Instruction: Generate impression based on findings.

Input: 73-year-old female. Evaluate for neoplasm and/or metastasis status post Whipple. ABDOMEN:LUNG BASES: No significant abnormality noted. Bilateral breast implants present.LIVER, BILIARY TRACT: There is a small amount of pneumobilia which is a normal finding status post Whipple. No focal hepatic lesions are identified. Patient status post cholecystectomy.SPLEEN: Multiple subcentimeter hypodense lesions within the spleen are nonspecific in appearance, but given the lack of lesions within the liver are more likely to represent benign lesions rather than metastatic disease. Calcified granuloma present in the spleen.PANCREAS: Patient is status post Whipple procedure. No mass is identified in the surgical bed. The remnant pancreatic duct is mildly dilated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesion in both kidneys likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is some infiltration of mesenteric fat anterior to the surgical bed. This likely represents postsurgical changes but attention should be paid to this area on subsequent examinations.BONES, SOFT TISSUES: Postsurgical change are identified in the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: An exophytic mass arising from the uterus likely represents a fibroid uterus. However, this is nonspecific by CT and could be further evaluated with gynecologic ultrasound or MRI as clinically indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine. A sclerotic focus is in the right iliac wing may represent a large bone island but is nonspecific. A smaller sclerotic focus in the left iliac wing adjacent to the SI joint is also nonspecific.OTHER: No significant abnormality noted

Output: 1. No definite evidence of metastatic disease. 2. Postsurgical changes from the Whipple procedure including some infiltrative changes near the resection site. This should be followed on subsequent exams.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 57-year-old male with elevated PSA and negative TRA. Negative biopsy x1. Evaluate for suspicious lesions. PELVIS:PROSTATE:Prostate Size: The prostate measures 5 cm in transverse, 3 cm in AP, and 4.4 cm in craniocaudal diameter.Peripheral Zone: There is nonspecific diffuse T2 hypointense signal intensity of the peripheral zone. In the left base/mid gland, there is a 5 x 8 mm focus of hypointensity ADC signal (axial series 809 image 304). At the same level on the right, there is a 4 mm additional focus of hypointense ADC signal. No abnormal early contrast enhancement. There are additional ill-defined areas of ADC hypointense signal at the apex (axial series 809 image 264).Central Gland: Heterogenous appearance of BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The background ill-defined diffuse T2 hypointense signal of the peripheral zone could represent diffuse prostatitis and limits evaluation for underlying lesions. Underlying malignancy cannot be excluded - two more focal areas as described above could be targeted for biopsy if indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: Is there evidence of occult bleed. Signs and symptoms: Headaches Nonenhanced CT of brain:Examination demonstrates a focal area of increased signal intensity in the right periventricular white matter of frontal lobe. This finding measures 6.2-mm x 8.9-mm on axial image 15. This finding was not reported on prior exam and likely represent a new finding. Differentials for this lesion includes a small area of hemorrhage or a hemorrhagic tumor. There is no evidence of any surrounding vasogenic edema but this finding. Follow-up with an MRI is recommended. This nonenhanced CT of brain is otherwise entirely within normal limits.

Output: 1.6.2 x 8.9-mm hemorrhage in the right periventricular white matter of frontal lobe with no surrounding edema as detailed above.2.Follow-up with an MRI is recommended.3.Negative nonenhanced CT brain otherwise.


Instruction: Generate impression based on findings.

Input: Male, 21 years old, with new right foot drop, numbness throughout the right and left legs at times. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of any concerning marrow signal alteration, edema or pathologic marrow enhancement is detected.The visualized lower spinal cord, conus and cauda equina demonstrate normal morphology. The conus tip terminates at the L1 level which is within normal limits. No pathologic intraspinal enhancement is seen. No abnormal epidural soft tissue or collections are seen.The intervertebral discs show normal signal intensity and normal height. Scattered small Schmorl's nodes are present. No evidence of any significant disc herniation is seen. No spinal canal or neuroforaminal narrowing is detected.

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


Instruction: Generate impression based on findings.

Input: Female, 40 years old. Right knee pain and locking since accident x 2 years ago An old MR coil was used due to body habitus, and the patient was having muscle spasms during the exam; therefore, the images are somewhat degraded.MENISCI: The medial and lateral menisci are normal, without evidence of tear.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the medial patellar facet and near complete cartilage loss on the lateral patellar facet, with associated underlying subchondral cysts and marrow reactive changes.LIGAMENTS: The cruciate and collateral ligaments are unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Near complete cartilage loss of the lateral patellar facet, with underlying marrow reactive changes and subchondral cysts.


Instruction: Generate impression based on findings.

Input: Clinical question:status post syncope. Signs and symptoms:status post syncopal episode. Unenhanced head CT: There is no evidence of any acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci and folia of cerebellum and vermis are more pronounced than is expected for patient's stated age of 57 and are concerning for underlying volume loss. Please correlate with history and patient's risk factors.These findings were observed on prior MRI examination from 2010.Calvarium is intact.Visualized mastoid air cells, paranasal sinuses are unremarkable with the exception of small osteoma in the left anterior ethmoid sinus.Images through the orbits are unremarkable.

Output: No evidence of acute intracranial findings.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease presents with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. No focal lesion biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.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: Demonstrated again is abnormal T2 weighted hypointense mild circumferential wall thickening of approximately 13 cm of the terminal ileum which is mildly narrowed throughout the exam with associated mild early arterial enhancement and restricted diffusion. There is minimal upstream dilatation.No significant peri-enteric inflammatory changes.The remainder of the small bowel is relatively well distended with oral contrast with a normal small bowel fold pattern and caliber without evidence of active inflammation or flow limiting stricture.No free fluid or loculated fluid collection.No evidence of a sinus tract/fistula formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Tampon noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No free fluid or loculated fluid collection in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Predominantly chronic appearing inflammation of approximately 13 cm of the terminal ileum with mild superimposed active inflammation, appearing slightly improved from prior. Mild upstream dilatation but no significant flow-limiting stricture or sinus/fistulous disease.


Instruction: Generate impression based on findings.

Input: Reason: Soft tissue mass that is very painful and enlarging in plantar foot. characterize. There is no abnormal soft tissue mass identified. There is no abnormal enhancement. Bone marrow signal is within normal limits. There are no significant degenerative changes in the forefoot or midfoot. There is no soft tissue fluid collection or bursitis. There is trace fluid at the first MTP joint, likely within normal limits. The extensor and flexor tendons are intact without evidence of tenosynovitis. The intramuscular signal is normal.

Output: Normal examination of the left forefoot.


Instruction: Generate impression based on findings.

Input: 28-year-old male patient with history of testicular cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No suspicious hepatic lesions.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 retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: Preoperative planning MRI for a left occipital lobe lesion in a patient with history of breast cancer treated with radiation, surgery, chemotherapy in 2013 and AML treated with chemotherapy and stem cell transplant, referred after a recent episode of everything went white". There is a mass that measures up to 30 mm in the left occipital lobe with predominantly low T2 signal and what may represent peripheral enhancement. There is surrounding vasogenic edema. There is effacement of the occipital horn of the left lateal ventricle, but no midline shift or herniation. There are skin-based fiducial markers.

Output: Preoperative planning MRI for a left occipital lobe mass.


Instruction: Generate impression based on findings.

