is mild mucosal thickening in the paranasal sinuses. There is no gross orbital abnormality. There is incidental finding of torus mandibularis.

Output: 1.Brain shows volume loss and cerebral white-matter findings of chronic microvascular ischemia. There is no focal brain abnormality.2.The intradural right vertebral artery does not show the expected flow-void which may reflect slow/decreased flow or thrombosis. However, there is no acute infarct and this is unchanged since the previous cervical spine MRI from October 8, 2015, therefore perhaps a chronic finding.


Instruction: Generate impression based on findings.

Input: Male, 17 years old, with epilepsy. Pre-surgical language localization is requested. Sensorimotor cortical activation maps as expected along the pre- and post-central gyri.All tested language paradigms produced reliable language related cortical activation, though Wernicke's area is visualized only on the sentence completion paradigm. Language is left dominant.Putative Broca's area activity is seen in the left inferior frontal lobe (predominantly pars triangularis). Putative Wernicke's area activity maps along the posterior aspect of the left superior temporal sulcus.

Output: Successful fMRI for language lateralization. Language is left dominant. Broca's and Wernicke's areas map to their expected locations as above.


Instruction: Generate impression based on findings.

Input: Studies are somewhat degraded secondary to patient motion. Given this caveat:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The spinal cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The conus is normal in signal and morphology and terminates at L1/2. There are no MRI findings of fatty filum terminale. There are no osseous dysplasias. The visualized paraspinal contents are unremarkable.

Output: Negative noncontrast MRI of the complete spine. Specifically, there are no MRI evident abnormalities associated with the patient's coccygeal dimple.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a full-thickness cleft of the articular cartilage of the medial facet of the patella. Additional signal heterogeneity of the central articular cartilage of the patella represents additional focal degeneration. The articular cartilage of the lateral and femoral compartments is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Degeneration of the articular cartilage of the patella as detailed above. There is no evidence of meniscal tear or additional internal derangement.