Instruction: Generate impression based on findings.

Input: A 14 year old female with history of transposition of the great vessels, s/p arterial switch operation and s/p repair of coarctation of aorta. Due to chest pain the patient was referred to cardiac stress MRI.MEDICATIONS: none First Pass PerfusionDuring hyperemia, no perfusion defect is noted.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe heart is mid-line, vertically oriented, and rotated counter-clockwise causing the shape of the left ventricular apex to be distorted by extrinsic compression from the sternum. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 115 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 45 g/m2, and the LV mass is 63 g. Left AtriumThe left atrium is normal in size (64ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 109 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is trace 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.AortaThe aortic root is to the left of the main pulmonary artery and both of its branches. The aorta is connected to the left ventricle, the aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is very mild narrowing of the descending thoracic aorta at the site of her coarctation procedure. There is an anomalous coronary origin noted. The right coronary artery originates from the right coronary cusp. The left anterior descending artery is a branch from the right coronary artery. It does not traverse in between the great vessels. It is unclear whether the left circumflex artery originates from the same anomalous coronary vessel or whether it originates independently from the left coronary cusp. The proximal portions of the right coronary artery and left anterior descending artery are without significant stenosis. The left circumflex is not well visualized. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is small in size (12mm). No stenosis was noted in the main PA or its major branches.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPost surgical findings were noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. d-TGA s/p arterial switch operation. The aortic root is to the left of the main pulmonary artery and both of its major branches.2. No perfusion defects/ "ischemia" present during hyperemia.3. No prior myocardial infarction. The entire myocardium is viable.4. Normal LV size and systolic function (LVEF 55%). The left ventricular apical shape is distorted by extrinsic compression from the sternum. No evidence of underlying myocardial fibrosis, inflammation, or infiltration.5. Normal RV size and systolic function (RVEF 54%).6. Main pulmonary artery and its branches are small in caliber. 7. Anomalous coronary origin noted. The right coronary artery originates from the right coronary cusp. The left anterior descending artery is a branch from the right coronary artery. It does not traverse in between the great vessels. It is unclear whether the left circumflex artery originates from the same anomalous coronary vessel or whether it originates independently from the left coronary cusp. The proximal portions of the right coronary artery and left anterior descending artery are without significant stenosis. The left circumflex is not well visualized. 8. Minimal aortic narrowing at site of coarctation procedure. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Prostate cancer.PSA 6 months ago: 7 ng/mL.PSA May 20, 2015: 14.5 ng/mL.Prostate biopsy June 5, 2015, Gleason 8 prostate cancer and left mid, right mid, and right lateral apex. Greatest volume in right mid gland. Gleason 7 cancer at left apex, right lateral base, right base, right lateral mid gland. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.2 cm.Peripheral Zone: There are several suspicious lesions in the peripheral zone demonstrating hypointense ADC and T2 signal abnormality. The largest, dominant lesion is located in the right mid gland extending to the apex, series 701, image 18. This demonstrates pathologic enhancement and suggestion of washout. The adjacent capsule is indistinct, suggesting extracapsular extension. Additional suspicious lesion in the left base is seen on series 701, image 21. There is bulbous appearance of the left mid gland as well, without definite T2 or ADC signal abnormality; this lesion is indeterminate.Central Gland: Nodular central gland. No nodules demonstrate suspicious signal characteristics.Seminal Vesicles: No evidence of seminal vesicle involvement.Extracapsular Extension: Extracapsular extension from the dominant right mid gland lesion is suspected, as above.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Lesions in the peripheral gland suspicious for known prostate adenocarcinoma. Dominant lesion in the right mid gland with appearance suspicious for associated extracapsular extension.


Instruction: Generate impression based on findings.

Input: Male, 89 years old, with spinal pain and weakness, lumbar spine fracture. For the sake of consistency, the numbering scheme utilized on the preliminary interpretation will be preserved. Please note that with this numbering scheme, L1 is a rib-bearing vertebral body and S1 demonstrates a transitional lumbosacral morphology.STIR hyperintensity compatible with edema is evident within the L2 vertebral body correlating with known fractures. Vertebral body height is preserved and there is no evidence of significant retropulsion.Elsewhere, vertebral body signal characteristics are unremarkable allowing for degenerative endplate changes most notably at L5-S1. Trace retrolisthesis of L5 relative to S1 is seen. Otherwise, spinal alignment is anatomic.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.A renal cyst is demonstrated on the left.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Minimal disc bulging. No significant spinal canal or foraminal stenosis. L3-4: Facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet arthropathy. Loss of disc height and mild disc bulging. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Loss of disc height with disc bulging and osteophytic ridging. No significant generalized spinal canal. Moderate to severe bilateral foraminal narrowing.

Output: 1.Edema is evident within the L2 vertebral body compatible with known fracturing.2.No additional areas of marrow edema are seen.3.Degeneration of the disks and posterior elements is seen contributing to significant foraminal stenoses at lower lumbar levels.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, with right arm and leg numbness and tingling. MRI brain:No restricted diffusion is seen. Scattered small foci of T2 hyperintensity are seen within the subcortical white matter of the cerebral hemispheres. No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology. A small polyp or mucous retention cyst is seen within the left maxillary sinus.MRA head:No significant intracranial vascular stenosis or occlusion is seen. Fetal origin of the left PCA is noted. The region of the ACOM artery is unremarkable. A small right PCOM artery is demonstrated. No aneurysms are detected within the limitations of technique.MRA neck:No significant stenosis is detected in the carotid vessels of the neck by NASCET criteria. The left vertebral artery is dominant. There may be scattered areas of mild narrowing within the right vertebral artery though this could also be artifactual. No significant or high-grade stenosis is suspected.

Output: 1.No evidence of acute ischemia or any other definite acute intracranial abnormality.2.Scattered small foci of white matter T2 hyperintensity are seen, a nonspecific finding which could reflect microvascular ischemic disease, vasculitis, demyelination or migrainous lesions among other possibilities.3.No significant vascular stenosis is detected in the head of the neck.


Instruction: Generate impression based on findings.

Input: Ms. Rafferty is a 25 year old female with a personal history of lymphoma treated with chest radiation (> 20 Gy) approximately 8 years ago. Upon examination of the provided sequences, no contrast enhancement is seen in the vessels or the breast parenchyma. No comment can therefore be made on abnormal enhancement. This is a non-diagnostic exam.

Output: Non-diagnostic exam. The patient will be brought back for a technical repeat MRI.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views.


Instruction: Generate impression based on findings.

Input: History of melanoma with possible liver metastases. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size and signal intensity. No intra or extrahepatic biliary ductal dilatation. Normal-appearing gallbladder.Several T2 hyperintense subcentimeter foci are noted without enhancement, likely representing benign cysts. No intrinsically T1 weighted hyperintense lesion or rim-enhancing lesion is appreciated to suggest a metastatic lesion, however given the small size of some of these foci evaluation is somewhat limited.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially imaged probable intramuscular lipoma in the right lateral chest wall.OTHER: No significant abnormality noted.

Output: Several punctate T2 hyperintense foci without intrinsic, rim or mural enhancement or intrinsic T1 weighted hyperintensity, likely hepatic cysts. No specific evidence of metastatic disease to the liver.


Instruction: Generate impression based on findings.

Input: Reason: r/o stroke History: as above A punctate single hyperintense are present in the left middle frontal gyrus. Another punctate signal hyperintense lesion diffusion-weighted imaging is present in the left occipital lobe. These are associated with a low signal on ADC maps.A focus of encephalomalacia is present along the left postcentral gyrus . This demonstrated diffusion restriction on the 2013 exam. A smaller focus of encephalomalacia is present in the right occipital lobe and unchanged since prior examThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and flair signal hyperintense lesions are also present in the basal ganglia, thalami and brainstem. These are stable when compared to the previous exam.On susceptibility imaging punctate type of intense lesions are present in the left temporal lobe, left occipital lobe and right temporal low. These were not clearly present on the prior exam. A punctate hypointense lesion in the right middle cerebellar peduncle is also present on the prior exam.Punctate lesions are present in the cerebellar hemispheres which are stable since the prior exam and are bright on T2 and flair. These are likely vascular relatedNormal 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. The left eyeball lens is thin.