Input: Second and third finger pain and swelling, clinical diagnosis of gout There is a soft tissue mass surrounding the DIP joint of the index finger that is predominantly isointense to skeletal muscle on T1 sequences and heterogeneous but predominantly hyperintense on T2 sequences which demonstrates diffuse and slightly heterogeneous enhancement following gadolinium administration. The mass results in erosion of the base of the distal phalanx and head of the middle phalanx with adjacent marrow edema and enhancement of the medial bone. The flexor digitorum profundus appears to insert on the base of the distal phalanx. The terminal extensor tendon is thinned distally and is suspected to be partially torn although a portion of the tendon appears attached to the bone. At the level of the DIP joint, the extensor tendon is displaced dorsally by the mass. The collateral ligaments at this joint are difficult to discern and may be torn.A similar but slightly less extensive mass surrounds the PIP joint of the middle finger with erosion of the base of the middle phalanx and small erosions of the head of the proximal phalanx. This mass extends into the subcutaneous fat dorsal to the extensor apparatus. There is perhaps slight volar displacement of the flexor apparatus although the tendons appear intact. The central slip of the extensor tendon attaches to the base of the middle phalanx. We suspect the collateral ligaments are intact.There is a 2 mm enhancing nodule within the soft tissues adjacent to the flexor tendon apparatus of the fifth finger near the base of the proximal phalanx. There is mild synovitis of the first MCP joint which contains small erosions. Small foci of nonenhancing signal abnormality are identified within the heads of the third and fifth metacarpals which likely represent cysts. The remaining bones and soft tissues of the hand are unremarkable.

Output: Finger masses as described above with erosions of the DIP joint of the index finger and PIP joint of the middle finger. While it is impossible to completely exclude a superimposed infection, these findings are compatible with gout.


Instruction: Generate impression based on findings.

Input: Diagnosis: SciaticaClinical question: eval for spinal stenosisSigns and Symptoms: radicular 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 a levocurvature to the lumbar spine associated with rotatory scoliosis. There is a perineural cyst in the sacral spinal canal.At L5-S1 there is loss of disk space height, disk dessication, diffuse disk bulge, endplate reactive change and facet and ligamentum flavum hypertrophy (left more than right). There is effacement of the fat at the left lateral recess and encroachment of the left exiting nerve roots at this level.At L4-5 there is loss of disk space height, disk dessication, diffuse disk bulge, endplate reactive change and facet and ligamentum flavum hypertrophy (left more than right). There is effacement of the fat at the lateral recess bilaterally and moderate spinal stenosis at this level with some mild encroachment of the exiting nerve roots bilaterally at this level.At L3-4 there is no significant compromise to the spinal canal. There is loss of disk space height, disk dessication and diffuse disk bulge at this level associated with mild facet and ligamentum flavum hypertrophy. There is encroachment of the right exiting nerve roots at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and diffuse disk bulge at this level associated with mild facet and ligamentum flavum hypertrophy. At L1-2 there is no significant compromise to spinal canal. There is a small broad based left paramedian and left lateral disk protrusion at this level extending into the left neural foramen and encroaching the left exiting nerve roots.

Output: 1.Multilevel degenerative changes are present associated with moderate spinal stenosis at L4-5 and neural foramen encroachment of exiting nerve roots as detailed above.2.There is a rotatory scoliosis and levocurvature most likely related to degenerative changes.


Instruction: Generate impression based on findings.

Input: There is a stable ovoid area of FLAIR hyperintensity and mild T1 hypointensity in the left supramarginal subcortical white matter which appears unchanged from the study in 8/2014. No new areas of FLAIR signal abnormality are identified. Postcontrast images show no areas of abnormal enhancement. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are normal.

Output: 1.Stable single nonenhancing focus of FLAIR and T1 signal abnormality in the subcortical white matter.No new foci of disease.


Instruction: Generate impression based on findings.

Input: Reason: rectal abbess History: pain. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sigmoid diverticulosis. Mild wall thickening of the rectosigmoid and visualized descending colon, which may represent proctocolitis. OTHER: No abnormal fluid collection.

Output: Mild rectosigmoid and visualized descending colonic wall thickening may represent proctocolitis. No evidence of abscess.


Instruction: Generate impression based on findings.

Input: Low back and leg pain. There is what may represent rib hypoplasia at T12 versus accessory ribs at L1. There is transitional lumbosacral vertebral anatomy with partial sacralization of what corresponds to the L5 or L6 vertebra. There is slight anterolisthesis at L4 or L5 upon L5 or L6 associated with bilateral facet joint effusion and synovial cyst formation. There is also mild disc bulging and bilateral neural foraminal narrowing at this level. There is no significant degenerative disease in the rest of the lumbar spine. There are small sacral perineural cysts. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from dependent edema in the posterior lower back subcutaneous tissues.

Output: Transitional lumbosacral vertebral anatomy with partial sacralization of what corresponds to the L5 or L6 vertebra, depending upon the actual number or ribs, which can be confirmed via imaging of the entire thorax. There is mild anterolisthesis at L4 or L5 upon L5 or L6 associated with bilateral facet joint effusions and synovial cyst formation. There is also mild disc bulging and bilateral neural foraminal narrowing at this level.


Instruction: Generate impression based on findings.

Input: There is no evidence of mass or acute infarct. There are extensive supratentorial perivascular spaces and multiple patchy foci of T2 hyperintensity within the supratentorial white matter, most prominent within the periatrial white matter. There is a punctate focus of susceptibility effect within the right frontal subcortical white matter. There is mild global volume loss. 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.

Output: 1.No evidence of mass or acute infarct.2.Extensive supratentorial perivascular spaces in an "etat crible" pattern with a subset of areas with associated white matter signal abnormality that may be related to the gliosis along the spaces or represent superimposed chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 43-year-old female status post left mastectomy for invasive lobular carcinoma in May 2011 with axillary node metastases, followed by chemotherapy and radiation therapy. Family history of breast cancer in her paternal grandmother and two paternal aunts. Mild parenchymal enhancement is noted bilaterally. The patient is status post left mastectomy.No abnormal enhancement is seen in either the right breast or left chest wall. Stable enhancing foci are again noted in the right breast. No abnormal axillary lymph nodes are identified in either axillary region. Post-surgical change is seen in the left axilla.

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


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:11/24/1954)Reason: MS or Cx disk History: R leg weak x 9 mo; bladder insensitive; new loss of vibration in LLEPROVIDER/ATTENDING NAME: ANTHONY T REDER ANTHONY T REDER MRI brain:There is redemonstration of periventricular and subcortical white matter lesions which are high signal on FLAIR and T2 MRI sequences and low signal on T1. Some are perpendicularly oriented to the lateral ventricles. These were also present on the previous exam and have not changed significantly.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are T2 hyperintense foci present throughout the cervical spinal cord. This includes the C2 level in the left posterior lateral and right lateral aspect, the C1 level posteriorly the C5 level posteriorly and to the right of midline, the C6 level at the left posterior lateral aspect and the C7 level on the right side.At C2-3 there is no significant compromise to the spinal canal. There is a left lateral recess disc protrusion at this level with some mild encroachment of left-sided exiting nerve rootsAt C3-4 there is no significant compromise to the spinal canal. There is a left lateral recess disc protrusion present associated with uncovertebral osteophyte which encroaches on the left-sided exiting nerve roots and left hemicord.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge and disc desiccation at this level.At C5-6 there is no significant compromise to the spinal canal . There are bilateral uncovertebral osteophytes more on the right than the left side associated with disc material and encroachment of the right-sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are endplate and uncovertebral osteophytes at this level with some narrowing of the neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions redemonstrated within the brain parenchyma which are compatible with patient's diagnosis of multiple sclerosis. There are unchanged prior exam.2.There are multiple lesions identified in the cervical spinal cord compatible with demyelination.3.There are multilevel degenerative changes present in the cervical spine with encroachment of the right-sided exiting nerve roots at C5-6 and left-sided exiting nerve roots and hemicord at C3-4


Instruction: Generate impression based on findings.

