Instruction: Generate impression based on findings.

Input: Female, 70 years old, history of sphenoid wing meningioma status post CyberKnife. Surveillance imaging. Findings related to right-sided craniotomy and tumor resection are redemonstrated. Mild encephalomalacia affecting the right orbital gyrus is unchanged. No evidence of new or concerning enhancement is seen in the operative bed to suggest residual or recurrent tumor.A 15 x 12 mm dural based enhancing mass along the left superior frontal gyrus is unchanged. No new enhancing or nonenhancing intracranial lesions are seen. A few scattered foci of white matter T2 hyperintensity are stable and nonspecific. No restricted diffusion is seen. No mass effect or parenchymal edema is detected.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.Stable postoperative findings related to resection of a right sphenoid wing meningioma. No evidence of residual or recurrent tumor is seen.2.Stable left frontal convexity meningioma.


Instruction: Generate impression based on findings.

Input: 55-year-old female with bilateral osteoarthritis walking with a cane, clumping, difficulty climbing stairs. MENISCI: The medial and lateral menisci are normal. ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the patellar articular cartilage, especially along the medial facet. The articular cartilage along the femoral condyles and proximal tibia is morphologically normal. Bone marrow signal is normal. There is a small amount of fluid in the knee joint with no frank effusion.LIGAMENTS: The cruciate and collateral ligaments are morphologically normal.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Findings suggestive of synovitis in the suprapatellar pouch.2. Generalized thinning of the patellar articular cartilage, especially along the medial facet.3. Inflammatory changes in the subcutaneous soft tissues anterior to the patella.


Instruction: Generate impression based on findings.

Input: 50-year-old male with alcoholic cirrhosis and HCV. Evaluate for hepatic lesions/HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Segment 6 lesion with vague T2 hyperintensity, arterial enhancement, questionable washout, and pseudocapsule highly concerning for hepatocellular carcinoma; this lesion measures 1.8 x 1.5 cm (series 11, image 70), previously measuring 1.9 x 1.5 cm. The portal vein is patent.There are additional multiple punctate arterially enhancing foci without definite washout (for example series 11, images 31, 53, and 62). Cholelithiasis.SPLEEN: Splenomegaly. Splenule is 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: 1.Cirrhotic liver morphology with segment 7 lesion as detailed above highly concerning for hepatocellular carcinoma based on UNOS/OPTN criteria, but not necessarily by AASLD.2.Multiple additional punctate arterially enhancing nonspecific hepatic foci without evidence of washout likely perfusional anomalies, but attention on subsequent follow up imaging suggested.


Instruction: Generate impression based on findings.

Input: 63 year old male with a history of heart failure with reduced ejection fraction, hyperlipidemia referred for stress cardiac MRI.MEDICATIONS: Atorvastatin, Benazepril, Carvedilol, and Eplerenone First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is evidence of mid-myocardial late gadolinium enhancement noted in the mid to basal septum and inferoseptum. This is atypical for myocardial infarction and may suggest prior myocarditis or fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is mildly dilated with moderately-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 120 ml/m2 (normal range: 74+/-15), the LVEDV is 239 ml (normal range 142+/-34), the LV end systolic volume index is 77 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 29 g/m2, and the LV mass is 57 g. There is global hypokinesis. The pre-contrast native myocardial T1 relaxation time was normal (1030 ms). Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 194 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 105 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild 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 40 mm. 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 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. No perfusion defects/ "ischemia" present during hyperemia. 2. The left ventricle is mildly dilated with moderately-severely reduced systolic function (LVEF 34%). There is global hypokinesis.3. The right ventricle is normal in size with mildly reduced systolic function (RVEF 46%).4. There is mid-myocardial late gadolinium enhancement noted in the mid to basal septum and inferoseptum. This is atypical for myocardial infarction and may suggest prior myocarditis or fibrosis, inflammation, or infiltration. 5. Mild biatrial dilatationI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate medial meniscus History: MJL pain, effusion MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Thinning of the patellar hyaline cartilage without focal defect. Minimal bone marrow edema in the medial plateau of the tibia.Red marrow of the femur and tibia noted. Small subchondral cyst in the proximal tibia.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Thinning of the patellar hyaline cartilage without focal defect.


Instruction: Generate impression based on findings.

Input: 14-year-old female patient with history of perianal abscess and anal fissures. Evaluate for Crohn's disease.EXAMINATION: MR enterography without and with IV contrast 10/20/2015, 15:36 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:There is approximately 8 cm of terminal ileum that is thickened and demonstrates mild increased enhancement. There is also decreased peristalsis of this segment of bowel. No stenosis or fistula formation is seen. No significant T2 signal hyperintensity is present. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Inflammatory changes in the perianal soft tissues are partially imaged and better seen on prior MRI of the pelvis.BONES, SOFT TISSUES: There is a small amount of subcutaneous edema in the posterior soft tissues at the level of the pelvis.OTHER: There is a small amount of free fluid in the pelvis.

Output: 1.8 cm segment of chronic inflammatory changes in the terminal ileum without stenosis.2.Inflammatory changes in the perianal soft tissues are partially imaged and better seen on MRI of the pelvis.


Instruction: Generate impression based on findings.

Input: Reason: evaluate structural abnormalities, enlarged ventricles History: macrocephaly, developmental delay, low muscle tone. There is no evidence of intracranial hemorrhage, mass, or acute infarct. No focal cortical lesions or parenchymal signal abnormalities are appreciated. The myelination pattern is within normal limits for age. The ventricles and basal cisterns are normal in size and configuration without evidence of hydrocephalus. No extra-axial collections are identified. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. The mastoid air cells are grossly clear.

Output: No focal structural abnormalities are identified. Specifically, no hydrocephalus or extra-axial collections to account for macrocephaly.


Instruction: Generate impression based on findings.

Input: Male, 69 years old. Biceps tendon rupture Evaluation of the elbow is limited by patient motion artifact. Furthermore, the patient refused further imaging to delineate the proximal extent of muscle retraction.LIGAMENTS: The anterior band of the ulnar collateral ligament as well as the radial collateral ligament proper appear intact. The lateral ulnar collateral ligament is difficult to visualize, but we suspect it is intact.TENDONS: Although a very thin (submillimeter) slip of biceps tendon can be traced to its insertion on the proximal radius, the remainder of the tendon has detached from the radius and retracted proximally by several centimeters to the lacertus fibrosis at the level of the humeral epicondyles. This appears to be a chronic, essentially complete tear of the biceps, as no edema is seen along its expected distal course. The brachialis muscle and tendon are intact. The triceps tendon is intact. The common flexor and common extensor tendons are intact.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is normal. The elbow joint appears normal for age. SURROUNDING STRUCTURES: There is mild subcutaneous edema superficial to the medial epicondyle. The remaining soft tissue structures are normal.

Output: Limited study as described above showing an essentially complete, chronic tear of the distal biceps tendon.


Instruction: Generate impression based on findings.

Input: Diagnosis: Facial weaknessClinical question: severe back pain after LP, rule out hematomaSigns and Symptoms: severe back pain 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. There is ventral epidural fat present in the ventral aspect of the lower lumbar spine which is bright on T1 and suppresses on the inversion recovery images.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.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: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Syringomyelia and syringobulbia [G95.0], Reason for Study: ^Reason: Evaluation for change in syrinx History: syrinx Redemonstration of syrinx from T6 to T8-9 disc space level, unchanged in terms of maximum diameter since prior scan (2.8mm x 2.8mm). There are also prominent central canal from T3 to T6 and T9 to T10 levels, unchanged in terms of its extent since prior scan.In homogeneous vertebral body MR signal intensities are seen on all sequences which grossly unchanged since prior scan. Specifically, there is no evidence of compression fracture, and no evidence of endplate fracture or deformity on thoracic spine.The spine alignment is anatomic. The vertebral body height is preserved. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression. The conus medullaris terminates at the T12-L1 level.The paraspinal soft tissues are unremarkable.

Output: Stable thoracic syrinx in terms of extent and maximum diameter since prior scan.


Instruction: Generate impression based on findings.