Output: 1.Findings suggest acute microinfarcts in the left occipital lobe and left frontal lobe.2.Foci of encephalomalacia in the left parietal lobe and right occipital lobe are probably related to prior vascular insults3.There multiple microhemorrhages with several new foci in the left temporal, left occipital and right temporal lobes and an old microhemorrhage in the right middle cerebellar peduncle.4.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are relatively stable when compared to the prior exam.5.Signal changes in the brainstem, basal ganglia and thalami are suspected to be vascular related as well and stable since prior exam6.Punctate lesions are present in the cerebellar hemispheres which are likely vascular related.7.Exam is mildly compromised by patient motion artifact which may obscure more subtle normalities


Instruction: Generate impression based on findings.

Input: 67 years, Female, new gait instability, cerebellar symptoms. Evaluate for evidence of CVA. Prior aneurysm clipping. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Again seen are postsurgical changes of right frontotemporal craniotomy for prior aneurysm clippings. There is associated susceptibility artifact which slightly limits evaluation of the adjacent parenchyma. There is linear T2/FLAIR signal abnormality involving the right frontal lobe extending from the cortex into the right frontal periventricular white matter which may represent chronic infarct or postsurgical change and also evident on multiple prior CT studies. Brain parenchyma is otherwise unremarkable for age. Left internal carotid artery aneurysm is better assessed on recent CT study. Paranasal sinuses and mastoid air cells are clear. Bone marrow signal is within normal limits.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with T2 hyperintensity involving the C3 and C4 vertebral bodies which is likely on a degenerative basis. There is abnormal T2 hyperintensity involving the bilateral aspects of the cervical cord at the C3-C4 level. Remainder of the cervical cord is unremarkable.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a large right paracentral disc protrusion which along with ligamentum flavum thickening contributes to moderate to severe spinal stenosis with mild deformity of the cord related to compression. There is abnormal T2 hyperintensity as mentioned above. There is moderate to severe right and mild to moderate left neural foraminal stenosis. There is also right-sided facet arthropathy. There is a subcentimeter cystic structure anterior to the right facet joint which may represent a synovial cyst or perineural cyst.C4-5: Small disc osteophyte complex and ligamentum flavum thickening with mild narrowing of the spinal canal. There is mild to moderate bilateral neural foraminal stenosis. There is bilateral facet arthropathy, worse on the right. C5-6: Small disc osteophyte complex without significant spinal canal stenosis. There is mild bilateral, left greater than right, neural foraminal stenosis.C6-7: Small disc osteophyte complex without significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy.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. There are small nodules involving the right thyroid lobe.

Output: 1. Postsurgical changes related to aneurysm clipping. There are mild chronic small vessel ischemic changes as well as small focus of encephalomalacia in the right frontal lobe which may be postsurgical. Brain parenchyma is otherwise unremarkable for age. Left ICA aneurysm is better assessed on recent CTA.2. Moderate to severe spinal canal stenosis at the C3-C4 level related to disc protrusion and ligamentum flavum thickening. There is abnormal signal involving the cervical cord at this level which is suspected to represent edema from compressive myelopathy.3. Multilevel neural foraminal stenoses, as detailed above, worst at the right C3-C4 level.


Instruction: Generate impression based on findings.

Input: 44-year-old female with constant knee pain and swelling. MENISCI: Note is made of a discoid lateral meniscus. There is linear increased signal abnormality within the posterior horn of the lateral meniscus which is consistent with a horizontal tear of the meniscus. There is blunting and deformity consistent with complex tearing of the posterior horn of the medial meniscus extending into the body of the meniscus. The anterior horn appears intact. ARTICULAR CARTILAGE AND BONE: There is tricompartmental osteophyte formation. There is full thickness articular cartilage degeneration involving nearly the entire weightbearing surface of the medial femoral condyle and medial tibial plateau. There is subchondral signal abnormality in the surrounding area, likely degenerative. There is subjective thinning of the articular cartilage of the lateral compartment. There is near full thickness to full thickness articular cartilage degeneration along the lateral facet of the patella. There is also a partial thickness articular cartilage fissure along the medial facet of the patella. LIGAMENTS: There is thinning and increased signal abnormality within the distal fibers of the ACL suggesting a partial tear. The PCL, MCL, and LCL appear intact.EXTENSOR MECHANISM: Extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of a discoid lateral meniscus as well as complex tearing of the medial meniscus.2. Degenerative changes including full-thickness articular cartilage degeneration as described above.3. Thinning and increased signal abnormality within the distal fibers of the ACL suggesting a partial tear. 4. Large knee joint effusion with foci of internal fat signal intensity suggesting lipoma arborescens as well as multiple loose bodies within the joint space.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post prostatectomy. PELVIS:PROSTATE: Status post prostatectomy. No evidence of tumor recurrence at the cystourethral anastomosis. No evidence of residual or recurrent disease in the prostatectomy bed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of tumor recurrence in the prostatectomy bed or pelvis.


Instruction: Generate impression based on findings.

Input: 61 year old man referred for cardiac MRI prior to AF ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 258 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 174 ml (normal range 47+/-19). There is mild concentric LVH. 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.Left AtriumThe left atrium is mild-moderately dilated (128ml).Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 262 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root (SOV) is mildly dilated (42mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.RUPV: 29 X 17mmRLPV: 18 X 17 mmLUPV: 16 x 8mmLLPV: 16 x 10mmPulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%.3. The left atrium is mild-moderately dilated (128ml) with normal pulmonary vein anatomy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: PELVIS:PROSTATE:Prostate Size: 5.0 x 6.3 x 7.5 cmPeripheral Zone: Dominant lesion in the left mid gland measuring 2.5 x 1.3 cm with low T2-weighted signal intensity, restricted diffusion and arterial enhancement.1.1 x 0.6 cm right paramedial apex lesion with similar imaging characteristics. 1.6 x 1.4 cm lesion in the left base with similar imaging characteristics.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: The left base lesion as well as the left mid gland region appear to extend into the left seminal vesicle.Extracapsular Extension: Suspected extracapsular extension of the left mid gland lesion posterolaterally.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged left pelvic lymph nodes in the common, external and internal iliac chains. The largest lymph node measures 3.1 x 1.9 cm (series 1 901/104 ). Nonspecific left perirectal fossa lymph node.BONES, SOFT TISSUES: Large left inguinal hernia containing sigmoid colon.MRI PROSTATE BIOPSY PROCEDURE

Output: 1. Foci suspicious for prostatic adenocarcinoma in the left mid gland, right apex and left base with suspected left seminal vesicle invasion and extracapsular extension. Successful MRI guided core-biopsies of the dominant 2.5 cm left mid-gland peripheral zone lesion.2. Pelvic lymphadenopathy.3. Large left inguinal hernia containing sigmoid colon.


Instruction: Generate impression based on findings.

Input: Left hip pain ACETABULAR LABRUM: There is tearing of the labrum superiorly and posteriorly which is best appreciated on series 11 images 8-11 of 22. The anterior labrum appears relatively spared. There are numerous associated paralabral cysts (series 9 image 19/40) which also involve the superior acetabulum.ARTICULAR CARTILAGE AND BONE: There is prominence of the femoral head neck junctions suggesting the the presence of a CAM type deformity. Multiple presumed paralytic labral cysts are noted within the superior acetabulum.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Tearing of the superior and posterior labrum with multiple associated paralabral cysts which appear to also involve the superior acetabulum.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: shaw S loss and MS History: ibid There are high signal intensity lesions at the level of C1 anterior middle aspect and left posterolateral aspect (series 14, image 7/38) and C34 right posterolateral aspect of the spinal cord (series 14, image 17/38). These lesions suggest possible cervical spinal cord involvement of the patient's known multiple sclerosis. Other areas of cervical spinal cord signal intensity appears to be normal.There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. Degenerative changes are specified by the intervertebral level as follows: C2-C3: disc dessication, no neuroforaminal narrowing or spinal stenosis. C3-C4: disc dessication, diffuse mild bulging of disc, no neuroforaminal narrowing or spinal stenosis. C4-C5: disc dessication, no neuroforaminal narrowing or spinal stenosis. C5-C6: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: there is 7mm x 8mm sized synovial cyst arising from the right side facet joint, no neuroforaminal narrowing or spinal stenosis.