Input: Known right breast cancer with metastatic lymph node on neoadjuvant chemotherapy. A targeted right ultrasound was performed for the known malignancy and metastatic node. The right breast cancer now measures 2.1 x 1.9 x 1.8 cm. Previously, this measured 3.6 x 2.7 x 2.4 cm on the June MRI. The original outside sonographic measurement was up to 2.9 cm. The known metastatic right axillary lymph node is well seen with clip artifact. This measures 2.1 x 1.3 x 2.1 cm. Previously, on MRI from June this measured up to 2.5 x 2.5 x 2.2 cm. The original outside ultrasound measurement of the node was up to 2.7 cm.

Output: Some interval decrease in ultrasound measurements compared to the June MRI and prior outside ultrasound. A current MRI might provide more accurate comparisons for interval change if that is clinically needed.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Chronic low back pain radiating to left buttock. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of lumbar disc herniation.


Instruction: Generate impression based on findings.

Input: 76 year old female. Right occipital intracranial hematoma from cavernous hemangioma. Large right posterior parietal hematoma is again identified. In comparison with the prior exam no definitive evidence of interval change is detected. In particular no evidence of new hemorrhage is present. Surrounding vasogenic edema is again identified. There is evidence of mass effect on the adjacent cortical sulci. MRI examination of patient from 3 -- 22 -- 2007 is also reviewed. No evidence of cavernous hemangioma on the MRI was detected. This examination was performed prior to patient's hemorrhage and demonstrated only small vessel disease.

Output: Stable right posterior parietal hematoma since prior study. No new findings.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, abnormal finding at the obex on a recent prior cervical spine MRI, further evaluation is requested. A 4 mm mildly T1 and T2 hyperintense nodule is evident within the medulla at the level of the obex. The lesion does not appear to follow CSF signal characteristics, and there is no correlating susceptibility artifact to suggest blood product. Furthermore it does not cause any significant structural deformation of the medulla.Elsewhere, scattered small periventricular T2 hyperintense lesions are seen, a nonspecific finding. No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or abnormal extra-axial collection is detected. The ventricular system is normal in size and morphology. No Chiari malformation is seen.

Output: A 4 mm nodule is evident at the level of the obex within the medulla correlating to the abnormal finding on a recent prior cervical spine MRI. Based on the signal characteristics, this lesion may be solid or cystic containing proteinaceous but not necessarily hemorrhagic contents. The differential diagnosis would include a developmental cystic lesion such as a neuroglial cyst, ependymal cyst, or dermoid/epidermoid. Although less likely, a low grade neoplasm such as a subependymoma could be considered. A follow-up examination in 6-12 months is suggested.


Instruction: Generate impression based on findings.

Input: Relapsed mul multiple myeloma, status post fall. Evaluate for fracture or mass. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is minimal L5-S1 retrolisthesis, alignment is otherwise maintained. Small osseous lesions are again seen such as at the dorsal L3 vertebral body compatible with known myeloma. L2 lesion with T1 hyperintensity most compatible with a benign hemangioma. No large lesions or compression fractures.There is extensive enhancing epidural tissue surrounding the lower thoracic cord extending superiorly outside the field-of-view and extending inferiorly to the upper L3 level. The more bulky component is at L1 and L2 levels. There is partial encasement of the lower thoracic cord, conus, as well as the cauda equina with mass-effect and leftward displacement. There is mild T2 hyperintensity within the visualized conus with swelling. There is soft tissue within the right T12-L1, L1-L2, and L2-L3 neural foramina. There is right paraspinous mass which is in contiguity with the epidural and right neural foramina tumor. The mass extends along the enlarged right psoas muscle inferiorly. There is T2 hyperintensity/edema involving the inferior aspect of the right psoas muscle which may be reactive.Degenerative changes are also seen in the lumbar spine with disk desiccation at L5-S1. There is moderate right and mild left L4-L5 neural foramina stenosis and mild to moderate right and mild left L5-S1 neural foramina stenosis related to disk bulge and facet arthropathy. No spinal canal stenosis is seen inferior to the mid L3 level.

Output: 1. Small osseous lesions in the spine and pelvis consistent with known multiple myeloma. No large lesions or compression fractures. Burden of osseous lesions can be correlated with prior PET studies. 2. Extensive epidural enhancing soft tissue with mass effect on the conus and upper cauda equina nerve roots extending inferiorly to the mid L3-level is most consistent with neoplasm. Please refer to separate thoracic spine MRI report for superior extent of tumor. Tumor extends to involve the right T12-L1, L1-L2, and L2-L3 neural foramina. There is also a right paraspinous mass which is in contiguity with the epidural and right neural foramina tumor. The mass extends along the enlarged right psoas muscle inferiorly with superimposed hemorrhagic psoas component not excluded.3. Edematous appearance of the conus with T2 hyperintensity. 4. Please refer to separate reports for findings in the pelvis as well as cervicothoracic spine. Findings of most likely epidural tumor at the thoracolumbar junction were discussed with Dr. Ramos (Neurosurgery) at 10 am on 1/22/2015.


Instruction: Generate impression based on findings.

Input: Known cavernomas: seizures, recently diagnosed lesions on outside imaging. There are subcentimeter lesions with susceptibility effect in the left basal ganglia, right anterior temporal lobe, right precentral gyrus, posterior right medulla, left superior cerebellar hemisphere, and at the junction of the left pons and midbrain. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple supratentorial and infratentorial subcentimeter lesions are compatible with cavernous malformations. No evidence of associated acute intracranial hemorrhage or developmental venous anomalies.


Instruction: Generate impression based on findings.

Input: 17 year old male with recent diagnosis of myopericarditis referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVEDV is 144 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 53 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 96 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a significant amount of epicardial late gadolinium enhancement along the basal and apical inferior and inferolateral walls which is atypical for myocardial infarction and rather suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is commonly described in myocarditis. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 167 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion. There is no significant pericardial thickening or inflammation noted.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with normal systolic function (EF 63%). 2. There is a significant amount epicardial late gadolinium enhancement in the basal and apical inferior and inferolateral wall which is atypical for previous myocardial infarction and suggests underlying infiltrative, inflammatory or fibrotic disease. The pattern is highly consistent with the diagnosis of myocarditis. 3. Normal size right ventricle with normal systolic function (EF 58%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:7/7/1946)Reason: grade II astrocytoma on TMZ. History: grade 2 astrocytoma.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is a mass involving right basal ganglia, thalamus, insular cortex and adjacent right frontal lobe which extends to involve gray and white matter of the insular cortex and right orbital gyrus and right inferior frontal gyrus as well as the anterior aspect of the right temporal lobe. It does not display any contrast enhancement. On the current exam there is new T2 signal hyperintensity which extends further superiorly into the right frontal lobe white matter. This is a new T2 signal hyperintensity is higher signal than the rest of the lesion. There is an associated cystic component measuring 12 x 17 mm in size within this tumor which on the March exam measured 8 x 6 mm axial dimensions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and mucosal thickening elsewhere in the paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a mass involving right frontal lobe, anterior temporal lobe, insular cortex, right thalamus and basal ganglia. Since the prior exam a new area of T2 signal hyperintensity has developed in the right frontal lobe subcortical white matter adjacent and superior to the previously seen lesion. It is possible this represents vasogenic edema with or without tumor infiltration. There is also a new cystic component within the tumor which has enlarged compared to the previous exam.