Input: Reason: Assess for foot abscess, osteomyelitis, foot as source of possible bacteremia History: No ulcers/soft tissue defects of the foot; significant swelling and pain; evidence of Charcot arthropathy on XR As seen on the recent radiographs, there are findings compatible with a neuropathic arthropathy of the tarsometatarsal joints with cyst/erosions of the metatarsal bases, cuneiforms, and cuboid. There is also fluid within the Lisfranc joint and abnormal signal intensity within the adjacent bones representing edema associated with the arthropathy. The bone fragments within the adjacent soft tissues are better seen on the patient's recent radiographs. There is also a fluid collection along the lateral aspect of the talonavicular joint, perhaps arising from the sinus tarsus. There is diffuse edema particularly along the dorsum of the forefoot and midfoot. Although there is edema within the subcutaneous fat of the forefoot and midfoot, we see no soft tissue defect or sinus tract extending from the skin to the bone to suggest osteomyelitis. There is diffuse atrophy of the imaged musculature of the midfoot and forefoot as well.

Output: Soft tissue edema and neuropathic arthropathy of the Lisfranc joint. There is also a small fluid collection along the lateral aspect of the talonavicular joint that may represent a synovial cyst or ganglion. While it is impossible to completely exclude infection, we see no soft tissue ulceration, sinus tracts, or other specific findings to support abscess formation or osteomyelitis.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, history of metastatic breast cancer to the brain, surveillance imaging. Again seen are findings related to tumor resection from the right paramedian parietal region. The resection cavity, and T2 hyperintensity surrounding cavity, have not significantly changed from the prior exam. Mild curvilinear enhancement within the resection cavity has decreased in conspicuity from the prior examination. No new areas of suspicious enhancement are seen within or around the treatment bed.Also redemonstrated is a treated left cerebellar lesion which continues to enhance similar to the prior examination. The lesion measures 15 x 10 mm and has not changed in size from the prior study. T2 hyperintensity surrounding this lesion is unchanged as well.No new or concerning areas of intracranial enhancement are identified. An incidental developmental venous anomaly is again seen adjacent to the left cerebellar lesion. A few scattered foci of nonspecific white matter T2 hyperintensity are unchanged. No evidence of significant parenchymal edema or mass effect is detected. The ventricular system is stable and normal in size.

Output: 1.Stable appearance of the right paramedian parietal resection bed with no evidence to suggest recurrent or progressive tumor.2.Stable appearance of the treated left cerebellar lesion. The lesion continues to enhance but is unchanged in size.


Instruction: Generate impression based on findings.

Input: 65-year-old female with history of renal cell carcinoma and ganglioneuroma. Status post right nephrectomy. Evaluate for recurrent disease. CHEST:LUNGS AND PLEURA: Stable apical and lateral pleural thickening, greater on the right. No change in several small micronodules as well as stable, minimal ground glass opacity in right upper lobe.MEDIASTINUM AND HILA: Stable small to borderline superior mediastinal lymph nodes. There are also several relatively large nodes but with fatty centers in the pre-carina and aorto - pulmonary window which are stable when compared to prior exam as well as a study from September of 2008.CHEST WALL: T7 vertebral body lesion at axial image 43 of series 8 was evaluated on thoracic MRI exam of 2/4/2010. T3 vertebral body hemangioma at axial image 17 of series 8. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No change in appearance is previously described.ADRENAL GLANDS: Right adrenal appears normal. The left is not visualized.KIDNEYS, URETERS: Probable small cyst in the upper pole right kidney cyst. Status post left nephrectomy. The bowel and pancreatic tail occupy the nephrectomy bed. No evidence for local recurrence.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Stable 1.7 x 2.9 cm rounded low attenuation mass in the left adnexa with fluid density.BLADDER: No significant abnormality noted.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: Stable CT of the chest, abdomen and pelvis.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of cholangiocarcinoma, possibly metastatic. History of NSTEMI. Septic shock, concern for abscess. Hypotensive. LUNGS AND PLEURA: Intubated. Predominantly upper lobe emphysema. Mild reticular opacities in the lung bases. Linear opacity in the left lung base likely represents atelectasis or scarring. No pleural effusions. Several scattered micronodules are present, several of which are calcified and likely related to prior granulomatous disease. The largest noncalcified lung nodule measures 3 mm in the right upper lobe. There is new bilateral lower lobe consolidation and volume loss. MEDIASTINUM AND HILA: Calcified right hilar and mediastinal lymph nodes are likely due to prior granulomatous disease. Other small mediastinal and hilar lymph nodes are present, but no significantly enlarged mediastinal or hilar node. Aortic and coronary atherosclerotic calcifications are present. Cardiomegaly. The orientation of the heart within the thorax is abnormal with posterior displacement of the ventricles. The pericardium is seen at the level of the right AV groove, but elsewhere, pericardium is not clearly apparent. This raises the possibility of partial absence of the pericardium, which could explain the abnormal orientation of the heart. CHEST WALL: Degenerative changes affect the thoracic spine.ABDOMEN: LIVER, BILIARY TRACT: There is a poorly defined hepatic mass with intrahepatic biliary dilatation in the left lobe. Multiple new hypodensities have appeared throughout the liver since the prior MRI exam. The dominant left lobe mass in hepatic segment 2/3 is larger and now measures 7 x 7 cm, associated with intrahepatic biliary dilation in left lobe; findings most consistent with cholangiocarcinoma (series 4, image 79). The fat layer between this exophytic mass and the pancreas appears preserved. The mass occludes the left bile duct approximately 1 cm from confluence, however, the confluence itself appears unaffected. Left hepatic and portal veins are obliterated by mass. The middle hepatic vein passes immediately lateral to mass but appears unaffected. No extrahepatic biliary ductal dilation. New metastasis in the posterior inferior right hepatic lobe measures more than 4 cm in diameter (image 93 of series 4). The metastases have indistinct margins. The new smaller hepatic hypodensities have better defined borders and may represent metastases vs. septic emboli, although metastases are more likely. There is an accessory left hepatic artery arising from the left gastric artery. The left gastric artery arises directly from the aorta adjacent to the celiac trunk (series 17, image 57). SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic calcification, probably from prior pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is diffuse retroperitlymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New moderate ascites. IVC filter is in place. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Foley catheter in a decompressed urinary bladder. There is an reservoir for the patient's penile prosthesis in the expected position adjacent to the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A rectal tube is in expected position.BONES, SOFT TISSUES: Degenerative changes of the lumbosacral spine and pelvis.OTHER: Moderate ascites. Probable carcinomatosis of the mesentery.

Output: Findings consistent with left liver lobe cholangiocarcinoma. Dominant left lobe mass is larger since 10/12/2011, and multiple new hepatic hypodensities have appeared. New hepatic metastases. New moderate ascites. New bilateral lower lobe consolidation / volume loss.New diffuse omental density suggests carcinomatosis.


Instruction: Generate impression based on findings.

Input: Vertigo, tinnitus with prolonged nystagmus on exam. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The left mastoid air cells and middle ears also appear unremarkable. There is minimal scattered right mastoid mucosal thickening and enhancement. There is cystic cavum septum pellucidum that measures 20 mm in width.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. Incidental cystic cavum septum pellucidum that measures 20 mm in width.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for cyst in Guyon's canal History: R wrist pain, ulnar nerve palsy We see no findings to account for the patient's ulnar nerve palsy, specifically we see no mass within Guyon's canal. There is a small nonenhancing collection of fluid signal intensity along the volar aspect of the capitohamate articulation near the carpometacarpal joint, likely representing a bilobed ganglion measuring approximately 7 mm in its greatest dimension. An additional small collection of fluid signal intensity is identified along the volar aspect of the base of the second metacarpal which also likely represents ganglion formation. These findings are not necessarily of any current clinical significance. There is mild edema and enhancement of the abductor pollicis brevis which is nonspecific and of uncertain etiology. We see no fatty atrophy of the muscle on T1-weighted images. The remainder of the musculature is unremarkable. Although this examination was not protocoled for detailed evaluation of the extrinsic ligaments of the wrist, we see no findings to suggest disruption of the scapholunate or lunotriquetral ligaments. The triangular fibrocartilage complex appears intact. No bone marrow signal abnormality is identified.

Output: Tiny ganglia near the carpometacarpal joint, but no mass within Guyon's canal or other findings to account for the patient's wrist pain or ulnar nerve palsy.


Instruction: Generate impression based on findings.