Output: 1. High signal intensity lesions on cervical spinal cord suggesting multiple sclerosis involvement at the level of C1 and C34 as described above.2. Minimal degenerative changes of cervical spine including synovial cyst on the right side of C7T1 fact joint.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with tremor and altered mental status. No evidence of restricted diffusion is seen. No edema, mass effect or significant parenchymal signal abnormality is detected. No findings are seen to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collections. Ventricular size and morphology are within normal limits. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is observed. Paranasal sinus mucosal thickening and a fluid level in the right maxillary sinus are demonstrated.

Output: No specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 78-year-old female with hx of CVA, DMII, HTN with dysequilibrium, tinnitus, hand numbness, evaluate for mass, stroke, other. There is no restricted diffusion on DWI sequences.There is a well-demarcated dural based extra-axial mass. Medially along the floor of the anterior cranial fossa on the right side measuring 16 mm in craniocaudal dimension (series 601, image 9) and 27 mm x 13 mm on axial sequences (series 1101, image 13). The lesion demonstrates low T1 intensity and increased T2 and FLAIR signal intensity with uniform marked enhancement. There is uniform subtle susceptibility artifact. The lesion demonstrates minimal if any mass effect and does not extend through the skull base with no associated destruction of the bony structures. There is no associated intraparenchymal edema adjacent to the mass. There are no additional abnormal areas of enhancement or mass lesions identified.There is minimal scattered periventricular and subcortical T2/FLAIR hyperintense foci compatible with small vessel white matter disease.The visualized paranasal sinuses are clear. The mastoid air cells are well pneumatized. The visualized orbits are unremarkable.The CSF spaces and ventricles are within normal limits for patient's age.

Output: 1. Well demarcated right-sided dural based extra-axial mass along the floor of the anterior cranial fossa as described above. The imaging characteristics favor a meningioma, however other differentials for a lesion in this location include in an esthesioneuroblastoma as well as a hemangiopericytoma. There is no associated extension through the skulls base, destruction of the osseous structures or intraparenchymal edema to suggest an esthesioneuroblastoma. Recommend CT to further characterize the mass including possible calcification which would also favor a meningioma. 2. Minimal small vessel white matter disease as described above.


Instruction: Generate impression based on findings.

Input: 31-year-old male with L1 compression fracture There is normal lumbar lordosis. Multilevel superior and inferior endplate undulation with multiple Schmorl's nodes with sclerotic margins. Unusually large lucency of the L5 vertebral body with well defined margins extending from the intravertebral disk and associated with L5 superior endplate depression most likely representing a large Schmorl's node. Minimal anterior wedging of T12 and L1 vertebral bodies is noted. Otherwise the pedicles, lamina, facets, and posterior elements are intact without evidence of fracture or subluxation. At the level of the L5-S1 there degenerative disk disease with posterior disk bulge to the right of the midline causing moderate neuroforamina narrowing.Otherwise there is no significant neuroforaminal narrowing on the lumbar spine.The thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. The paraspinal and prevertebral soft tissues are unremarkable.

Output: 1.Findings compatible with Scheuermann's disease no acute fractures identified.2.L5-S1 degenerative disk disease with moderate right neuroforaminal narrowing.


Instruction: Generate impression based on findings.

Input: 68-year-old woman with history of ulcerative colitis and possible stricture at Klatskin's point. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal in signal and morphology. There are no suspicious focal hepatic lesions.The intrahepatic ducts are minimally dilated and irregular, but stable from the prior examination. There is no focal stricture, specifically no dominant stricture at Klatskin's point.Patient is status post cholecystectomy. The extrahepatic bile duct is smooth in contour and within normal limits of size.SPLEEN: No significant abnormality noted.PANCREAS: In the pancreatic body (6/53) and tail (6/86) there are cystic lesions communicating with the main pancreatic duct, stable in size compared to the prior examination. The remaining parenchyma is normal and the main duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left cortical cysts. The kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There is mild intrahepatic biliary ductal irregularity similar to the prior examination. No dominant stricture or mass.2.Stable pancreatic side branch IPMNs.


Instruction: Generate impression based on findings.

Input: Dizziness: MRI for surgical planning of left brain lesion. There is an unchanged left frontal convexity arachnoid cyst that measures up to approximately 30 mm and compresses the underlying brain parenchyma. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are skin-based fiducial markers in position.

Output: Preoperative planning MRI demonstrates an unchanged left frontal convexity arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Evaluate for SEGA, cortical tubers: Cardiac rhabdomyomas on fetal imaging. There high T1 and low T2 signal nodules at the bilateral caudothalamic grooves, measuring 10 mm on the right and 8 mm on the left, but no evidence of hydrocephalus. There are also several subcentimeter high T1 and low T2 signal subependymal nodules scattered along the bilateral lateral ventricular margins. Furthermore, there are numerous, predominantly linear high T1 and low T2 signal lesions in the bilateral cerebral hemisphere white matter, oriented perpendicular to the lateral ventricles, which likely represent radial migration bands related to cortical dysplasia. The cerebellum and brainstem appear to be unremarkable. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with tuberous sclerosis complex, including bilateral caudothalamic groove tumors, measuring up to 10 mm on the right side, which is suggestive of subependymal giant cell astrocytoma.


Instruction: Generate impression based on findings.

Input: Reason: r/o meniscus tear History: pain MENISCI: The lateral meniscus appears intact. There is poorly defined intermediate signal within the posterior horn of the medial meniscus suggesting intrasubstance degeneration, but we see no discrete tear. There is vertically oriented linear signal within the periphery of the posterior horn of the medial meniscus, seen on a single image, likely representing the interface of the meniscus with the central band of the posterior oblique ligament.ARTICULAR CARTILAGE AND BONE: There is a full-thickness defect of the articular cartilage of the femoral trochlea, centrally and inferiorly, with additional near full-thickness degeneration of the articular cartilage along the medial facet of the femoral trochlea, inferiorly, with underlying subchondral cyst formation. There is mild superficial degeneration of the articular cartilage of the patella, but we see no full-thickness defect. There is also degeneration of the articular cartilage of the medial tibiofemoral compartment with possible full-thickness cartilage loss along the medial femoral condyle above the posterior horn of the meniscus.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis with a large joint effusion.2. Mild degeneration of the medial meniscus, but no discrete tear of either meniscus.


Instruction: Generate impression based on findings.

Input: Altered mental status. Assess for stroke. The study is limited by patient motion.There is no diffusion restriction to indicate a recent infarct. There is inflammation related to the chronic right temporal infarct. Addition, there is extensive confluent periventricular cerebral white-matter T2 hyperintensity reflecting chronic microvascular ischemia. Focal volume loss and increased T2 signal involving the posterior-superior aspect of the right cerebellar hemisphere is probably related to chronic right superior cerebellar artery infarct. There is no gross parenchymal hemorrhage though the study is limited by motion.Posterior right lateral ventricular ex vacuo dilatation is superimposed on diffuse dilatation of the ventricular system and the other CSF-containing spaces reflecting moderate to severe volume loss.There is minimal fluid in the mastoid air cells and minimal mucosal thickening in the paranasal sinuses. The orbits show no gross abnormality.

Output: 1.Study is limited by patient motion. 2.No evidence of acute intracranial hemorrhage, mass, or acute infarct.3.Moderate cerebral volume loss and chronic right temporal and cerebellar infarcts are present, as described above and on the previous CT scan report.


Instruction: Generate impression based on findings.

Input: The T1 postcontrast 3D images are degraded, limiting evaluation.MRI Brain: The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, 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. There are scattered foci and minimally confluent areas of T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes.MRA brain: The anterior and posterior circulation is intact. No evidence of aneurysm or occlusion.