Instruction: Generate impression based on findings.

Input: Male 62 years old with cirrhosis and HCC s/p TACE/RFA. Assess for liver lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There is mild diffuse loss of signal on in phase imaging compared to out of phase, not significantly changed and suggestive of iron deposition. No biliary ductal dilatation.Wedged shaped T2 hyperintensity within segment 6 and segment 8 are likely due to posttreatment change. Again seen are persistent hemorrhagic/proteinaceous products within the segment 6 of ablation cavity which measures 3.6 x 2.7 cm (series 901, image 238). The segment 8 ablation cavity measures 1.8 x 1.4 cm (series 901, image 359). There is ill-defined pericavity enhancement adjacent to both ablation cavities without nodularity or washout compatible with treatment related perfusional changes.No new suspicious arterially enhancing hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts including a right lower pole renal cysts containing layering blood/proteinaceous material.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.Stable post ablation changes in hepatic segment 6 and segment 8 without evidence of recurrent or residual disease.2.Cirrhotic liver with no new suspicious lesion.


Instruction: Generate impression based on findings.

Input: New onset seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, including the internal capsules. There is no abnormal intracranial enhancement. The lateral ventricles are mildly asymmetric, left larger than right. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There are degenerative changes involving the right temporomandibular joint. There is mild swelling in the left frontal scalp.

Output: 1. No evidence of seizure foci.2. Small left frontal scalp contusion.


Instruction: Generate impression based on findings.

Input: Male 18 years old with abdominal pain and bloating since age 10, family history of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology and is without enhancing lesion. There is a punctate right hepatic cyst. The hepatic vasculature is patent.The gallbladder is normally distended without cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances normally. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 7 mm left upper pole renal cyst. No suspicious renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average stool burden. No evidence of acute or chronic small or large bowel inflammation. No strictures, sinus tracts or fistulae are identified. There is no intra-abdominal abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of acute or chronic small or large bowel inflammation to suggest inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Severe right hand pain/numbness. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis. However, there are multilevel tiny perineural cysts in the lower cervical and upper thoracic spine bilaterally. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No significant spinal canal or neural foraminal stenosis.2. Multilevel tiny perineural cysts in the lower cervical and upper thoracic spine bilaterally. 3. No evidence of cervical spinal cord demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Ms. Smoke is a 35 year old female with a personal history of left breast lumpectomy in 03/2015 for IDC treated with radiation, chemotherapy and hormonal therapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There is diffusely increased parenchymal enhancement seen throughout the left breast, which is asymmetric when compared to the contralateral breast. However, there is no discrete enhancing focus/mass within the left breast which is more suspicious than the rest. Expected postsurgical distortion is seen in the left superior breast, compatible with history of recent lumpectomy.There is no abnormal enhancement seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Diffusely increased parenchymal enhancement in left breast, likely related to post-therapy changes. However, a short-term six-month follow-up MRI is recommended in order to confirm stability/resolution of these findings.(2) No MRI evidence for malignancy in the right breast. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Abscess. Evaluate for "osteo" There is a lobulated collection of fluid signal intensity within the soft tissues medial to the medial malleolus. The collection is approximately 4.5 x 2 cm in transverse dimension and approximately 4.5 cm in craniocaudal dimension. Superficially, the collection lies just beneath the skin surface. Its deep margin lies against the medial malleolus and medial aspect of the distal tibial metaphysis. There appears to be mild periosteal reaction along the distal tibial metaphysis. There is mild increased signal intensity within the underlying medullary bone on the fat-suppressed T2-weighted images, but I suspect that this is reactive osteitis, as lack of signal abnormality on the T1-weighted images argues against medullary infection. Anteriorly, the collection approaches the medial aspect of the tibialis anterior tendon, but appears to lie superficial to the retinaculum. Posteriorly the collection approaches the tibialis posterior tendon.There is reticulation of the subcutaneous fat of the ankle indicating edema. This extends along the dorsum of the foot where it becomes confluent. Signal intensity of the tendons is within normal limits. Small amounts of fluid in the sheaths of the medial and lateral tendons are within normal limits. There are small amounts of fluid within the tibiotalar and subtalar joints, within normal limits. The lateral collateral ligament complex appears normal. The distal tibiofibular syndesmotic complex appears normal. Loss of normal fatty striations within the deep portion of the deltoid ligament may reflect prior sprain injury. There is edema-type signal within the head and neck of the talus which is nonspecific and may be arthritic in etiology or perhaps represent a stress reaction.

Output: Findings compatible with the medial soft tissue abscess, with probable underlying periosteal reaction along the distal tibia perhaps reflecting early cortical osteomyelitis. Although there is mild increased signal intensity within the underlying medullary bone on fat-suppressed T2-weighted images, I suspect that this is reactive osteitis, as the fatty signal intensity on T1-weighted images is preserved. Other findings as above.


Instruction: Generate impression based on findings.

Input: Female, 62 years old. Reason: r/o cord compression History: urinary incontinence The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.Mild degenerative changes affect the cervical spine including disc osteophyte complex at C5-6.There is prominence of the epidural fat at the L5 level which appears to mildly to moderately narrow the spinal canal at this level.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. There is mild to moderate spinal canal stenosis suspected at the L5 level related to prominence of the ventral epidural fat.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedure, the patient was instructed to take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained.  Dynatrim was used to localize the right apex peripheral zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the right side of the prostate. Upon confirmation of the tip of the needle close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: Successful core-biopsies of the right apical peripheral zone.


Instruction: Generate impression based on findings.

Input: Aphasia. Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There is moderate patchy cerebral white matter T2 hyperintensity. There is a subcentimeter lesion within the right internal auditory canal. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, which may represent a chronic microhemorrhage. There is diffuse prominence of the sulci and ventricles due to cerebral volume loss. There is cavum septum pellucidum and vergae, which represents an anatomic variant. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions or retention cyst formation in the right maxillary sinus. Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is a two vessel aortic arch, in which the left common carotid artery arises from the brachiocephalic trunk, which is an anatomic variant. The ascending aorta appears to be enlarged, measures at least 4.5 cm in width. There is no evidence of significant steno-occlusive lesions in the neck.

Output: 1. Probable chronic small vessel ischemic disease and diffuse cerebral volume loss, but no evidence of acute intracranial hemorrhage or acute infarct.2. An incompletely characterized subcentimeter right internal auditory canal lesion may represent a schwannoma.3. No evidence of significant steno-occlusive arterial lesions in the head or neck.4. The ascending aorta appears to be enlarged, measures at least 4.5 cm in width.


Instruction: Generate impression based on findings.

Input: Radiculopathy, lumbar region [M54.16], For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L1-L2: Disc desiccation. Bilateral ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation with bilateral ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation. Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal canal stenosis at this level. L4-L5: Disc desiccation. There is grade 1 anterolisthesis of L4 on L5. There is a pseudo bulging of disc of L4-5 with bilateral ligamentum flavum thickening and sclerotic changes of bilateral facet joints results mild spinal canal stenosis. L5-S1: Disc desiccation. There is grade 1 anterolisthesis of L5 on S1. Sclerotic changes of bilateral facet joints with minimal thickening of ligamentum flavum thickening are seen. No definitive evidence of spinal stenosis.