Input: Brain MRI:Restricted diffusion with ADC hypointensity and T2 hyperintensity is present involving right basal ganglia crossing the anterior limb of the internal capsule as well as separate foci within the right frontal, right temporooccipital, and temporal lobes. There is no susceptibility abnormality or significant enhancement.There is an unchanged arachnoid cyst overlying the left anterior temporal lobe, inferior left frontal lobe, and insula, with mass effect upon the underlying brain parenchyma. There are mild scattered foci of cerebral white matter T2 hyperintensity and a small area of encephalomalacia in the left basal ganglia. There is also small cortical gliosis involving the left post central gyrus from remote infarct, unchanged. Redemonstrated is lack of the normal flow void in the left internal carotid artery, unchanged.The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is lack of flow in the distal left internal carotid artery involving its petrous and cavernous sinus portions, as demonstrated previously by MRI. Flow is noted involving the left MCA, presumably secondary to flow across a visualized anterior communicating artery as the left posterior communicating artery is nonvisualized. There is a tiny right visualized posterior communicating artery. There is a small area of focal stenosis involving the right MCA M1 segment, with patent flow noted in distal MCA segments. There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery. Neck MRA:There is irregular plaque with possible ulceration at the origin of the right internal carotid artery without hemodynamically significant stenosis.There is complete occlusion of the left internal carotid artery from its origin.There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant, although the left vertebral artery origin is previously visualized as it primarily lies outside the slab of acquisition.

Output: 1.Acute right MCA territory distribution infarct.2.Unchanged left arachnoid cyst.3.Stable chronic vascular disease.4.Irregular plaque with possible ulceration at the origin of the right internal carotid artery without hemodynamically significant stenosis.5.Complete occlusion of the left internal carotid artery from its origin.6.Results were discussed with Dr. Palai on 10/3/2016 at 10:10 AM


Instruction: Generate impression based on findings.

Input: Langerhans cell histiocytosis with new onset polydipsia and polyuria; assess for pituitary involvement. Pituitary: The T1 hyperintense posterior pituitary bright spot is no longer evident. There is also new mild thickening of the pituitary infundibulum. Otherwise, there is no evidence of sellar tumors. The optic apparatus and cavernous sinuses are intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma is unremarkable and there is no abnormal intraparenchymal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. In particular, there is no evidence of recurrent temporal bone lesion.

Output: 1. Mild thickening of the pituitary infundibulum and loss of the posterior pituitary bright spot suggests incipient Langerhans cell histiocytosis of the hypothalamic-pituitary axis. 2. No evidence of recurrent temporal bone region Langerhans cell histiocytosis.


Instruction: Generate impression based on findings.

Input: Left-sided numbness. Altered status. BRAIN MRI:The moderate frontoparietal periventricular white-matter hypoattenuation on the CT scan correlates with T2/FLAIR hyperintensity without diffusion restriction. This is most compatible with chronic microvascular ischemia. There is no abnormal brain diffusion restriction or susceptibility effect to suggest acute infarct or hemorrhage, respectively. The brain volume loss is more pronounced in the frontotemporal lobes. There is no mass-effect or midline shift. There is no destructive skull lesion. There is no gross orbital abnormality, accounting for findings of previous bilateral cataract surgery. Left occipital fat intensity lesion is compatible with a lipoma and measures in the axial plane 2.0 cm x 0.6 cm.CRANIAL MRA:There is no significant, flow-limiting stenosis of the major intracranial arteries. Of note, the left vertebral artery is smaller than the right which is probably developmental/congenital. The right posterior cerebral artery is almost fetal-type, which is a normal variation.NECK MRA:There is mild focal narrowing in the distal left common carotid artery, just upstream from its bifurcation which involves the origin of the left external carotid artery without hemodynamically significant stenosis. Otherwise, the cervical carotid arteries show preserved caliber, contrast opacification and flow-related signal.The left vertebral artery is smaller than the right, throughout its length and without ostial narrowing. This is probably congenital/developmental.

Output: 1.There is no acute brain ischemia or acute intracranial hemorrhage.2.Moderate cerebral chronic microvascular ischemia is also associated with volume loss that is more pronounced in the frontal and temporal lobes.3.Cranial MR angiography shows no significant stenosis or aneurysm.4.Neck MR angiography shows mild distal left common carotid artery narrowing but no significant, flow-limiting stenosis otherwise. The small size of the left vertebral artery is felt to be congenital/developmental.


Instruction: Generate impression based on findings.

Input: Reason: eval for TFCC tear History: wrist pain for months LIGAMENTS: No contrast is visualized in the mid carpal joint to indicate scapholunate or lunotriquetral ligament tear.TRIANGULAR FIBROCARTILAGE COMPLEX: There is a tiny defect in the articular disc of the triangular fibrocartilage complex near the radial attachment, likely corresponding to the full-thickness defect seen on conventional arthrography. Additionally, the proximal lamina of the articular disc appears disrupted near its attachment, and the distal lamina may be torn as well.TENDONS: There is contrast within the second and third extensor compartments, which is iatrogenic.BONES: No significant abnormality noted.

Output: Tear of the triangular fibrocartilage, as detailed above.


Instruction: Generate impression based on findings.

Input: 49-year-old history of CHF 3 presenting with headache and dizziness x 2 days. Increased right-sided weakness and paresthesia. There is no evidence of intracranial hemorrhage, mass or edema. No definite acute cortical stroke is seen however MRI is recommended if concern for ischemia is present. Focal hypoattenuation in the left centrum semiovale consistent with old subcortical infarct. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No evidence of acute cortical stroke. Old left subcortical stroke.


Instruction: Generate impression based on findings.

Input: 31-year-old male with pain, FAI signs, evaluate labrum ACETABULAR LABRUM: There is branching signal abnormality within the acetabular labrum extending from 12 to 2 o'clock, consistent with a complex tear.ARTICULAR CARTILAGE AND BONE: Mild osteoarthritis affects the hip joint with osteophytes, subchondral cysts within the acetabulum as well as mild degeneration of the articular cartilage along the superior aspect of the joint. There is prominence along the anterior aspect of the femoral head-neck junction, with an alpha angle measuring approximately 60 degrees. There are also cystic changes along the anterior aspect of the femoral head-neck junction.There also appears to be a CAM deformity affecting the lateral femoral head-neck junction of the right hip.SOFT TISSUES: The visualized soft tissues are within normal limits. ADDITIONAL

Output: CAM type deformity with associated osteoarthritic changes of the hip and complex labral tear as described above.


Instruction: Generate impression based on findings.

Input: Female, 75 years old, with back pain. Assess for reevaluation of tethered cord or progression of degenerative disc disease. Thoracic:There is a mild scoliotic curvature and slight exaggeration of the thoracic kyphosis, similar to prior. Vertebral body alignment is otherwise unremarkable.Marrow signal characteristics are generally heterogeneous with scattered T1/T2 hyperintense lesions likely representing hemangiomas, without significant interval change. No new or concerning marrow space disease is seen.The visualized spinal cord demonstrates normal signal intensity throughout.Small disc protrusions at T6-7, T7-8, T11-12 and T12-L1 are unchanged. These cause no significant spinal canal stenosis. No high-grade foraminal narrowing is suspected.Lumbar:Redemonstrated is evidence of a posterior instrumented spinal fusion with pedicle screws bilaterally at L4, L5 and S1. The posterior elements in the sacral region are thin or absent which may be postoperative or congenital.A grade 1 anterolisthesis of L4 relative to L5 is not significantly changed. Spinal alignment is otherwise within acceptable limits.Vertebral body height and morphology are normal. Again, marrow signal is generally heterogeneous with scattered superimposed probable hemangiomas. No concerning marrow signal abnormality is detected.The visualized spinal cord and conus demonstrate normal signal characteristics. The conus tip terminates at the L3 level similar to prior. Fatty infiltration of the distal filum terminale is also unchanged.The discs show loss of T2 signal with evidence of loss of disc height at L2-3, similar to prior. Additional level specific findings are as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L2-3: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a right far lateral protrusion versus osteophyte. Mild generalized spinal canal narrowing. Moderate to severe right foraminal narrowing. No significant interval changes. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Mild disc uncovering and minimal disc bulging. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L5-S1: Unremarkable.

Output: 1.No significant interval change in mild degenerative findings of the thoracic spine.2.Redemonstration of postoperative findings in the lumbosacral region. Moderate to severe posterior element hypertrophy, along with relatively mild degenerative disc disease, cause no more than mild spinal canal stenosis. A moderate to severe narrowing of the right L2-3 neural foramen is noted. No significant interval change is seen in these degenerative findings.3.Findings are redemonstrated compatible with tethered cord including low-lying conus and fatty infiltration of the filum terminale without interval change.


Instruction: Generate impression based on findings.