Output: 1. No acute intracranial abnormality. Chronic small vessel ischemic changes.2. Intact intracranial circulation, without evidence of aneurysm or occlusion.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: Eval stroke vs MS flare - please use MS protocol in addition to cuts History: L face/arm/leg weakness There is focal restricted diffusion on the right side posterior aspect of basal ganglia extends toward periventricular white matter and external capsule without evidence of hemorrhagic transformation indicating acute ischemic infarct.Underlying brain shows multifocal scattered periventricular and deep white matter FLAIR/T2 high signal intensity lesions on bilateral hemisphere as well as brain stem which is consistent with the patient's known demyelinating disease such as multiple sclerosis. Comparing to prior scan performed at outside hospital, there is no significant interval change of FLAIR/T2 high signal intensity lesions.There is no evidence of abnormal enhancement.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, 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: 1. Acute ischemic infarct involving right posterior aspect of basal ganglia as described above without evidence of hemorrhagic transformation.2. Unchanged scattered multifocal bihemispheric, supra and infratentorial FLAIR/T2 high signal intensity lesions consistent with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for growth of GBM. Patient on PD L1 abnormality immunotherapy trial. First MRI on treatment. Signs and symptoms: Evaluate GBM. Pre and post enhanced brain MRI:Examination demonstrates significant interval increased vasogenic edema surrounding an interval increased enhancing left posterior temporal necrotic GBM.The enhancing necrotic tumor measures at least at 44 x 41x 38 mm in transaxial dimensions compared to prior study remeasurement of 27 x 25 x 23 mm. Thick tumor extensively encases the left occipital horn of lateral ventricle and reaches the trigone the surrounding vasogenic edema that was localized around the tumor now extends anteriorly to nearly the tip of the left temporal lobe and into the left basal ganglia/thalamus and posteriorly extending to left occipital lobe. Findings results in increased intracranial pressure and weightRightward deviation of midline of approximately 14 mm. There is also mild increased size of left lateral ventricle since prior study which measures approximately 16 mm in largest transverse axis compared to prior study measurement of 13.5 mm.All the CSF spaces remain widely patent. Stable postoperative changes of left posterior temporal craniotomy.No detectable new foci of parenchymal abnormal signal intensity or ecchymosis/leptomeningeal abnormal enhancement.Unremarkable images through the orbits, calvarium, paranasal sinuses and mastoid air cells.

Output: 1.Interval increased size of a necrotic enhancing left posterior temporal GBM and its surrounding vasogenic edema with resultant new rightward deviation of midline as detailed/measured above. Tumor currently measures at 44 x 41 x 38 mm compared to prior study measurement of 27 x 25 x 23mm.2.Mild interval increased size of left lateral ventricle since prior exam is also noted.


Instruction: Generate impression based on findings.

Input: 21 year old male. Evaluate for perirectal infection. PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Perianal rectal soft tissue thickening with subtle 1 cm diameter left anterolateral hypodensity, suspicious for a small abscess. If indicated, pelvic MRI would be helpful for further evaluation. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Small fluid collection in peranal region is suspicious for a small abscess. No intrapelvic extension. ER MD notified by RROC.


Instruction: Generate impression based on findings.

Input: 22-year-old female with Crohn's disease and abdominal pain. Evaluate for abscess. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Narrowing with mild wall thickening and increased enhancement of the descending and sigmoid colon, compatible with active inflammatory bowel disease. Greater than average stool burden in the proximal colon. No evidence of pericolonic abscess or fistula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Thin intrasphincteric perianal fistula measuring up to 2.2 cm in length arising from the posterior 6 o'clock position and extending inferiorly at the midline. No evidence of abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Active inflammatory bowel disease of the descending and sigmoid colon. No evidence of pericolonic abscess.2.Small perianal fistula.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post prostatectomy with rising PSA. Evaluate for recurrence. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. In the right prostatectomy bed there is a 1.5 x 1.1 cm arterially enhancing lesion (series 1 401/2 734) demonstrating low T2-weighted signal intensity (series 801/20) and mild restricted diffusion suspicious for local recurrent disease.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific inguinal and right external iliac lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.5 cm arterially enhancing lesion (with corresponding T2 hypointense signal and restricted diffusion) in the right prostatectomy bed is suspicious for local recurrent disease.


Instruction: Generate impression based on findings.

Input: Images are limited by patient motion. The intracranial internal carotid arteries are normal in course and caliber. There is a hypoplastic right A1 segment. The middle and anterior cerebral arteries are otherwise unremarkable. Right vertebral artery is slightly dominant. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK

Output: 1.Significantly motion limited exam. Findings suggestive of subtle asymmetric enhancement of the right geniculate ganglion and possibly the proximal right tympanic segment of the facial nerve. Questioned focus of enhancement in right Meckel's cave along the trigeminal nerve. No significant inner ear or cranial nerve VIII abnormality is appreciated. Findings could represent mild inflammatory changes such as a focal neuritis.2.Mild dural thickening and enhancement persists along the right internal auditory canal walls which may be reactive in etiology. No focal mass identified.3.Motion limited MRA, although grossly unremarkable.


Instruction: Generate impression based on findings.

Input: Male 50 years old Reason: Newly diagnosed Follicular Lymphoma in which staging CT scan showed an abnormal left renal mass that needed further evaluation History: Follicular Lymphoma CT scan showed an abnormal left renal mass that needed further evaluation ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. Spleen is top normal in size.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney enhances homogeneously. There are few scattered T2 hyperintense foci in the right kidney that do not enhance and are compatible with cysts. In the left kidney, there is a T1 hyperintense lesion that is T2 hypointense involving the posterior midpole of the left kidney measures 1.4 x 1.2 cm on image 95/ series 24. The lesion does not show definite internal enhancement on postcontrast imaging (image 94/series 101) and is probably a hemorrhagic cyst. The lesion seen on CT along the medial aspect of the kidney is T2 hyperintense measuring 1.7 x 1.4 cm on image 32 of series 23. This lesion also does not show any appreciable enhancement and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes measurements provided below.BOWEL, MESENTERY: Mesenteric lymph nodes with haziness of the mesentery persists.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 7/8/2016 13:30:00)LEFT RENAL MASS: 1.7 x 1.4 cm (Image 32, Series 23); 2.2 x 1.5 cm on prior (6/23/2016) (Image 93, Series 3).LEFT PARA-AORTIC ADENOPATHY: 2.1 x 1.0 cm (Image 86, Series 25); 2.2 x 1.2 cm on prior (6/23/2016) (Image 94, Series 3).AORTOCAVAL ADENOPATHY: 2.0 x 1.0 cm (Image 90, Series 25); 1.7 x 1.1 cm on prior (6/23/2016) (Image 92, Series 3).LEFT RENAL LESION 2: 1.4 x 1.2 cm (Image 95, Series 24).

Output: 1.Lesion seen on CT compatible with a cyst.2.Second left renal lesion along the posterior aspect of the kidney likely represents a hemorrhagic cyst (within the limitation of its small size and proximity to the renal parenchyma)


Instruction: Generate impression based on findings.

Input: 32 years, Female, shooting pain down both legs, evaluate for demyelinating lesions. Brain: There are two foci of T2/FLAIR hyperintensity involving the left frontal subcortical and periventricular white matter as well as a possible third focus involving the left callosal genu. No infratentorial lesions are appreciated. Brain parenchyma appears otherwise unremarkable without evidence of intracranial mass or mass effect. Ventricles are normal in size. No extra-axial collections. Brain parenchymal volume is maintained. Calvarium and extracranial soft tissues are unremarkable.Lumbar Spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position and without focal lesions.Individual levels described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.There is minimal facet arthropathy in the lower lumbar spine. Paraspinous soft tissues are within normal limits. Subcentimeter benign-appearing cystic lesion in the left sacrum is nonspecific and incidentally noted.