Output: 1. Degenerative spondylosis of lumbar spine.2. Grade 1 spondylolisthesis of L4 on L5 and L5 on S1.3. Mild to moderate spinal canal stenosis at the level of L3-4.


Instruction: Generate impression based on findings.

Input: History of biliary cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with geographic areas of T2 hypointensity and heterogeneous enhancement, appearing similar to the prior study.Multifocal irregular intra and extrahepatic biliary ductal dilatation compatible with history of PSC. The right and left intrahepatic ducts are again poorly seen proximal to Klatskin's point, unchanged. The common bile duct remains attenuated proximally and distally near the ampulla. No new dominant stricture or worsening ductal dilatation.Normal distended gallbladder.SPLEEN: Splenomegaly, measuring 17.5 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific mild periportal lymphadenopathy which is nonspecific in the setting of primary sclerosing colitis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with primary sclerosing cholangitis without significant interval change or focal mass evident. 2.No acute abnormality identified.


Instruction: Generate impression based on findings.

Input: T2 versus T3 glottic carcinoma. Neck CT:There is a mass at the larynx, involving the left vocal cord, extending superiorly to the false cord with partial infiltration of the left paraglottic fat, and inferiorly to the subglottic region. There is thickening of the anterior commissure and the right true cord, suggesting extension across midline to the right. There is sclerosis of the left arytenoid cartilage, which may be involved. There is minimal soft tissue thickening overlying the left lamina of the thyroid cartilage, which is also thinner compared to the right. Very early extralaryngeal extension therefore cannot be excluded; this can be further evaluated with MRI.There is slightly prominent lymph node at left level 2, measuring approximate 10-mm in short axis. A 11-mm node is seen at level 5B. These nodes may be involved.There is a 6-mm cystic lesion at the left tonsil.There is a 9-mm lytic lesion in the left scapular glenoid. It is well marginated, and is likely benign.Degenerative disease of cervical spine is noted.

Output: 1. Left laryngeal mass, with supraglottic and subglottic involvement, and extension across midline to the right. There is suggestion of involvement of the left arytenoid cartilage and left thyroid cartilage, and very early extralaryngeal extension. These findings can be further confirmed with MRI.2. Well marginated lytic lesion at the left scapular glenoid, likely benign given its imaging appearance.3. Small left tonsillar cyst.4. Borderline adenopathy at the left level IIA, and level 5B.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecifiedClinical question: eval etiology of bleed/lesionSigns and Symptoms: confusion MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a 22 x 20 mm sagittal dimension and 15 x 20 mm coronal dimension mass centered at the anterior aspect of the third ventricle which has intermediate signal on T1 and low signal on T2 and associated susceptibility effect. There is adjacent T2 and FLAIR signal hyperintensity along the dependent surface of the third ventricle. Temporal horns of the lateral ventricles are mildly dilated. There is minimal incomplete peripheral enhancement associated with this. The optic chiasm and infundibulum are mildly displaced inferiorlyThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is approximately 70% stenosis of the proximal left middle cerebral artery at the mid M1 segment. There is extracranial origin of the right posterior inferior cerebellar artery. The right vertebral artery is smaller than the left vertebral artery. The left posterior communicating artery is medium-sized whereas the right is very small. Anterior communicating artery is small to medium sized

Output: 1.There is 70% stenosis present at the proximal left middle cerebral artery.2.There is a hemorrhagic lesion present at the anterior aspect of the third ventricle associated with a very mild enlargement of the lateral ventricles. The possibility that this represents a neoplasm cannot be excluded. Other considerations include a colloid cyst. 3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Multiple congenital anomalies (including encephalocele and macrocephaly). Status post encephalocele repair. BRAIN:There are changes of the recent occipital encephalocele resection. Blood products are present along the resection margin from the left occipital lobe and in the posterior body of the left lateral ventricle. There is also minimal similar signal intensity deep in the left occipital lobe, within or just inferior to the occipital horn of the left lateral ventricle, image #11 of series #401 and series #501. The right lateral ventricle continues to be almost entirely collapsed while the left lateral ventricle is mildly dilated. While the corpus callosum is absent posteriorly, the genu and anterior body of the corpus callosum appear to be present but thin. There is suggestion of malformation of cortical development, probably polymicrogyria, involving the remaining left occipital lobe. The sylvian fissures are not well formed, worse on the right. Nodularity that is isointense to gray matter along the margins of the left lateral ventricle probably represent subependymal heterotopia. Similar signal intensity in the deep right frontal white-matter which likely is also periventricular around the the collapsed right lateral ventricle is fel to be of the same etiology. The posterior pituitary bright spot is preserved.There is no evidence of peri-Rolandic/central deep white matter myelination. Myelination of the posterior limb of internal capsules is difficult to assess given the distortion caused by the large left occipital encephalocele and posterior fossa malformation, although there may be minimal linear T2 hypointensity in the posterior limb if the right internal capsule.The posterior fossa is crowded with the cerebellum wrapped around the brainstem, although this configuration may be related to the presence of previous occipital encephalocele. The tectum is beaked-shaped. The cerebellar tonsils are peg-shaped and extend below the level of foramen magnum though it is difficult to measure the degree of ectopia. The fourth ventricle is small. These findings are similar to the Chiari II malformation. Of note, the occipital encephaloceles typically associated with the rare Chiari III malformation contain cerebellum or other posterior fossa structure unlikely this patient.Secretions are present in the nasopharynx and oropharynx by the patient is intubated. There is no gross orbital abnormality.WHOLE SPINE:Alignment of the spine is anatomic. The spinal canal is preserved. There is mild expansion of the central canal within the cord which is most prominent in the cervical region at C5-C6 level down to C7-T1 level, where it less then 2 mm in diameter.The spinal cord shows normal signal otherwise. The tip of the conus medullaris is at L1-L2 level, which is normal. There is no open spinal dysraphism. Linear thickening of the posterior subcutaneous fat to the left of midline might be part of the Y shaped gluteal cleft described in the clinical note. Unfortunately, it is only included on the last axial image.6 mm T1-hypointense, T2-hyperintense subcarinal focus may reflect a small bronchogenic/foregut duplication cyst or fluid-filled pericardial recess. There is suggestion of asymmetric enlargement of the left first sacral segment ala.

Output: 1.Expected findings related to the recent occipital encephalocele resection.2.Other congenital brain abnormalities include Chiari type appearance of the posterior fossa, partial callosal agenesis with dilated left lateral ventricle containing blood products, and suspected left occipital polymicrogyria which can be further evaluated in the future with 3D T1 weighted images. There is bilateral subependymal heterotopia. For the posterior fossa malformation, although the morphology is similar to Chiari II or III malformations, there is no open spinal dysraphism and the occipital encephalocele did not contain posterior fossa structures to fit any of these 2 diagnoses, respectively. The configuration may more be due to distortion of the intracranial structures with respect to abnormal calvarial contour from the encephalocele.3.There is no open spinal dysraphism. Incompletely imaged linear hypointensity reversing the inferior lumbar posterior subcutaneous fat to the left of midline may represent a portion of the Y-shaped gluteal cleft described in the clinical note. 4.Mild but focal expansion of the lower cervical spinal canal is compatible with a syrinx. Otherwise, diffuse subtle prominence of the remainder of the central canal within the cord may reflect either transient dilatation or soft syrinx. Contrast-enhanced follow-up MR of the spine may be obtained.5.Other developmental abnormalities including delayed myelination and poor sylvian sulcal development.6.Subcentimeter subcarinal fluid signal may reflect a small bronchogenic/foregut duplication cyst or fluid-filled pericardial recess.