Input: 57-year-old male with history of bladder cancer, on surveillance ABDOMEN:LIVER, BILIARY TRACT: Unchanged punctate T2 hyperintensity in the inferior right liver lobe. No new liver lesions present. The gallbladder is within normal limits.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense cysts in the left kidney are unchanged. There is unchanged mild bilateral hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No evidence of recurrent or metastatic disease.2.Unchanged mild bilateral hydroureteronephrosis and mild distention of the neobladder.


Instruction: Generate impression based on findings.

Input: Reason: Pt is a 57 y/o male with RCC, evaluate for recurrence, attention to L2 vertebrae History: RCC Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is anterior compression fracture present at L1. This is unchanged since the prior exam The conus medullaris on sagittal imaging is grossly intact. No enhancing lesions are appreciated within the lumbar spinal canal.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation, loss of disk space height and a diffuse disk bulge present at this level. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation, loss of disk space height and a diffuse disk bulge present at this level. There is mild facet hypertrophy at this level right more than left. There is a left paramedian disk protrusion at this level. There is mild encroachment of the nerve roots of the right lateral recess at this level. This is unchanged compared to the previous examAt L3-4 there is a left lateral recess disk protrusion at this level which encroaches on the nerve roots of the left lateral recess and is unchanged since prior exam. There is bilateral facet hypertrophy at this level as well as some ligamentum flavum hypertrophy. There is loss of disk space height, disk desiccation and diffuse disk bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a compression fracture present at L1 which is stable compared to the prior exam.2.Multilevel degenerative changes are present in the lumbar spine with encroachment of the nerve roots at the left lateral recess at L3-4 due to a disk protrusion. This is stable compared to the prior exam.3.No evidence for lumbar spine metastases


Instruction: Generate impression based on findings.

Input: 21-year-old male with right elbow pain. Four views of the right elbow are provided. The right elbow appears normal with no findings to account for the patient's pain.

Output: Normal right elbow with no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: History of medulloblastoma status post craniotomy, radiation therapy, SRS, chemotherapy, and autologous stem cell transplant: off therapy evaluation. There is fatty marrow within the vertebral bone marrow related to radiation therapy. There is no evidence of tumor in the cervical spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: Post-radiation effect in the vertebral bone marrow diffusely without evidence of drop metastases in the thoracic and lumbar spine.


Instruction: Generate impression based on findings.

Input: Increasing dementia in an immunocompromised patient. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of high T2 signal in the cerebral white matter bilaterally. The brainstem and cerebellum appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild staphylomatous deformity of the bilateral globes.

Output: A few punctate foci of high T2 signal in the cerebral white matter bilaterally are nonspecific and may represent chronic small vessel ischemic disease or perhaps sequela of infection, but characterization is limited without intravenous contrast. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 73-year-old female with history of breast cancer with brain metastases presenting with fulminant hepatic failure. Please evaluate for evidence of increased intracranial pressure. Focal encephalomalacia affecting the left temporal lobe is unchanged in appearance. Patchy low attenuation within the subcortical and periventricular white matter is nonspecific, and may be vascular in etiology. There is no intracranial hemorrhage or abnormal extra-axial fluid collections. There is no midline shift or mass effect. The ventricles are midline, with normal volume and morphology. The basilar cisterns are normal in appearance.Poorly defined lytic lesions affecting the right frontal and left frontal bones may represent metastases. There is also new lytic destruction of the right aspect of the clivus and petrous apex, concerning for metastasis. These were not present on the 4/25/2007 exam. Further evaluation with contrast-enhanced MRI may be considered to evaluate for leptomeningeal extension if clinically indicated. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No intracranial hemorrhage or evidence of increased intracranial pressure.2. New lytic lesions affecting the frontal bones and skull base are suspicious for metastases. Further evaluation with contrast-enhanced MRI may be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of bone [C79.51] / Intrahepatic bile duct carcinoma [C22.1], Reason for Study: ^Reason: brain mets vs stroke History: slurred speech Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is a focal susceptibility lesion on the right basal ganglia (series 900, image 9), however the lesion is not associated with the surrounding edema or other evidence of acute hemorrhage, therefore, this is nonspecific likely represent focal parenchymal calcification or chronic petechial hemorrhage.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The paranasal sinuses are clear.Focal opacifications of bilateral mastoid air cells are seen.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No evidence of significant intracranial arterial luminal stenosis. No evidence of intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine with aura, not intractable, without status migrainosusClinical question: headache in lupus patientSigns and Symptoms: headache and vision changes MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The AP dimension of the eyes are increased in the sclerae thin bilaterally compatible with staphyloma. Incidental note is made of empty sella.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. There is extracranial origin of the right posterior inferior cerebellar artery. The right vertebral artery slightly larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for intracranial aneurysm. 3.There is no evidence for extracranial cerebrovascular occlusive disease.4.There are staphylomas present involving the eyes bilaterally.5.There is no evidence for intracranial mass lesion.6.No evidence for ischemic cerebral infarction.7.Incidental note is made of empty sella.


Instruction: Generate impression based on findings.

Input: 53 years, Male, Reason: cirrhosis. rising AFP. evaluate for liver lesion History: rising AFP. ABDOMEN:LUNG BASES: Moderate left pleural effusion is new.LIVER, BILIARY TRACT: Cirrhotic liver morphology. Multiple nonenhancing cysts are unchanged.There are two enhancing lesions in segment 8 which washout on delayed phase imaging measuring 1.2 cm (802/262) and 1.1 cm (802/297), consistent with hepatocellular carcinoma.Re-cannulization of the umbilical vein.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval node measuring 2.0 x 1.1 cm (701/308).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left posterior eighth and ninth rib fractures with decreased size of adjacent fluidOTHER: Large amount of increased ascites.

Output: 1.Two enhancing lesions with washout in segment 8, consistent with hepatocellular carcinoma.2.Large amount of ascites is increased.3.Cirrhotic liver morphology with enlarged portacaval nodes.4.New small left pleural effusion.


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: Female, 55 years old. Reason: asymptomatic goiter found on exam, eval for nodules RIGHT LOBE MEASUREMENTS: 6.1 x 3.2 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.6 x 2.6 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Heterogeneous echotexture, with multiple nodules of varying sizes. A right upper pole nodule measures 1.9 x 1.6 x 1 .2 cm, predominantly solid with cystic component a, noncalcified, without significant internal vascularity. An right lower pole nodule measures 1.2 x 1.0 x 1.1 cm, predominately cystic, noncalcified, nonvascular.LEFT LOBE: Heterogeneous echotexture, with multiple nodules of varying sizes. A dominant lower pole nodule measures 2.8 x 2.4 by 1.3 cm, heterogeneous, hypoechoic, predominantly solid with cystic components, and suggestion of peripheral calcification.ISTHMUS: Heterogeneous echotexture. A nodule at the left aspect of the isthmus measures 3.0 by 3.3 x 1.9 cm, heterogeneous and hypoechoic, with mild internal vascularity, noncalcified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous thyroid with multiple nodules of varying size and character, as detailed above. A dominant left thyroid nodule is amenable to biopsy.


Instruction: Generate impression based on findings.

Input: Male, 34 years old, with chronic pain in the left ulnar distribution stemming from a work injury in 2013, continuing to worsen with entire arm to hand in ulnar distribution. The neural structures of the brachial plexus demonstrate normal morphology and signal characteristics. No pathologic enhancement is identified. No compressive mass or fluid collection is seen along the course of the left brachial plexus. Scattered mildly prominent lymph nodes are evident in the neck, of uncertain significance. Anterior fixation instruments are present at C7-T1.

Output: No findings to suggest an injury to the left brachial plexus.


Instruction: Generate impression based on findings.

Input: 51-year-old female with prominent pancreas on an outside hospital CT in March 20, 2014. Evaluate for etiology of recurrent acute pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter segment 6 T2 hyperintense nonenhancing focus most compatible with a cyst; there is an additional T2 hyperintense, nonenhancing caudate lesion measuring up to 3 cm, consistent with a cyst. No intra or extra hepatic biliary ductal dilatation.There is a lesion in the gallbladder fundus as noted on series 501, image 18.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic mass or ductal dilatation. Normal T1 intrinsic hyperintensity in the pancreatic parenchyma. No evidence of pancreatic divisum or annular pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of pancreatic divisum, annular pancreas, pancreatic mass, or pancreatic ductal dilatation.2.Gallbladder fundus lesion may be fundal adenomyomatosis versus a polypoid lesion. Ultrasound may be helpful in further characterizing this lesion.3.Hepatic cysts.


Instruction: Generate impression based on findings.