Output: 1. Brain MRI is essentially within normal limits for age. There are few foci of T2/FLAIR hyperintensity in the left frontal lobe white matter with a nonspecific appearance and distribution. No specific findings to suggest demyelinating disease. 2. There is no significant disc disease or neural foraminal stenosis at any level in the lumbar spine.3. Minimal facet arthropathy in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Reason: HCV cirrhotic History of HCC s/p TACE/RFA with new lesion on follow up imaging. Reviewed at radiology conference instruction to f/u with surveillance imaging History: History of HCC s/p TACE/RFA with new lesion on follow up imaging. Reviewed at radiology conference instruction to f/u with surveillance imaging ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver.RFA defect in the inferior segment 6 is unchanged with no new arterial enhancement.RFA defect in segment 8 is unchanged. There is heterogeneous signal with intrinsic T1 hyperintense signal compatible with proteinaceous or blood products. No abnormal enhancement. Adjacent focal intrahepatic biliary ductal dilatation, likely related to fibrosis. Surrounding parenchymal perfusional abnormality.Small arterial phase enhancing lesion in the dome of the liver is not visualized.No new arterial enhancing lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 8 ablation defect with intrinsic T1 signal compatible with proteinaceous or hemorrhagic products. Stable segment 6 ablation defect. No evidence of residual or recurrent tumor.2.Small arterial enhancing lesion in segment 8 seen on CT is not identified on this examination.


Instruction: Generate impression based on findings.

Input: Left buccal angiosarcoma.Additional history from EMR: submucosal lesion of the left buccal mucosa inferior to the punctum of the salivary gland. It is non-friable. It seems to be adherent to the mucosa but is slightly pigmented and firm, measuring about 1 cm in greatest dimension. 3/10/16, wide local excision of left buccal lesion with primary closure. Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered T2-hyperintense foci in the cerebral white-matter. There is also symmetric globular T2-hyperintensity in the globi pallidi. The brain parenchyma and pituitary gland appear unremarkable otherwise. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact accounting for hypoplastic right vertebral artery, small right internal carotid artery and probably absent right A1 segment. There is mild ethmoid mucosal thickening. Globes show very mild staphylomas, which can be associated with myopia.Neck:The patient was imaged deeply sedated and the study is at least mildly limited by patient breathing motion. There is asymmetric increased STIR signal and contrast enhancement in the left posterolateral buccal mucosa but no discernible mass (15/23-27). These findings are nonspecific and may relate to recent tumor resection. There is no significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are grossly unremarkable. The major cervical vessels are patent accounting for a nondominant right vertebral artery. An artificial airway is present in the oral cavity/oropharynx. Otherwise, the airway is patent. There are findings of remote internal fixation of right clavicle fracture with associated susceptibility. There are bilateral injectable facial fillers.

Output: 1.The patient was imaged deeply sedated and the study is at least mildly limited by patient breathing motion. 2.No brain metastasis. A few T2-hyperintense lesions in the cerebral white-matter are nonspecific but may represent chronic microvascular ischemia.3.Symmetric T2-hyperintensity in the globus pallidi may represent sequela of prior metabolic injury.4.Asymmetric contrast enhancement and STIR signal in the left lateral buccal region without discernible mass is nonspecific and may reflect postoperative change. No discrete mass or cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: A surgical defect is noted involving the right parietal lobe, specifically containing an encephalomalacic cavity lined with hypointensity, most prevalent on susceptibility technique. A small developmental venous anomaly is immediately posterior. Expected overlying calvarial changes are evidence of the prior craniectomy.There are several other punctate lesions identified on susceptibility weighted imaging throughout the supratentorial and infratentorial brain, none of which demonstrate mass effect or perilesional edema.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.A surgical defect is noted involving the right parietal lobe, specifically containing an encephalomalacic cavity lined with hypointensity, most prevalent on susceptibility technique, consistent with resection of a cerebral cavernous malformation. A small developmental venous anomaly is immediately posterior. 2.There are several other punctate lesions identified on susceptibility weighted imaging throughout the supratentorial and infratentorial brain, none of which demonstrate mass effect or perilesional edema, consistent with cerebral cavernous malformations.


Instruction: Generate impression based on findings.

Input: There are partially imaged spondylotic changes within the cervical spine. THORACIC SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There are mild end plate degenerative changes at T10-T11 and T11-T12. There is evidence of epidural lipomatosis without evidence of high grade spinal canal stenosis. There is a small right pleural effusion. LUMBAR SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is mild multilevel disc desiccation and ligamentum flavum thickening. There is mild bilateral neural foramen stenosis at L5-S1. There is no significant spinal canal stenosis. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology with the conus terminates at mid L2 body. There is an atrophic right kidney. The left kidney is not well visualized. There is a transplanted kidney within the pelvis.The paravertebral soft tissues are unremarkable.

Output: 1. Mild degenerative changes in the thoracic and lumbar spine. 2. Evidence of thoracic epidural lipomatosis with mild spinal canal narrowing. No evidence high-grade stenosis or cord compression.3. There is mild bilateral neural foramen narrowing at L5-S1. Otherwise no significant spinal canal or neural foramina narrowing in the lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with weakness and paresthesias. No evidence of focal parenchymal signal abnormality, edema or mass effect is seen. No restricted diffusion is evident. On postcontrast imaging, there is no pathologic parenchymal or extra-axial enhancement. There are no findings to suggest acute intracranial hemorrhage nor are there any abnormal extra axial fluid collections. The ventricles are normal in size and morphology. Bone marrow signal characteristics are within normal limits.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 20-year-old woman with history of abdominal distention and diarrhea. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No findings to explain patient's symptoms.


Instruction: Generate impression based on findings.

Input: Reason: Dx of smoldering multiple myeloma. History: Dx of smoldering multiple myeloma w/ back pain Note is made of heterogeneous bone marrow signal abnormality likely representing residual islands of red marrow. There is a punctate focus of enhancing signal abnormality along the posterior aspect of the medial wall of the right acetabulum likely representing a subchondral cyst. Otherwise no discrete enhancing myelomatous deposit is identified. The imaged musculature of the pelvis unremarkable. Mild osteoarthritis affects the hips.

Output: Diffuse heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow, although diffuse myelomatous involvement is considered a less likely differential consideration. No discrete enhancing myelomatous deposit is identified.


Instruction: Generate impression based on findings.

Input: History of elevated PSA with prior negative biopsies. Evaluate for targetable lesion. PELVIS:PROSTATE:Prostate Size: 1.2 x 5.2 x 3.7 cm (AP by transverse by CC)Peripheral Zone: There is patchy mildly decreased T2 signal throughout the peripheral zone possibly reflecting prostatitis. No focal discrete lesion is evident.Central Gland: The central gland is normal in appearance for patient's age.Seminal Vesicles: Mild prominence of the seminal vesicles, but no focal pathology.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is thickening and hyperenhancement of the sigmoid colon with heterogeneous enhancement extending into the pericolonic soft tissues. This is incompletely evaluated as it is seen only on the large field-of-view images, but is suspicious for diverticulitis.

Output: 1.No focal prostatic lesion to indicate primary malignancy. Patchy areas of minimally decreased signal in the peripheral zone may represent prostatitis.2.Incompletely evaluated thickening and hyperenhancement of the proximal sigmoid colon and adjacent soft tissues as described. This may reflect diverticulitis, but further evaluation with dedicated imaging is recommended.


Instruction: Generate impression based on findings.

Input: Palpable mass along right sacroiliac joint with cordlike structure on ultrasound that is associated pain radiating in the leg. MRI to provide further delineation. A marker placed was placed on the skin of the lower back to the right of midline just above the right sacroiliac joint.We see no mass or other abnormality deep to the marker. The musculature and soft tissues appear normal. The bones appear normal. We see no enhancement of the sacroiliac joints or hips to indicate synovitis.

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


Instruction: Generate impression based on findings.

Input: Right acoustic neuroma, SRS planning: right hearing loss. There is a well-defined, but mildly heterogeneous mass in the right cerebellopontine angle cistern and internal auditory canal that measures up to 19 mm. There is no mass effect upon the brainstem or cerebellum. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: Preoperative planning MRI demonstrates a right vestibular schwannoma. Please refer to the recent MRI for additional details.