Instruction: Generate impression based on findings.

Input: Reason: S/p excision of left thigh atypical lipoma, evaluate for recurrence History: Above Markers were placed along the lateral aspect of the upper thigh. There is a band of low signal intensity again seen traversing the subcutaneous fat, indicating a surgical scar. Again seen is an elongated fusiform collection of fat within the vastus lateralis, along the mid thigh, which appears similar to that seen on the prior study. This may simply represent focal atrophy or postoperative changes. We see no discrete mass. There is mild edema type signal and minimal enhancement within the vastus lateralis muscle just proximal to this fat, which we suspect is postoperative in etiology, appearing similar to slightly less pronounced when compared the prior study. We see no specific findings to suggest tumor recurrence. The bone marrow signal intensity is normal.

Output: Surgical changes of atypical lipoma excision. We see no evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological cord enhancement. Fairly extensive edema and increased enhancement is seen within the left posterior paraspinal musculature at the cervicothoracic junction.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1.Nonspecific, nonenhancing upper thoracic cord signal abnormality slightly less prominent than prior exam. Differential considerations include inflammation, transverse myelitis, ischemia, or less likely pre-syrinx state.2.Cervical and lumbar paraspinous edema/myositis.3.Mild lumbar spine degenerative changes as described above including L5-S1 disc protrusion which abuts the right S1 nerve root and could produce radicular symptoms.4.Bilateral lower lobe atelectasis.Findings discussed by Dr. Ali with Dr. Reubeiz (neuro critical care fellow) at 5 p.m. on 8/28/2015.


Instruction: Generate impression based on findings.

Input: Ms. Cooney is a 56 year old female with a strong family history of breast cancer (mother and maternal aunt). Personal history of benign right breast biopsy in 2015 for benign duct wall. Personal history of bilateral breast lift 10 years ago. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable subcentimeter enhancing mass in the right nipple with associated biopsy marker clip, with prior benign pathology results. Extending posterior to this enhancing mass is a tortuous ectatically dilated duct with increased T1 signal, consistent with proteinaceous fluid. There is no new abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Medulloblastoma. Off treatment now. Status post resection, twice. Status post chemotherapy and radiation treatment. BRAIN: There are postoperative findings related to suboccipital craniotomy for resection of a cerebellar medulloblastoma. There is unchanged mild confluent T2 hyperintensity in the medial cerebellar hemispheres along the margins of the resection site, but no evidence of tumor. There are also unchanged scattered punctate foci of susceptibility effect in the cerebellar hemispheres and along a right occipital surgical tract. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is a focal left occipital scalp thickening and contrast enhancement with overlying subcutis fat stranding and skin tethering. Though these are new since the previous examination, they likely reflect scarring. Otherwise, the skull and extracranial soft tissues are unchanged. There is increased mucosal thickening in the maxillary and ethmoid sinuses, worse on the right. This is associated with bubbly secretions in the sphenoid sinuses. In the proper clinical setting, this may reflect acute sinusitis. There is no gross orbital abnormality. Mastoid air cells are clear.COMPLETE SPINE: The spinal cord and cauda equina nerve roots display normal signal characteristics. There is no evidence of abnormal enhancement within the spinal canal. The vertebral bone marrow displays diffuse T1 and T2 hyperintensity, compatible with radiation effects. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The marrow signal is more fatty than expected for age which reflects previous radiation treatment. Lungs show dependent changes. There is symmetric fullness of the pelvicalyceal systems and ureters but there is over distention of the urinary bladder.

Output: 1.No convincing evidence of tumor recurrence in the posterior fossa. 2.No evidence of drop metastases in the spinal canal.3.Increased mucosal thickening in the maxillary and ethmoid sinuses along with bubbly secretions in the sphenoid sinuses may reflect acute sinusitis in the proper clinical setting.4.Left occipital scalp soft tissue thickening may represent scarring.


Instruction: Generate impression based on findings.

Input: 66 year old with history of left breast pleomorphic and classic LCIS status post lumpectomy and on Aromasin. Also history of right mastectomy and reconstruction for breast cancer in 1992. There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.The patient is status post right mastectomy with stable appearance of the right reconstruction with implant. No abnormal enhancement is seen in either the left breast or right breast reconstruction. A small enhancing mass with benign kinetics in the left inner breast is stable on MRI and mammography. Post-operative change in the left outer breast are present, without suspicious enhancement. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. The patient's annual diagnostic mammogram is due in August 2015. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of uncertain behavior of bone and articular cartilageClinical question: Eval change to Cervical lesion for changeSigns and Symptoms: upper extremity numbness The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal. There is some left-sided facet hypertrophy present at this level associated with narrowing of the left neural foramen and mild to moderate encroachment of the left-sided exiting nerve roots. This is stable compared to the prior exam.At C3-4 there is no significant compromise to the spinal canal. There is loss of disc space height at this level associated with uncovertebral osteophytes and narrowing of the neural foramina bilaterally with mild to moderate encroachment of the exiting nerve roots bilaterally. This is stable compared to the prior exam. There are associated contrast enhancement within the right posterior lateral aspect of the C3 vertebral body which is unchanged since the previous exam and may represent some subacute inflammatory change related to DJD.At C4-5 there is no significant compromise to the spinal canal. There is a left paramedian disc protrusion present at this level which partially effaces spinal fluid ventral to the left hemicord. There are uncovertebral osteophytes present at this level associated with disc material especially in the left side where there is encroachment of the left-sided exiting nerve roots. This is stable compared to the prior exam.At C5-6 there is loss of disc space height, disc desiccation and endplate and uncovertebral osteophytes associated with disc material. There is posterior ligamentous hypertrophy at this level. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level resulting in a mild to moderate degree of spinal stenosis. There is bilateral neural foramen encroachment of exiting nerve roots at this level which is worse on the right than the left side. This is stable compared to the prior exam.At C6-7 there is some loss of disc space height, disc desiccation and endplate uncovertebral osteophytes. There is some posterior ligamentous hypertrophy at this level. There is effacement of the spinal fluid ventral and posterior the spinal cord at this level associated with some mild flattening of the spinal cord as well as cord signal change. There is encroachment of the neural foramina bilaterally at this level which is worse on the right side compared to the left . Overall there is a moderate degree of spinal stenosis at this level. This is stable compared to the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.At T1-T2 and T2-T3 there are uncovertebral osteophytes present bilaterally with narrowing of the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.There is a 15 x 12 mm axial dimension enhancing focus adjacent to the left C6-7 facet joint which has been stable since prior exams at the adjacent to posterior elements of C7 lamina there is some contrast enhancement present which was also present on prior exams. There is a PET scan from 3/18/15 which suggests that these are most likely inflammatory reaction.