Input: Male 24 years old Reason: Right hip labral tear History: Right hip pain ACETABULAR LABRUM: Mild blunting and fraying of the right superior acetabular labrum may represent undersurface partial tearing.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Possible undersurface partial tearing of the right superior labrum.


Instruction: Generate impression based on findings.

Input: 5 day old male with history of perinatal acidosis undergoing cooling protocol. Evaluate for HIE and extent of ischemic injury. Born at 40 1/7 weeks, C-section, low APGARs, suspect infection. There are no areas of restricted diffusion to suggest acute ischemic infarct. There is no evidence of acute intracranial hemorrhage. Myelination is age-appropriate. The ventricles and sulci are symmetric. Flow-voids are appreciated within the major intracranial vessels. The imaged paranasal sinuses, mastoid air cells, and orbits are within normal limits.

Output: Normal brain MRI without evidence of HIE or ischemia.


Instruction: Generate impression based on findings.

Input: Male 31 years old with right knee pain and MCL sprain. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema consistent with contusions, anteriorly within the lateral tibial plateau, posteriorly within the medial tibial plateau, posteriorly within the lateral femoral condyle, and within the posterior aspect of the medial femoral condyle subjacent to the proximal attachment of the medial collateral ligament. LIGAMENTS: There is abnormal high signal at the tibial attachment of the medial collateral ligament and fluid tracks superficial to the medial collateral ligament along its length, suggestive of a sprain. The ligament is intact. There is no evidence of disruption of the meniscocapsular junction.The anterior and posterior cruciate ligaments are intact and the lateral collateral ligament is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial patellofemoral ligament injury.2. Medial collateral ligament sprain.3. Nonspecific bone contusion pattern.


Instruction: Generate impression based on findings.

Input: 12 year old male with knee pain. Evaluate meniscus, possible discoid meniscus. MENISCI: The medial and lateral meniscus appear intact. There is no evidence of a discoid meniscus.ARTICULAR CARTILAGE AND BONE: The bone marrow signal intensity is within normal limits. The articular cartilage of the medial, lateral, and patellofemoral compartments is normal in appearance.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: Normal appearing knee with no specific findings to account for the patient's knee pain. Specifically, we see no findings of a discoid meniscus.


Instruction: Generate impression based on findings.

Input: Prostate cancer. Please evaluate for high risk features PELVIS:PROSTATE:Prostate Size: 2.8 x 3.7 x 3.3 cmPeripheral Zone: In the right apex gland peripheral zone there is a 9 x 12 mm lesion demonstrating T2 weighted hypointensity (series 1001, 90) with associated restricted diffusion (ADC image 244, series 704). Otherwise the peripheral zone is atrophic and diffusely heterogeneous in T2-weighted signal intensity without a dominant lesion on ADC or T2-weighted imaging.Central Gland: No suspicious abnormality noted.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right gland dominant lesion has a broad base of abutment with the prostatic margin with mild bulging but no frank extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Highly suspicious right apex peripheral zone lesion measuring 9 x 12 mm with restricted diffusion.2. Nonspecific small external iliac lymph nodes.


Instruction: Generate impression based on findings.

Input: Reason: mycosis fungoides with new onset chest pain History: pleuritic chest pain LUNGS AND PLEURA: Mild streaky basilar opacities compatible with subsegmental atelectasis. The examination was not optimized for evaluation of pulmonary medicine. However at least one subsegmental filling defect is visible in the right lower lobe on the source images and other questionable very small defects are visible in left lower lobe arteries. In the presence of chest pain and unexplained basilar atelectasis this is suspicious for pulmonary embolism. A text page was sent to Dr. Sadiq at the time of interpretation.MEDIASTINUM AND HILA: Multiple small collateral vessels are present.No significant lymphadenopathy.CHEST WALL: Decrease in the size of an enlarged left axillary node which now measures 16 x 14 mm.Obstruction of the left axillary and subclavian veins of uncertain etiology with extensive collateral formation suggesting chronicity.New focal area of sclerosis or contrast pooling in the posterior T2 vertebral body, not visible on the recent CT of 11/3/2010, all of uncertain significance. If clinically indicated this could be further evaluated by MRI.UPPER ABDOMEN: Very limited evaluation with no gross abnormalities.

Output: 1. Subsegmental right lower lobe pulmonary embolus and possibly additional small emboli in the left lower lobe. A repeat examination could be performed with CTA technique for more optimal evaluation if clinically indicated.2. Focal area of sclerosis or contrast pooling in the posterior T2 vertebral body of uncertain significance.


Instruction: Generate impression based on findings.

Input: Reason: Eval liver lesions, masses, HCC screen, vessel patency, coronary calcification History: cirrhosis, PVT, seg 7 lesion eval ABDOMEN:LIVER, BILIARY TRACT: Liver is cirrhotic in morphology. The splenic vein and SMV are patent. The extrahepatic portal vein is markedly narrowed with partial thrombus, similar to the prior exam. The intrahepatic portal veins are narrowed but patent. No suspicious hepatic lesions are present. Multiple splenic collaterals as well as gastric and esophageal varices.SPLEEN: Mildly enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left subcapsular fluid collection is unchanged measuring 6.0 x 3.6 cm (4/31), previously 6.2 x 3.7 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right ventral hernia containing bowel loops without evidence of obstruction.BONES, SOFT TISSUES: Multiple compression fractures involving T7, T8, T10-T12, L2, better evaluated on dedicated spine MRI. Scoliosis.OTHER: .Ascites is increased since the prior exam.

Output: 1.No suspicious hepatic lesions.2.Narrowing of the portal vein with partial thrombus appears similar to the prior exam.3.Increased abdominal ascites.4.Cirrhotic liver morphology and sequela of portal hypertension including gastric and esophageal varices.5.Multiple vertebral and lumbar compression fractures, better evaluated on recent dedicated spine MRI.


Instruction: Generate impression based on findings.

Input: Preoperative evaluation for liver transplant. ABDOMEN:LIVER, BILIARY TRACT: T2 mildly hyperintense lesion in segment 5/8 measures approximately 5.4 x 4.3 cm. This is associated with biliary ductal dilatation peripherally. No additional lesion is evident. The vasculature is not evaluated on this non-enhanced foreshortened exam.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: Mildly prominent peripancreatic, periportal and pericaval lymph nodes are not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right bibasilar atelectasis.INDEX LESION MEASUREMENTS (Current exam date/time: 4/25/2016 15:00:00)SEGMENT 5/8 LESION: 5.4 x 4.3 cm (Image 29, Series 501); 3.2 x 2.5 cm on prior (4/7/2016) (Image 39, Series 11).PARACAVAL LYMPH NODE: 2.1 x 1.0 cm (Image 13, Series 801); 2.5 x 1.2 cm on prior (4/7/2016) (Image 62, Series 11).

Output: Segment 5/8 lesion has increased in size. The study was terminated early due to the patient's claustrophobia and is significantly limited.


Instruction: Generate impression based on findings.

Input: Evaluate for right thalamic bleed versus calcification. Brain MRI: There is a punctate hemorrhage in the right thalamus with mild surrounding vasogenic edema. There are numerous other supratentorial and infratentorial punctate foci of susceptibility effect. There is a punctate focus of restricted diffusion in the right peritrigonal white matter with corresponding high T2 signal. There are subcentimeter defects in the pons and left cerebellar hemisphere. There is no midline shift. There is a tortuous and mildly ectatic vertebrobasilar system that impresses upon the pons.Brain MRA: There is no evidence of significant steno-occlusive lesions of the circle of Willis or aneurysms.Neck MRA: There is no definite evidence of significant steno-occlusive lesions, within the limits of patient motion artifact.

Output: 1. Punctate acute hemorrhage in the right thalamus superimposed upon a background of extensive chronic microhemorrhages, likely hypertensive in nature. 2. Acute punctate infarct in the right peritrigonal white matter superimposed upon a background of extensive chronic hypertensive encephalopathy or small vessel ischemic disease and chronic lacunar infarcts.3. No definite evidence of significant steno-occlusive lesions in the major head and neck arteries, although the neck images are degraded by patient motion artifact. A Doppler ultrasound may be useful for further evaluation if clinically warranted. 4. Vertebrobasilar dolichoectasia that impresses upon the pons.


Instruction: Generate impression based on findings.