Instruction: Generate impression based on findings.

Input: 47-year-old male with sensory level at T6-7 level. Evaluate for multiple sclerosis flare up. MRI Brain:There is redemonstration of multiple periventricular and subcortical white matter lesions which are high signal on T2 and FLAIR and low signal on T1-weighted imaging. Several of the lesions, especially in the periventricular region have become more pronounced compared to the prior exam and some are new, for instance in the right posterior opercular region, right anterior frontal region and left periventricular regions. There is an additional lesion present in the right posterior pons which was also present on the prior exam.Mild supra and infratentorial volume loss again seen. Findings of inferior cerebellar vermis hypoplasia again seen. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Again demonstrated is evidence of congenital hypoplasia of the right ICA and basilar origin of the right MCA. The visualized portions of the paranasal sinuses demonstrate mild scattered mucosal thickening, particularly the bilateral maxillary sinuses. The visualized portions of the mastoid air cells are clear. MRI C-Spine:Examination is somewhat limited due to metallic hardware artifact from a previous multilevel laminectomy and posterior fusion with placement of lateral mass screws at multiple levels. Redemonstrated is congenital fusion at C5-C6 (as numbered previously, although there also appears to be partial C2-3 fusion) Again seen is straightening of the cervical lordosis and mild degenerative changes, not significantly changed form the prior exam. No significant spinal canal stenosis. The bone marrow signal is benign.Again demonstrated are multiple foci of T2/STIR hyperintensity in the cervical cord, most conspicuously spanning from C2 through C4 but also including the C7 level as before. No new lesions are appreciated in the cervical spine. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits. MRI T-Spine:There is congenital fusion of T1 and T2, as numbered in the cervical spine previously. There is also congenital fusion posteriorly involving the T8-T9 vertebral bodies. There are T2/STIR hyperintense lesions within the thoracic spinal cord most conspicuously involving the T9-T10 level. There may be additional smaller lesions more superiorly in the thoracic spine although evaluation is limited secondary to motion evaluation. The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. There is increased T2 signal anteriorly at the endplates of T9 and T10 which is degenerative in nature. Otherwise there is no worrisome focal marrow signal abnormality appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1.Compared to MRI dated 2/23/2016, there are multiple new bilateral T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter consistent with progression of demyelinating disease.2.Multiple lesions in the cervical cord, without evidence of new lesion compared to prior cervical MRI from 9/30/2014.3.Additional lesions are visible within the thoracic spine (no prior thoracic comparison), most conspicuous at the T9-T10 level and also likely more superiorly although the exam is degraded by motion artifact.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: h/o metastatic melanoma s/p resection of left frontal and SRS to left frontal and right cerebellar lesionsSigns and Symptoms: surveillance post SRS The patient is status post left-sided craniotomy. There is a small extra-axial collection present at the craniotomy defect which was also previously present and appears thinner on the current exam versus the prior. A lesion located in the left middle frontal gyrus on the prior exam is not significantly smaller. It currently measures approximately 7 x 9 mm axial dimensions and previously measured approximately 17 x 17 mm axial dimensions. The amount of adjacent T2 signal hyperintensity is also regressed. There is some associated susceptibility effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam a left middle frontal gyrus hemorrhagic lesion has decreased in size.2.Status post left-sided frontal craniotomy with associated evolving postoperative change.


Instruction: Generate impression based on findings.

Input: 66 year old man with prior myocardial infarction now presenting with atypical chest pain and is referred to evaluate for ischemia and viability.MEDICATIONS: ASA, atorvastatin, lisinopril, and metoprolol First Pass PerfusionDuring hyperemia, there were perfusion abnormalities involving the basal anterior, anterolateral, inferolateral, inferior, and inferoseptal walls and the mid inferior wall. All of the perfusion defects except the basal anterior wall are a result of the below described myocardial infarctions. Viability/ Myocardial ScarThe are transmural myocardial infarctions involving the basal anterolateral, inferolateral, inferior, and inferoseptal walls; the mid inferior and inferolateral walls, and the apical inferior wall. These segments are unlikely to be viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable.Left VentricleThe left ventricle is normal in size with mildly reduced overall systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 98 g. There is severe hypokinesis of the basal to mid anterolateral, inferolateral, and inferior walls.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 112 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 100 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is extensive transmural myocardial infarction involving much of the RCA and LCx territory which is unlikely to be viable. 2. There is a small amount of ischemia involving the basal anterior wall. There is no associated myocardial scar in this segment and it is likely to be viable. The remainder of the above described perfusion defects are secondary to transmural scar in territories that are not viable.3. Normal LV size with mildly reduced systolic function (LVEF 48%). There is severe akinesis of the basal to mid inferior, inferolateral, and anterolateral walls.4. Normal RV size and systolic function (RVEF 53%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Dysarthria and anarthria [R47.1], Reason for Study: ^Reason: stroke workup History: h/o 3 strokes, worsening dysarthria Brain MRIMultiple high signal intensity lesions on DWI are most likely T2 shine through artifacts except one on the right superior parietal lobule (series 506, image 200) which could represent an acute or subacute ischemic lesion.There are multifocal bihemispheric lacunar infarctions. There are patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease. There are susceptibility lesions on the right occipital lobe and right frontal lobe which are corresponding to FLAIR/T2 high signal intensity indicating chronic ischemic lesion with focal hemorrhagic conversion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal arterial luminal stenosis. In particular, there is about 20-30% luminal stenosis at the mid portion of the right ICA carotid canal (petrous segment), about 80-90% stenosis at the right ICA cavernous sinus segment genu portion, about 70-80% stenosis of left ICA distal carotid canal segment, and about 80% stenosis of the left ICA cavernous sinus segment. Bilateral MCAs and ACAs as well as vertebrobasilar system are unremarkable.

Output: 1. Suspicious focal acute or subacute ischemic stroke on the right superior parietal lobule.2. Moderate degree non specific small vessel ischemic disease.3. Multifocal bihemispheric lacunar infarctions.4. Multifocal bilateral distal intracranial ICA luminal stenosis involving petrous segments and cavernous segments with the degree of about 20-30% to 80-90%.


Instruction: Generate impression based on findings.

Input: 44 year old with biopsy proven right breast cancer with metastatic right axillary lymph node presents for I-SPY research MRI, pre-chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.Biopsy proven index cancer is present as an enhancing mass at posterior 3 o'clock position in the right breast, measuring 19 x 25 x 25 mm (AP x LR x CC). Marker clip is identified within the mass. Biopsy proven satellite lesion is present as an enhancing mass at anterior 3 o'clock position in the right breast, measuring 9 x 9 x 7 mm, with internal marker clip. There are several small masses and non mass enhancements between these two masses. In addition, there is an enhancing mass measuring 6 mm at lateral retroareolar region of right breast. Overall measurement from the index mass to the proven satellite lesion is 55 mm, and to the most anterior lateral retroareolar mass is 79 mm.There is extensive fluid filling dilated ducts in the right outer breast. There is no distinct suspicious enhancement around these duct.In the right axilla, a biopsy proven metastatic lymph node is visualized at upper aspect with internal marker clip, measuring 11 mm in maximum diameter.No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in left axillary region.

Output: 1. Biopsy proven index cancer and satellite mass in the right inner breast with multiple additional masses and non mass enhancements.2. Biopsy proven right metastatic axillary lymph node.3. No MRI evidence for malignancy in the left breast or left axilla. BIRADS:6 - Known cancer. RECOMMENDATION:X - No Letter.


Instruction: Generate impression based on findings.

Input: New vertigo. There appears to be a punctate focus of restricted diffusion in the medial right occipital lobe. There is no evidence of intracranial hemorrhage or mass. There are numerous scattered foci of T2 hyperintensity in the cerebral white matter. There is also punctate foci of T2 hyperintensity in the bilateral basal ganglia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary retention cyst.