Output: 1.There are multilevel degenerative changes present in the cervical spine which are worse at C6-7 where there is moderate spinal stenosis and cord signal change suggestive of a spondylitic myelopathy. There is a moderate degree of spinal stenosis present at C5-6 and multilevel encroachment of exiting nerve roots as detailed above. Overall there is no significant interval change when compared to the previous exam2.A ring-enhancing lesion at the C3 vertebral body and a lesion at the left posterolateral aspect of C7 are stable. Continued follow-up would help insure that these are not neoplastic.


Instruction: Generate impression based on findings.

Input: Hodgkin's lymphoma, with symptoms or right-sided bell's palsy. There is fluid within the right middle ear and mastoid air cells with extensive mucosal thickening. There is persistent diffuse enhancement of the bone marrow in the right lateral and central skull base, with mild overlying dural enhancement diffusely, including within the right internal auditory canal. Furthermore, there is ill-defined enhancing tumor in the right prevertebral and paravertebral spaces, with extension in the right jugular foramen, hypoglossal canal, foramen lacerum and perhaps into portions of the facial nerve canal. A small amount of tumor protrudes into the right cerebellomedullary angle cistern. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland 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 orbits are grossly unremarkable.

Output: Ill-defined right lateral skull base tumor with soft tissue components in the right prevertebral and paravertebral spaces, with extension in the right jugular foramen, hypoglossal canal, foramen lacerum and perhaps into portions of the facial nerve canal, as well as dural reaction, including within the right internal auditory canal. Persistent right tympanomastoid opacification, which may be related to Eustachian tube obstruction and/or otomastoiditis.


Instruction: Generate impression based on findings.

Input: Reason: staging exam, biopsy scheduled History: Prostate cancer treated with cyberknife in 2010, rising PSAFrom Epic: Gleason 4+3=7 treated with Cyberknife radiotherapy without ADT in May 2010. His PSA did nadir at approximately 2 ng/mL and has had consecutive rising PSA values since October 2015. The most recent PSA is 7.95 ng/mL on 4/14/2016. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.9 x 4.6 cmPeripheral Zone: T1 signal in the right mid peripheral zone associated with heterogeneous T2 signal likely represents hemorrhage. There is ill-defined hypointense T2/ADC signal in the mid to base peripheral zone, medial to the region of hemorrhage. No measurable lesion is identified.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Enhancement at the hamstring origins may reflect tendinosis. Enhancement within the sacrum adjacent to the right sacroiliac joint is likely degenerative.OTHER: No significant abnormality noted.

Output: 1.Limited exam due to therapy-related changes. There is ill-defined low T2/ADC signal in the central peripheral zone of the mid gland and base but no definite measurable lesion. However, given the pronounced therapy-related changes, cancer in this region cannot be excluded.


Instruction: Generate impression based on findings.

Input: History of spinal cord injury following a fall in 2012 resulting in cervical cord impingement requiring C3-C6 laminectomies and C3-C5 instrumented fusion. New upper extremity numbness post assault 2 weeks ago. There are postoperative findings related to previous C3-C6 laminectomies and C3-C5 instrumented fusion. There is reversal of the usual cervical lordosis. The vertebral column alignment is within normal limits otherwise. The vertebral body heights are preserved. There is mildly increased STIR signal within bone marrow of the C5, C6 and C7 vertebral bodies. This correlates with subtle hypointensity on T1 and may reflect edema. The vertebral bone marrow signal is otherwise less fatty than expected, which may reflect red marrow reconversion. The thecal sac is expanded at the laminectomy levels. However, C6-C7 and C7-T1 disc-osteophyte complexes cause slight spinal canal stenosis. There is no significant spinal canal narrowing otherwise. The focal T2 hyperintensity within the spinal cord centrally at the upper C4 level in unchanged. The remainder of the spinal cord displays normal signal and morphology.

Output: 1.No evidence of spinal cord compression. 2.Focal central T2 hyperintensity in the cervical spinal cord has not changed since 2012 and may represent myelomalacia. 3.Findings related to previous cervical spine laminectomies and instrument fusion, as described above, with mildly altered signal in the marrow of the corresponding vertebral bodies, which likely represents edema, and residual C6-C7 and C7-T1 disc-osteophyte complexes cause slight spinal canal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left arm, leg, eye twitching in setting of fever. There is a right choroid fissure cystic lesion that measures up to 15 mm, with compression of the hippocampus and mild surrounding T2 hyperintensity. There are small patchy areas of T2 hyperintensity in the bilateral periventricular regions, particularly in the parietal lobes, which may represent terminal zones of myelination. The ventricles are not enlarged. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with a right choroid fissure arachnoid cyst with compression of the hippocampus. Nevertheless, follow up via MRI with contrast may be useful for further characterization.


Instruction: Generate impression based on findings.

Input: 60-year-old male with alcoholic cirrhosis. Recent ultrasound showed possible pancreatic mass. Evaluate pancreas and liver. Pre and postcontrast T1 images are limited by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour with widened fissures. Moderate abdominal ascites.There are a few scattered subcentimeter T2 hyperintense, circumscribed, nonenhancing lesions consistent with simple cysts. No suspicious liver lesion.Distended gallbladder with no cholelithiasis. There is intrahepatic and extrahepatic biliary ductal dilatation. The common duct is diffusely dilated up to 14 mm and contains multiple filling defects and layering sludge.SPLEEN: The spleen measures 14 cm in length.PANCREAS: The pancreatic parenchyma enhances normally. There is no evidence of pancreatic mass or pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 3.1 cm T2 hyperintense, circumscribed, nonenhancing left upper pole renal lesion consistent with a cyst. There is a circumscribed, nonenhancing 1.9 cm T2 hypointense, mildly intrinsically T1 hyperintense lesion in the lower pole of left kidney. There are limitations in postcontrast imaging however this lesion does not appear to enhance and is favored to represent a proteinaceous/hemorrhagic cyst however follow-up with CT is recommended to ensure stability.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left and trace right pleural effusion.

Output: 1.Choledocholithiasis with moderate intra and extrahepatic biliary ductal dilatation.2.Cirrhotic liver morphology with moderate ascites.3.Left inferior renal lesion is favored to represent a proteinaceous/hemorrhagic cyst. However, given the limitations and postcontrast imaging, follow-up CT in 6 months is recommended to ensure stability.


Instruction: Generate impression based on findings.

Input: 63 year old female with metastatic breast carcinoma to liver, pleura, and bone, complaining of shortness of breath, compare to previous CHEST:LUNGS AND PLEURA: Stable pleural thickening and nodularity with contrast enhancement. No pulmonary nodules or masses can be identified.MEDIASTINUM AND HILA: Right paratracheal lymph node now measures 10 mm x 5 mm (image 31, series 4), previously, measuring 12 mm x 6 mm.Redemonstration of a hiatal hernia.Cardiac size is normal. No evidence of pericardial effusion.CHEST WALL: Bilateral breast implants. Partial collapse of the T6 vertebrae, without interval changeABDOMEN:LIVER, BILIARY TRACT: Stable well-defined cystic lesions. However, laterally in the right lobe of the liver. Ill-defined hypodense lesion most likely represents metastatic disease. This is better visualized than on the prior exam and may be related to phase of contrast enhancement.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Peripelvic cysts versus caliectasis on the left kidney is unchangedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lumbar metastatic disease noted on the recent MRI exam is not visualized on this CTOTHER: No significant abnormality noted

Output: Stable intrathoracic disease. Better delineated hepatic metastases may be related to phase of contrast enhancement. However, progression of metastatic disease cannot be excluded. Dedicated CT or MR imaging of the liver would be of value.


Instruction: Generate impression based on findings.