Input: Suspected pancreatic mass seen on CT. EGD/US revealed an intramural lesion in ampulla, unclear if inflammatory or neoplastic. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity without focal lesions. There is redemonstration of a percutaneous cholecystostomy tube with tip in the contracted gallbladder. There has been interval decrease in pericholecystic inflammatory changes compared to the 11/4/2015 CT. There is trace intrahepatic biliary ductal dilatation appearing similar to prior. The common bile duct is prominent measuring up to 11 mm which remains dilated up until the ampulla appearing similar to prior.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement without focal lesions identified. There is once again mild fullness of the uncinate process. The pancreatic duct is tortuous and is mildly dilated in the pancreatic neck and body measuring up to 5 mm in diameter appearing similar to prior CT. There is no associated ductal wall thickening or enhancement. The pancreatic duct abruptly and smoothly narrows in the region of the pancreatic head for length of approximately 2 cm proximal to the ampulla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A mildly prominent periportal lymph node appears similar to prior. An IVC filter is present.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Interval improvement of pericholecystic inflammatory changes. Cholecystostomy tube remains in place. 2. Dilation of the common bile duct to the level of the ampulla measuring up to 11 mm appearing similar to prior and which may be related to patient's reported ampullary lesion.3. Mild dilation of the pancreatic duct up to 5 mm with smooth narrowing in the pancreatic head for 2 cm proximal to the ampulla. No discrete pancreatic mass identified, findings suggest a stricture. It is unclear whether or not this is related to patient's reported ampullary lesion. An alternative explanation for the prominent pancreatic duct could be a main duct IPMN, but this is considered less likely given that the pancreatic duct is only dilated up to 5 mm and there is a lack of additional associated findings to suggest IPMN such as ductal wall enhancement. Correlation with patient's ERCP/pathology findings recommended.


Instruction: Generate impression based on findings.

Input: Again noted are low-lying cerebellar tonsils which extend up to 7 mm below the level of the foramen magnum, although they retain a rounded contour. There is moderate crowding at the level of the foramen magnum. CSF flow imaging appears to have been only obtained during flexion and extension, without neutral positioning as reference. There is slight interval change in morphology of the CSF space caudal to the cerebellar tonsils upon the different positions, more diminutive in the extension position, although overall the tonsillar pathology appears similar.Upon extension, there is biphasic CSF flow along the ventral brainstem cervical cord, although slightly attenuated at the C1-C2 level. Dorsally, minimal biphasic flow is seen along the CSF space just caudal to the cerebellar tonsils, as well as along the dorsal cervical spinal canal with slight attenuation at the C3 level. On flexion, more conspicuous biphasic flow seen ventrally along the cervical spinal canal and to a lesser degree along the ventral brainstem. Dorsally, there is a similar pattern of biphasic CSF flow is described previously, although there is slight improved visualization of the flow including a small component which appears to be located along the fourth ventricular outflow.The cervical spine is in normal alignment, with slight straightening of the normal cervical lordosis. There is mild disc narrowing at C5-C6 and moderate disc narrowing at C6-C7. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.Minimal focal disc disease at C6-C7, with a shallow left paracentral disc protrusion flattening the left ventral cord, likely impinging on the left ventral C7 nerve root. There is no significant stenosis. Minimal disc bulges are present from C3-C4 through C5-C6.

Output: 1.Redemonstration of crowding at the level the foramen magnum with abnormal caudal extension of the cerebellar tonsils below this level although they remain rounded in morphology. Slight interval change in extent of CSF space caudal to the tonsils at this level upon change in patient positioning from flexion to neutral to extension, with slight decreased extent of the space on extension.2.CSF flow imaging not definitively obtained in the neutral position, although from extension to flexion, biphasic flow actually appears slightly improved both ventrally and dorsally.3.Minimal cervical spondylotic changes, most prominent at C6-C7. There is flattening of the left ventral cord at this level with probable impingement of the left ventral C7 nerve root.


Instruction: Generate impression based on findings.

Input: Reason: C3 lesion. Osteoblastoma, Osteosarcoma. Dr. Christoforidis performing the case History: Neck pain Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: 1.C3 vertebral bone biopsy under CT guidance. A total of five samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: 74-year-old female with newly diagnosed lung cancer and neurologic deficit. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is a 6 x 6 mm enhancing mass in the left parietal lobe (image 36 series 11) with minimal surrounding T2 signal abnormality. There is also a 3 mm enhancing right parietal lesion (image 66 series 11). No other abnormal parenchymal or meningeal enhancement. The ventricles are within normal limits in size and configuration. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There are few scattered tiny foci of susceptibility including the right frontal lobe as well as the left parietal lobe, which are compatible with chronic microhemorrhages. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is diffuse low T1 marrow signal which is nonspecific, but without focal destructive lesions.

Output: 1. A 6-mm enhancing left parietal and a 3-mm right parietal enhancing lesions are compatible with metastasis. No significant edema or mass effect.2. Chronic small vessel ischemic changes.3. Several foci of chronic microhemorrhage in a nonspecific distribution.


Instruction: Generate impression based on findings.

Input: 40 yo female. Progressive parenchymal abnormality involving the left paracentral lobule with associated right lower extremity seizure. fMRI requested for surgical planning. There is susceptibility artifact from the recent biopsy of the lesion involving the left paracentral lobule. There is also susceptibility effect related to the overlying skull and scalp postoperative changes.There is sensorimotor cortical activation as expected along the pre- and post-central gyri bilaterally for the hand and face.Lower extremity sensorimotor cortical activation also maps as expected to the paramedian paracentral lobules. This activation is of reduced intensity on the left relative to the right. Nevertheless, activity is seen on the left and maps to the posterior edge of the lesion. No definite cortical activation is seen specifically within the lesional tissue but this does not exclude functional capacity within the lesion. Cortical activation in the supplementary motor area was present bilaterally, even somewhat accentuated on the left side of the brain.

Output: Sensorimotor cortical activation maps as expected along the pre and postcentral gyri bilaterally.Sensorimotor cortical activation of the lower extremity is seen bilaterally though the intensity of this activation is markedly reduced on the left. This discrepancy may reflect the patient's right lower extremity clinical deficit, or it could be an artifact related to edema or lesion related neurovascular decoupling. Nevertheless, activity related to the right lower extremity maps along the posterior edge of the left paracentral lobule lesion. The presence of some functional capacity within the lesion is not excluded.


Instruction: Generate impression based on findings.

Input: Reason: evaluate menisci History: medial joint line pain, effusion, "popping" MENISCI: There is a complex tear of the posterior horn of the medial meniscus which extends to involve the body of the meniscus. There is slight medial extrusion of the body of the meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness articular cartilage defect along the lateral facet of the femoral trochlea, centrally, measuring approximately 12 mm in the craniocaudal dimension (image 15; series 4). There is a full-thickness articular cartilage fissure along the medial facet of the femoral trochlea. There is a partial-thickness articular cartilage defect along the lateral facet of the patella. There is a full-thickness articular cartilage defect affecting the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus measuring approximately 2 cm in the AP dimension (image 28; series 4). There is increased bone marrow signal abnormality within the medial femoral condyle and medial tibial plateau which may be degenerative in etiology. Note is made of a subcentimeter focus of lobulated signal abnormality in the proximal fibula likely representing an enchondroma.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn and body of the medial meniscus.2. Full-thickness articular cartilage defects as described above.3. Joint effusion with large Baker's cyst with findings suggestive of a synovitis.


Instruction: Generate impression based on findings.

Input: Sagittal images of the thoracic spine demonstrate the thoracic spine to be in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There appears to be mild congenital narrowing of the thoracic spinal canal but otherwise no significant disk bulge, herniation, or high-grade spinal canal or foraminal stenosis within the thoracic spine is appreciated based on the sagittal images.

Output: Please note examination is limited to sagittal T1 and T2 sequences of the thoracic spine. There is mild congenital narrowing of the thoracic spinal canal. Examination of the thoracic spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Meningioma treated with SRS. There are postoperative findings related to suboccipital craniotomy with extensive left cerebral and to a lesser extent cerebellar vermian and right cerebellar hemisphere encephalomalacia. There is no significant interval change in the mildly enhancing tumor along the medial left tentorium, which extends and likely invades the confluence of the sinuses. The lesion measures approximately up to 20 mm, previously also 20 mm. There are mild scattered nonspecific foci of cerebral white matter T2 hyperintensity, which are likely related to chronic micrangiopathy. There is no evidence of acute infarct. There is diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes. The major cerebral artery flow voids are grossly intact. There is a left maxillary sinus retention cyst.