Output: 1. An apparent punctate focus of restricted diffusion in the medial right occipital lobe may represent an acute infarct. 2. Chronic lacunar infarcts and/or prominent perivascular spaces in the bilateral basal ganglia. 3. Numerous scattered foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.Discussed Physician: AMBER TALYN PINCAVAGE at 1 PM on 11/20/15.


Instruction: Generate impression based on findings.

Input: Metastatic sarcoma. There are postsurgical changes with spinal rods extending from T2 to T8 affixed by laminar hooks and transpedicular screws. There are significant streak artifacts secondary to the presence of hardware, limiting evaluation. Lytic lesion involving T6 is again seen correlating with the lesion seen on prior MRI study. There is a significant paraspinal component. There is extension of tumor to the posterior elements. There is suspicion of extension into the spinal canal, but this is difficult to assess due to the presence of streak artifacts.There is a compression fracture, with wedging deformity of T8 vertebral level, also seen on prior x-ray study of 7/6/2011. This results in kyphotic angulation, which is unchanged. There is posterior disk protrusion, with calcification, causing spinal canal stenosis, and likely spinal cord impingementRight lung mass is seen. Please correlate with chest x-ray and CT chest.

Output: 1. Compression fracture of T8, not significantly changed compared to prior x-ray.2. Lytic lesion involving T6, with significant paraspinal and epidural component. There is likely extension into the spinal canal, with impingement of spinal cord which is difficult to assess due to streak artifacts.3. Posterior calcified disk protrusion at T7 -- T8 level, likely resulting in spinal cord impingement.4. Right lung mass. Please correlate with chest x-ray and CT chest.


Instruction: Generate impression based on findings.

Input: Left lumbar radiculopathy since 2 months Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Small Schmorl's nodes are noted at T11-T12 endplates. Minimal disc bulges in the lower thoracic spine are also evident. 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: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening. There is minimal central canal stenosis. Neural foramina are patent.L3-L4: There is a disc bulge which is eccentric to the left, with associated effacement of the left lateral recess and moderate left-sided neural foraminal stenosis. There is is also mild to moderate central canal stenosis related to disc bulge, ligamentum flavum thickening, and facet arthropathy. Mild right neural foraminal narrowing.L4-L5: There is mild disc bulge as well as ligamentum flavum thickening and facet arthropathy contributing to mild to moderate central canal stenosis. There is mild to moderate left and minimal right neural foraminal stenosis. L5-S1: No significant disc disease. There is moderate bilateral facet arthropathy. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine with mild to moderate central canal stenosis at L3-L4 and L4-L5. There is also multilevel neural foraminal narrowing, worst at the left L3-L4 and to a slightly lesser degree left L4-L5 levels, with possible impingement of the exiting left L3 and L4 nerve roots, respectively. Additional details as above.


Instruction: Generate impression based on findings.

Input: Reason: liver mass history of hep c and b History: liver mass history of hep c and b ABDOMEN:LIVER, BILIARY TRACT: Adjacent to the gallbladder in the periphery of the right lobe of the liver is a 1.2 cm T2 hyperintense nonenhancing lesion most compatible with a cyst.A punctate foci of arterial enhancement with no demonstrable washout are noted, likely representing perfusional anomalies, but attention on subsequent follow-up imaging is suggested. (1301:60).A 1.1 x 1.1 cm arterially enhancing lesion with washout (1304:81 and 1301:72) along the first bifurcation of the anterior right hepatic vein (not the accessory hepatic vein, which is present and an anatomic variant) is suspicious for HCC given history of hepatitis C. This measured ratio versus super several HCC accessory: Back the same size compared to prior outside MRI (7:31)No new suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.1 cm right hepatic lesion as described above most compatible with HCC. Stable from most recent outside institution examination. No new suspicious lesions. Attention to foci of arterial enhancement without washout as described above is recommended on subsequent surveillance imaging.


Instruction: Generate impression based on findings.

Input: Headache and blurry vision status post craniotomy. CT evidence of stroke. There are postoperative findings related to a transcallosal resection of a colloid cyst with a small amount of pneumocephalus. There is interval resolution of previously seen susceptibility effect within the left lateral ventricle choroid plexus. There is a punctate focus of enhancement at the site of the previous colloid cyst, which appears slightly more prominent though this could be technical. The ventricles are otherwise unchanged in size. There is patchy T2 hyperintensity and restricted diffusion in the body of the corpus callosum and right cingulate gyrus along the surgical approach that measures up to 22 mm, previously 18 mm. There is a question of mild restriction diffusion versus edema at the left aspect of the corpus callosum body. There is an associated faint blush of enhancing T2 hyperintense tissue, which is probably postoperative. There is otherwise unchanged mild cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no midline shift or herniation. There are postoperative findings related to rhinoplasty. There is hypertrophy of the right inferior turbinate.

Output: 1. Postoperative findings related to colloid cyst resection with slight expansion in the restriction diffusion along the right cingulate gyrus. 2. Question of mild restriction diffusion versus edema at the left aspect of the corpus callosum body. 3. Nonspecific punctate focus of enhancement at the site of the previous colloid cyst, which may be slightly more prominent though this could be technical. This could represent a vessel, granulation tissue, or residual tumor. Followup imaging is recommended to exclude recurrence.


Instruction: Generate impression based on findings.

Input: 38-year-old woman personal history of triple negative left breast cancer status post lumpectomy and sentinel biopsy in April 2012 and adjuvant radiation therapy presents for screening MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Left breast: Postsurgical changes of lumpectomy with distortion of the breast parenchyma in the upper-outer quadrant. No abnormal enhancement in the left breast or axilla.Right breast: There are three new areas of non mass enhancement in the right breast. All of these demonstrate mixed kinetics on dynamic evaluation and are indeterminate.-The first focus is seen in the central right breast, anterior depth, near 6:00 immediately inferior to the nipple measuring 14 x 7 x 7 mm (AP x TV x CC).-A second focus is seen posterior and lateral to the first focus near 7:00 measuring 8 x 4 x 7 mm (AP x TV x CC).-The third focus is seen in the lateral breast, posterior depth, near 9:00 at the level of the nipple measuring 11 x 6 x 6 mm (AP x TV x CC).The distance between the areas are 4.5 cm (AP), 3.8 cm (CC) and 4.1 cm (TV). Further evaluation of these areas is recommended with right unilateral diagnostic mammogram and MR guided second look ultrasound. If there is no MR correlate identified, MRI guided biopsy should be performed.

Output: Three new indeterminate areas of non mass enhancement in the right breast as described, with the largest area measuring 14 x 7 x 7 mm. Further evaluation of these areas is recommended with right unilateral diagnostic mammogram and MR guided second look ultrasound. If there is no correlate identified, MRI guided biopsies can be performed.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Injury, other and unspecified, unspecified site (fracture of facial bones, rupture of diaphragm, renal injury etc). Motor vehicle collision with pedestrian, pedestrian injured MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is subtle T2 and FLAIR signal hyperintensity along the medial aspects of the cerebellar hemispheres. There is a small focus T2 and FLAIR signal hyperintensity along the lateral aspect of the left orbital gyrus.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are partially opacified. The visualized portions of the mastoid air cells are opacified. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is fluid in the posterior nasopharynx and oropharynx.There are pleural effusions and partial opacification of the right lung apex.There appears to be a tubular structure looped in the patient's hypopharynx.

Output: 1.Findings suggest subtle injuries to the left orbital gyrus and medial aspects of the cerebellar hemispheres.2.No evidence for cervical spinal cord injury.3.The patient has known skull base and facial fractures. Please refer to prior CT exams for further comments.4.The nasogastric tube is suspected to be looped in the patient's nasopharynx.5.Pleural effusions and lung opacity. Please refer to chest x-ray for further comments.


Instruction: Generate impression based on findings.