Output: 1. Stable post-operative findings without significant interval change in the residual meningioma along the medial left tentorium that extends and likely invades the confluence of the sinuses and measures up to 20 mm. 2. Diffuse cerebral volume loss, which is perhaps most pronounced in the bilateral medial temporal lobes, may represent Alzheimer disease.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with dizziness and history of petrous apex lesion. Reevaluate. The previously seen expansile enhancing lesion centered at the left basiocciput shows no significant interval change over the two prior examinations. No other osseous lesions are seen.Brain parenchymal morphology is unremarkable. No pathologic enhancement is seen. A few scattered foci of white matter T2 hyperintensity are not significantly changed. No evidence of edema or mass effect is detected. Ventricles are normal in size and morphology.The cervical carotid vessels show normal contrast opacification with no evidence of significant stenosis by NASCET criteria. Likewise, the vertebral vessels of the neck are free of significant stenosis or occlusion. No abnormal vascularity is seen in association with the left basiocciput lesion.

Output: 1.The expansile lesion at the left basiocciput shows no significant interval change.2.No significant vascular abnormalities are detected in the neck.


Instruction: Generate impression based on findings.

Input: 72-year-old male with prostate cancer, PSA 2.1, Gleason 6 on prior biopsy right and left apex. PELVIS:PROSTATE:Prostate Size: 5.4 x 3.5 x 5.2 cm.Peripheral Zone: Focus of T2 hypointensity with corresponding ADC map restriction measuring 6 x 5 mm in the paramedian mid gland peripheral zone abuts the capsule. This focus also represents mild early enhancement. Ill-defined T2 hypointensity in the left mid gland peripheral zone with corresponding focus of restriction on ADC map is nonspecific.Central Gland: Moderate degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension.BLADDER: Extension of benign prostatic hypertrophy and the base of the bladder.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focus of T2 hypointensity in the paramedian mid gland peripheral zone is suspicious for malignancy.2.Ill-defined T2 hypointensity in the left mid gland peripheral zone with corresponding focus of vague restriction on ADC map is nonspecific.


Instruction: Generate impression based on findings.

Input: 60 year old male with history of metastatic lung cancer, metastasis to bone, recent C2-C5 laminectomy, now with altered mental status. No evidence of acute ischemic or hemorrhagic lesion.There is no abnormal enhancement.There are multifocal scattered high signal intensities on bilateral periventricular white matter on FLAIR images indicating non specific small vessel ischemic disease.There are metallic artifacts on C2 level which corresponds the patient history of C2-C5 laminectomy.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.There are focal fluid collections on the left mastoid air cells.

Output: No acute ischemic or hemorrhagic lesion on this scan.No abnormal enhancement.Mild non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness. Evaluate for cord compression. There is developmental narrowing of the cervical spinal canal and superimposed mild degenerative changes including small disc osteophyte complexes at the C3-C4 to C6-C7 levels. There is mild or mild to moderate degree of spinal canal stenoses at these levels, relatively worse at the C3-C4 level. No higher grade spinal canal stenosis or evidence of acute cord compression. There are mild multilevel degenerative changes in the thoracic spine with disc height loss and disc bulges but without evidence of significant spinal canal stenosis.There is subcentimeter focus of T1 hypointensity and T2 hyperintensity involving the T5 vertebral body which is nonspecific.No obvious cord signal abnormality. Vertebral body heights and alignment are maintained. Please refer to separate report for findings in the lumbar spine.

Output: 1. This is a limited exam specific for the exclusion of cord compression only. No evidence of acute cord compression.2. Degenerative changes in the cervical spine as described above with mild or mild to moderate degree of spinal canal stenosis, relatively worse at the C3-C4 level. Dedicated cervical spine MRI can be considered for more detailed evaluation if clinically indicated.3. Dedicated lumbar spine study is reported separately.4. Subcentimeter lesion involving the T5 vertebral body, possibly an atypical hemangioma but nonspecific.


Instruction: Generate impression based on findings.

Input: Low back pain There is mild degenerative disc disease of the lumbar spine particularly at the L2-L3 and L4-L5 levels. There is mild to moderate facet osteoarthritis of the lower lumbar spine as well. There is grade 1 anterolisthesis of L4. The vertebral body heights are preserved.

Output: Degenerative disc disease and facet osteoarthritis of the lumbosacral spine.


Instruction: Generate impression based on findings.

Input: Increasing PSA. PELVIS:PROSTATE:Prostate Size: 4.5 x 6.4 x 5.9 cm.Peripheral Zone: The peripheral zone is mildly heterogeneous but predominantly T2 weighted hyperintense.In the left apex there is a mildly T2 hypointense 1.1 x 0.8 cm wedge-shaped focus (series 701/60) which is associated with mildly decreased ADC signal intensity (series 904/224). No associated abnormal arterial enhancement.In the right lateral apex there is a 6 mm linear focus of decreased ADC signal intensity (series 904/224) with associated T2 weighted signal hypointensity.Central Gland: Benign prostatic hyperplasia without a discrete suspicious lesion. In the right apex a well-defined nodule bulges the prostate margin, likely a BPH nodule.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular tumor extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Wedge-shaped region of decreased T2 weighted and ADC signal intensity in the left medial apex peripheral zone measuring 1.1 x 0.8 cm may represent a site of prostatic adenocarcinoma or focal prostatitis. Additional right apex peripheral zone punctate signal abnormality as described above.


Instruction: Generate impression based on findings.

Input: 42 year old with history of ALH, LCIS and dense breasts. Family history of breast cancer in her mother at age 54 and sister at age 50. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Multiple cysts are present in both breasts.An enhancing focus at posterior left upper outer quadrant is stable.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to occipital craniectomy and cranioplasty for resection of eosinophilic granuloma with no evidence of recurrent tumor. There is no abnormal enhancement, acute infarct, mass, or cerebral edema. There is a stable nonspecific and nonenhancing T2 hyperintense streaky focus in the right globus pallidus measuring up to 15 mm. The ventricles and basal cisterns are normal in size and configuration. The pituitary gland and the stalk are grossly unremarkable. There is no midline shift or herniation.

Output: 1.Unchanged postoperative findings with no recurrent tumor.2.Continued stability of nonenhancing T2 hyperintense focus in right globus pallidus.


Instruction: Generate impression based on findings.

Input: Left middle cerebral artery infarct. Assess stroke evolution.Additional clinical history from the electronic medical record: Past medical history of hypertension and daily heroin use, who initially presented to ED with 1 week history of vaginal bleed. Evaluated by Gynecology, had exploratory laparotomy with radical hysterectomy due to concern of invasive cervical carcinoma. Procedure Lasted ~6-7 hours with an estimated blood loss of 800 mL but no reported hypotensive event during surgery. Patient was neurologically intact before procedure. After extubation, the patient was noticed to be persistently lethargic, mute and not moving her right side. A stroke code was activated. Initial neurological evaluation remarkable for right side paralysis (0/5), mute patient with left gaze deviation and not blinking to threat on right side. BRAIN MRI:The left middle cerebral artery territory infarct is now more extensive compared to the previous MRI with more anterior left frontal extension, now involving the left frontal operculum, and more posterior-inferior extension into the left temporal lobe. There is also new diffusion restriction along the posterior left insular cortex. There is a gyriform susceptibility are present within these areas of infarct representing petechial hemorrhage. Though these infarcts are increased/new on diffusion-weighted imaging and T1/T2 sequences, retrospectively there was very subtle hypointensity on the ADC maps of the baseline examination. Also, they are associated with edema and increased T2 signal, which are findings that typically take few days to develop (subacute). The component of the infarct along the left central sulcus and in the left parietal lobe shows expected evolution with gyriform susceptibility effect and intrinsic T1 hyperintensity reflecting blood products. Also, the infarction in the head of the left caudate nucleus is evolved. Post contrast images show expected gyriform contrast enhancement compatible with subacute infarct. Of note, the peripheral margins of the current left MCA territory infarct are suggested of watershed etiology. The infarcts are associated with mild mass-effect especially on the left lateral ventricle but no significant midline shift and no brain herniation. There is no new diffusion restriction outside the left middle cerebral artery territory. Punctate foci of susceptibility effect in the central pons and the anterior left subinsular region remain unchanged without associated edema. T2/FLAIR hyperintensity centrally within the pons is unchanged and probably represent chronic microvascular ischemia. Similarly, the other foci of deep and periventricular white-matter T2 FLAIR hyperintensity, especially parietal, are unchanged and probably represent chronic microvessel ischemia. There is incidental right cerebellar developmental venous anomaly.There is no destructive skull lesion. There is no gross orbital abnormality.Dynamic, susceptibility-weighted, contrast-enhanced MR perfusion was also performed but is limited by motion. The color coded maps show expected increased MTT correlating with area of infarcts, more pronounced in the previously recognized areas of infarct, and less so in the newly seen areas, with corresponding decreased CBV and CBF. CBF appears slightly increased in the non-infarcted posterior frontal and parietal lobes as well as the anterior left temporal lobe in the left MCA territory.HEAD MRA:The short segment lack of flow-related signal involving the region of the left middle cerebral artery has not changed. There is attenuated flow-related signal in the distal left middle cerebral artery and its major branches, also without significant change. The right anterior cerebral artery continues to be smaller than the left though without focal stenosis, which is likely developmental. Otherwise, there is no significant intracranial stenosis. Of note, the ACOM and PCOM's are not well visualized.

Output: 1.The left middle cerebral artery infarct is more extensive now when compared to baseline but is already showing signs suggestive of being subacute on today's examination. Areas of gyriform blood products are present within the infarct which is also associated with mild mass-effect but no brain herniation.2.Unchanged short segment of near occlusion involving the proximal left middle cerebral artery with attenuated downstream flow. No other significant intracranial focal arterial stenosis.3.Perfusion imaging suggests relative mild increased CBF in areas of currently noninfarcted left MCA territory, as to be expected.


Instruction: Generate impression based on findings.

Input: Clinical question: Sciatica. Signs and symptoms: Sciatica. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.There is marrow signal changes of vertebral column secondary to degenerative disease and unremarkable signal intensity of vertebral column otherwise.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild disc desiccation and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. A shallow left paramedian disc protrusion results in subtle mass effect on the left L4 nerve root in the left lateral recess. Mild central spinal stenosis and no neural foraminal compromise.L4-L5 demonstrate moderate disc disease and loss of disc height, mild facet hypertrophic changes without evidence of central spinal stenosis. There is a left paramedian and left lateral disc-osteophyte complex present with resultant left lateral recess compromise however without detectable mass effect on the nerve roots. There is evidence of a prior left-sided laminectomy at this level. Mild left neural foraminal compromise and patent right.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy changes. There is a central and right lateral shallow broad-based disc protrusion which results in subtle indentation of the thecal sac. No central spinal stenosis. Unremarkable perispinal soft tissues.

Output: 1.At L3-L4 there is a shallow left-sided broad-based disc protrusion resulting in mild left lateral recess compromise and mass effect on the left L4 nerve root. Mild central spinal stenosis and no neural foraminal compromise.2.At L4-L5 there is evidence of a left-sided laminectomy, no central spinal stenosis. Left-sided disc/osteophyte complex is noted.3.At L5-S1 there is a shallow right paramedian disc protrusion with subtle indentation of thecal sac without spinal stenosis.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of bronchus and lung, unspecified site [162.9], Reason for Study: ^Reason: Evaluate for abnormality; Hx. SCLC History: None There is about 10.5 mm sized ring-enhancing lesion on the right frontal lobe with significant surrounding edema indicating metastatic nodule.No other enhancing lesion is found.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Right maxillary sinus opacification.

Output: About 10 mm sized metastatic nodule on the right frontal lobe with significant surrounding edema consistent with metastatic lesion.


Instruction: Generate impression based on findings.

Input: MRI Brain:Full evaluation is limited by extensive motion degradation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. There is moderate global volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact.Similar to the recent prior head CT, there is near complete opacification of the right maxillary sinus with opacities involving the right greater than left ethmoid air cells and small amount of fluid in the bilateral sphenoid sinuses. T2 hyperintensity and mild swelling seen in the subcutaneous fat of the right posterior neck, may represent dependent edema or related to recent trauma. A left parietal scalp fat intensity lesion likely represents a lipoma. An old burr hole is seen along the left parietal bone.MRA Brain: Full evaluation is limited by extensive motion degradation. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The anterior communicating artery is not definitely visible. The majority of the basilar artery is not visualized extending cranially from the vertebrobasilar junction, measuring approximately 1 cm in length. The bilateral PCAs are visualized and supplied by posterior communicating arteries with small P1 segments bilaterally. The upper aspect of the short segment of visible basilar artery as well as the small bilateral SCAs likely have retrograde flow-related enhancement, from the anterior circulation. The AICAs are not definitely seen. The vertebral arteries are patent with no significant stenosis. The bilateral PICA arteries are visualized. No evidence of aneurysms.

Output: 1.Full evaluation is limited by extensive motion degradation. No evidence of acute infarct. 2.Mild chronic likely small vessel ischemic disease and moderate diffuse cerebral atrophy.3.The majority of the basilar artery is not visualized, with likely retrograde filling of the distal portion. This is favored to be chronically occluded, less likely developmental. The AICAs are not definitely visualized.4.Diffuse paranasal sinus findings. Please correlate clinically for possible acute sinusitis.


Instruction: Generate impression based on findings.

Input: A 27 year old male with an antero-lateral ST elevation myocardial infarction on 1/2015 with PCI to proximal left anterior descendent artery, an echocardiography showed left ventricular ejection fraction of 35% (3/2015). Referred to stress cardiac MRI because of chest pain.MEDICATIONS: aspirin, atorvastatin, metoprolol, niacin, ramipril, ticagrelor. First Pass PerfusionDuring hyperemia, perfusion defects were present in the (1) basal anteroseptum, anterolateral, and inferolateral walls; (2) mid anteroseptum, anterior, and anterolateral walls; and (3) apical septum. The overall ischemia score is 5 and 19% of the myocardium is ischemic. Viability/ Myocardial ScarThere is a large transmural myocardial infarction involving the mid to apical anterior wall and the mid anterolateral wall. The remainder of the myocardium is free of myocardial infarction and is viable.Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 225 ml (normal range 142+/-34), the LV end systolic volume index is 68 ml/m2 (normal range 25+/-9), the LVESV is 131 ml (normal range 47+/-19), the LV mass index is 44 g/m2, and the LV mass is 85 g. There is hypokinesis of the mid to apical anterior wall and the mid anterolateral wall. There is no intracavitary thrombus is noted.Left AtriumThe left atrium is normal in size (89ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVEDV is 190 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large transmural myocardial infarction in the LAD territory which has a mild to moderate amount of residual peri-infarct ischemia.2. There is a small amount of mild ischemia in the usual territory of the left circumflex artery. This territory, however, was difficult to interpret due to the presence of a nearby imaging artifact. 3. The territories affected by the myocardial infarction described in the body of the report above are not viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable. 4. The left ventricle is mildly dilated with mildly reduced systolic function (LVEF 42%). There is hypokinesis and thinning of mid to apical anterior wall and the mid anterolateral wall. 5. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: h/o GBM currently on trial with MRI changes concerning for progression. Signs and Symptoms: preop planning for biopsy Pre- and post enhanced brain MRI:Examination is performed utilizing Stealth protocol and is not a true diagnostic exam.Examination redemonstrates a large infiltrative type enhancing tumor in the right anterior frontal lobe extending from vertex inferiorly to the corpus callosum and inseparable from the right lateral ventricle. There is no significant change since prior exam from 6-24-15 considering difference in current surgical planning study and prior diagnostic brain MRI.Similar in signal intensity and with similar pattern of enhancement there is an adjacent high convexity right frontal mass immediately posterior to the larger lesion is again noted. This finding on axial post enhanced image 158 of series 5 measures at 27 x 26 mm which is larger than prior study measurement of approximately 20 x 20 mm. There is extensive surrounding vasogenic edema with resultant effacement of adjacent cortical sulci, significant mass effect on the right lateral ventricle and leftward radiation of midline of approximately 11 mm with interval progression since prior study measurement of 8 mm.

Output: Large infiltrating necrotic loculated mass in the right anterior and mid frontal lobe with significant surrounding vasogenic edema and resultant 10 mm midline shift to the left as detailed.


Instruction: Generate impression based on findings.

Input: Acute on chronic left sciatica. There are disc bulges with associated annular fissures are L3-4 through L5-S1, with up to moderate spinal canal stenosis at L4-5 and bilateral facet hypertrophy with at least moderate neural foraminal stenosis at L5-S1 bilaterally. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at L3-4 through L5-S1, with up to moderate spinal canal stenosis at L4-5 and at least moderate neural foraminal stenosis at L5-S1 bilaterally.