Input: Examination is limited without intravenous contrast.There is a somewhat suspicious 0.9 x 1.4 cm T2/FLAIR hyperintense lesion involving the superior frontal gyrus of the right frontal lobe. There is a punctate focus of diffusion restriction in this region which may be related to tumor as opposed to ischemia. There is an additional 8 mm rounded focus of T2/FLAIR hyperintensity in the right temporal lobe (series 4, image 13), possibly also a metastasis. There are several additional punctate T-2/FLAIR hyperintense lesions which are nonspecific. For example there is a 2 mm lesion in the left frontal lobe (series 4, image 22). In addition there is a 4 mm lesion in the right temporal lobe (series 4, image 17). There is a punctate focus of susceptibility in the right frontal lobe compatible with microhemorrhage and nonspecific.The cortical sulci are in proportion to the cerebral ventricles. No intra-axial or extra-axial fluid collections are visualized. There is no midline shift or mass effect. The basal cisterns are visualized. No fluid collections are visualized in the paranasal sinuses and mastoid air cells.

Output: 1. Please note lack of contrast significantly limits evaluation for small metastatic lesions. A 1.4 cm lesion in the right frontal lobe and an 8 mm lesion in the right temporal lobe are somewhat suspicious for metastatic disease. There is punctate focus of restricted diffusion in the region of the right frontal lobe lesion which may be related to tumor itself rather than represent a punctate infarct.2. Several additional punctate nonspecific foci of T2/FLAIR hyperintensity are demonstrated which may relate to chronic microvascular ischemic disease but also nonspecific. As renal function allows, would suggest considering postcontrast CT or MRI for further evaluation. Alternatively, follow-up MRI may be obtained to assess for enlargement. There is otherwise no large mass or evidence of mass effect intracranially.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:4/28/1960)Reason: lower back pain and LLE radiculopathy History: abovePROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level associated with some ligamentum flavum hypertrophy and some mild facet hypertrophy. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is loss of disc space height, diffuse disc bulge and bilateral ligamentum flavum hypertrophy associated with partial effacement of the fat at the right lateral recess and some encroachment of the nerve roots of the right lateral recess. There is is some crowding of the nerve roots within the thecal sac at this level. The nerve roots appear to be adherent to the walls of the thecal sac. There is mild to moderate spinal stenosis present at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is loss of disc space height, diffuse disc bulge and disc desiccation associated with some ligamentum flavum hypertrophy. There is a disc extrusion present at this level with disc material extrudes behind the L4 vertebral body. This contributes significantly to the spinal stenosis at this level. There is narrowing of the spinal canal at this level and there is crowding of the nerve roots within the thecal sac. This suggests moderate spinal stenosis. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina. At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the lumbar spine with moderate spinal stenosis at L3-4 (where there is a large disk extrusion), mild to moderate spinal stenosis at L4-5 and encroachment of nerve roots at the right lateral recess at L4-5 due to degenerative changes.2.Nerve roots appear to adhere to the wall of the thecal sac in the lower lumbar spine. This may raise the question of arachnoiditis. Alternatively this could be a coincidental appearance and explained by the effect of the disc extrusion on the position of the nerve roots within the thecal sac. Please correlate patient's clinical history. If based on this evaluation further imaging is warranted, contrast enhanced MRI may be of benefit.


Instruction: Generate impression based on findings.

Input: 43-year-old female patient with right knee pain with medial joint tenderness. MENISCI: The medial and lateral menisci appear normal.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the lateral patellar facet with areas essentially devoid of cartilage. There is also a full-thickness cleft within the median eminence of the patella articular cartilage with underlying subchondral cysts. There is full-thickness degeneration of the articular cartilage of the inferior aspect of the lateral facet of the femoral trochlea with underlying subchondral cysts. There is a 1 cm full-thickness defect of the articular cartilage of the lateral femoral condyle just above the posterior horn of the lateral meniscus with thinning of the articular cartilage above the anterior horn. There is mild focal degeneration of the articular cartilage of the lateral tibial plateau. The medial tibiofemoral compartment articular cartilage appears relatively preserved.LIGAMENTS: The cruciate and collateral limits are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Osteoarthritis predominantly involving the patellofemoral joint and lateral femoral condyle cartilage with other findings as described above.


Instruction: Generate impression based on findings.

Input: 33 year old female with history of GBM. Evaluate for metastatic disease. The spinal cord is normal without evidence of leptomeningeal or intramedullary signal abnormality. No abnormal enhancement.MRI CERVICAL SPINE WWO, 2/11/2015 10:19 AMCLINICAL INFORMATION:Clinical question: Evaluate for progression of known GBM, new cranial nerve involvement. Signs and symptoms: Fossa bulge.COMPARISON: Brain MRI 1 -- 21 -- 15TECHNIQUE:Pre-and post-enhanced brain MRI is performed.11 cc of Multihance is intravenously and 4cc is wasted.

Output: 1.No convincing evidence of an acute or definite acute new finding since prior exam.2.Stable residual enhancing tumor in the right posterior temporal lobe with extension into the splenium of corpus callosum and along the medial aspect of left temporal lobe in signal intensity, extent, size and pattern of enhancement. Please see above comments.


Instruction: Generate impression based on findings.

Input: History of rectal abscess status post seton placement. Now with increasing rectal tenderness. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered bilateral inguinal lymph nodes are upper limit of normal in size, but likely reactive.BOWEL, MESENTERY: Arising from the 5:00 position of the anal verge there is a linear focus of increased T2 signal, restricted diffusion, and enhancement reflecting a fistulous tract with a seton in place. There is no associated drainable fluid collection or abscess.At the 9:00 position in the external sphincter there is a 4 mm rim-enhancing fluid collection (series 4 image 21 and series 112 image 69) compatible with a small abscess.Remaining visualized bowel is normal in appearance. No evidence of active inflammatory disease. BONES, SOFT TISSUES: At least one rounded focus of fat signal intensity, e.g., in the right iliac bone, compatible with an intraosseous lipoma formation.OTHER: No significant abnormality noted.

Output: 1.4 mm abscess confined by external anal sphincter on right side as described.2.Perianal fistulous tract arising from the 5:00 perianal position and extending towards the intergluteal cleft.


Instruction: Generate impression based on findings.

Input: Neck pain (meningismus) and headache. Confusion. Evaluate for signs of infection. The patient could not hold still for the examination. Multiple sequences were repeated.There are multiple rounded and punctate foci of T2 hyperintensity that are non diffusion-restricted and noncontrast-enhancing in the frontoparietal white matter. There is no space-occupying brain lesion. There is no midline shift or mass effect. The ventricles and the other CSF-containing spaces are enlarged, reflecting global volume loss, especially affecting the cerebellum. There is subtle contrast enhancement along the interfolial spaces on the inferior surface of the cerebellum. Similarly, there is subtle scattered increased contrast enhancement within the sulci, especially near the vertex. FLAIR images are degraded by patient motion and therefore corresponding sulcal FLAIR hyperintensity cannot be assessed for. There is no intracranial hemorrhage or brain abscesses. The dural venous sinuses and major intracranial arteries are patent.There is a small left orbital floor fracture with herniation of fat and abnormal contour to the inferior rectus muscle.

Output: 1.Subtle supratentorial and infratentorial leptomeningeal contrast enhancement may reflect leptomeningitis in the proper clinical setting. There is no focal collection or brain abscess.2.Generalized volume loss greater than expected for patient's stated age. 3.Frontoparietal white matter T2 hyperintense foci without diffusion restriction or contrast enhancement are nonspecific, with the differential including infectious/inflammatory etiologies, demyelinating disease, or relating to chronic microvascular ischemia advanced for patient's stated age. Please correlate clinically.4.Chronic appearing left orbital floor fracture with herniation of orbital fat.


Instruction: Generate impression based on findings.

Input: 62-year-old male with HCV cirrhosis. HCC surveillance scan. Reevaluate hepatic cysts. ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter cysts of hepatic segment 4A and segment 2 (axial series 8 images 17, 25). Cirrhotic liver morphology. Cholelithiasis. No suspicious arterially enhancing lesions with washout.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small portacaval lymph nodes.BOWEL, MESENTERY: Suspected duodenal diverticulum (coronal series 7 image 28).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Prominent blooming artifact related to mitral valve calcifications (axial series 9 image 27).

Output: Cirrhotic morphology. No suspicious lesions.