Input: Clinical question: History of prostate cancer. Failure lesion seen on outside imaging. Signs and symptoms: Vertigo. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates few punctate foci of flair hyperintensity primarily in the left frontal subcortical and periventricular white matter which are nonspecific and non-hemorrhagic and without evidence of enhancement. Possibility of mild chronic small vessel ischemic strokes should be considered in a patient of this age group. There is normal anatomical morphology and signal intensity of brain parenchyma otherwise and without detectable abnormal enhancement to suggest presence of a mass/metastatic lesion. There is however enhancement of a small high convexity right anterior parietal developmental venous anomaly.Examination demonstrate a punctate focus of T2 signal changes in the right complexity anterior parietal with significant well demarcated susceptibility signal pattern. The finding is highly suggestive of a tiny metallic fragment. Recommend follow up with head CT for further evaluation.Susceptibility MRI images in addition demonstrate multiple small varying sized foci of susceptibility consistent with multiple foci of microhemorrhages. None of the findings is detected on the flair or T2-weighted images and are not associated with any surrounding edema or mass effect.The signal void in the major intracranial arterial branches are identified.Calvarium demonstrate an irregularly shaped foci of T2 hyperintensity in high convexity left paramedian frontal bone with erosion of the inner table of the skull. The lesion demonstrates a very thin rim of enhancement. There is a second tiny similar type lesion immediately posterior to the larger lesion and measures at approximately 7.5 mm. The lesions do not have the typical signal pattern, morphology or pattern of enhancement of metastatic lesions.Follow up with a non-enhanced head CT may be helpful for further assessment. Unremarkable calvarium and soft tissues of the scalp otherwise.Unremarkable images through the orbits and including axial fat sat post enhanced series. Next all paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No diffusion weighted abnormalities.2.Findings suggestive of minimal chronic nonhemorrhagic small vessel ischemic strokes.3.Multiple foci of susceptibility in the supratentorial and infratentorial brain parenchyma which are not identified in any other MRI sequence and likely representing multiple chronic microhemorrhages.4.Small right parietal developmental venous anomaly as detailed.5.Left frontal calvarial lytic changes without solid enhancement are not typical for metastatic lesions. Recommend follow-up with CT exam for further assessment.6.A right high convexity punctate foci of metallic artifact in the right posterior frontal -- parietal region which can also be further evaluated with head CT.


Instruction: Generate impression based on findings.

Input: 31-year-old female. Right dorsal hand cellulitis failed PO antibiotics, evaluate for abscess. Again seen is edema within the dorsal soft tissues of the wrist and hand which enhances and extends into the fingers, compatible with cellulitis. There is also a nonenhancing collection of fluid signal intensity within the soft tissues dorsal to the third, fourth, and fifth metacarpals with perhaps a thin rim of enhancement. The collection surrounds the third and fourth extensor tendons although there does not appear to be fluid within the tendon sheaths themselves. Part of the collection lies deep to the third and fourth extensor tendons suggesting involvement of the subaponeurotic space. The fluid extends into the bases of the third, fourth, and fifth fingers dorsal to the extensor tendons. The overall size of this collection is approximately 1 cm in AP dimension, 5 cm in radioulnar dimension, and approximately 5 cm in longitudinal dimension. Edema and enhancing tissue extends into the palmar soft tissues along the head and neck of the fourth metacarpal. There may be mild synovitis of the fourth MCP joint. We see no fluid in the flexor tendon apparatus. We see no fluid collections or significant edema within the musculature of the hand. A small focus of signal abnormality in the third metacarpal head may represent a cyst, unchanged from prior study.

Output: Cellulitis with findings suggestive of a dorsal soft tissue abscess, as described above.


Instruction: Generate impression based on findings.

Input: 53 year old male with history of hypertension, diabetes admitted with acute decompensated heart failure and pericardial effusion now s/p pericardiocentesis. MEDICATIONS: atorvastatin, lisinopril, carvedilol, furosemide First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is linear mid myocardial gadolinium enhancement in the basal to apical inferior, inferolateral and lateral walls. This is atypical for myocardial infarction. In the setting of wall motion abnormality and pericardial effusion, this is suspicious for myocarditis. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 247 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 144 ml (normal range 47+/-19), the LV mass index is 64 g/m2, and the LV mass is 154 g. The left ventricular systolic dysfunction is global with regional variation, specifically with hypokinesis in the inferolateral, inferior and lateral walls. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mild-moderately reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 209 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 129 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion. There is no abnormal thickening in the pericardium is present. Extracardiac FindingsSmall bilateral pleural effusions. There is high signal in the left superior major fissure suggestive of loculated fluid with scarring.

Output: 1. Mid-myocardial enhancement in the basal to apical inferior, inferolateral and lateral walls, systolic dysfunction with small pericardial effusion suggestive of a myocarditis/perimyocarditis. 2. No perfusion defects/ "ischemia" present during hyperemia.3. Normal LV size with mildly reduced systolic function (LVEF 42%).4. Normal RV size with mild to moderately reduced systolic function (RVEF 39%).5 Biatrial enlargement.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke workup History: left sided weakness and numbness Brain MRIThere is no evidence of acute ischemic lesion.A small susceptibility lesion on the left thalamus is seen indicating chronic petechial hemorrhage or mineralization, unchanged since prior scan.Multifocal bihemispheric scattered T2/FLAIR high signal intensity lesions seen on bilateral periventricular white mater and centrum semiovale. These lesions are non specific, unchanged since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic and hemorrhagic lesion.2. Nonspecific white mater T2/FLAIR high signal intensity lesions, unchanged since prior scan.3. No evidence of arterial luminal stenosis on both intracranial and extracranial arterial system. No intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma, restaging. Post chemotherapy and transplantation. Redemonstration of right cerebral hemispheric posttreatment related lesion, and particular, postbiopsy encephalomalacic and hemosiderin deposition, no change since prior study.Multifocal patch and slightly asymmetric scattered nodular high signal intensity lesions on FLAIR imaging on bilateral periventricular white matter and centrum semiovale do not show any significant interval change since prior scan.Multifocal signal voids indicating susceptibility artifacts on gradient echo images on bilateral basal ganglia, do not show any interval change since prior scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Post treatment changes on the right cerebellar hemisphere, no change since prior scan.Periventricular and centrum semiovale white matter high signal intensities on FLAIR imaging do not show any significant interval change since prior scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Female 68 years old Reason: right adrenal adenoma History: adrenal adenoma ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions in the imaged portion of the liver.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic atrophy or mass is evident.ADRENAL GLANDS: The reference right adrenal gland nodule measures 2.0 x 1 .8 cm, previously 2.0 x 1.5 cm (image 138/series 10). The lesion loses signal on out of phase imaging, indicating microscopic fat/lipid, compatible with a lipid-rich adenoma. The left adrenal gland is normal in morphology.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in the reference 2.0-cm right adrenal lesion with imaging features compatible with benign lipid rich adrenal adenoma.


Instruction: Generate impression based on findings.

Input: Ms. Mansfield is a 65 year old woman with a strong family history of breast cancer (sister diagnosed at the age of 36, two maternal aunts, and maternal cousin diagnosed in her 40s). She has a personal history of benign left breast biopsy in 2003. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.There is susceptibility artifact from biopsy marker clip in the left upper outer breast, at site of prior benign breast biopsy.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Follow-up regarding Chiari malformation and syringomyelia, which were decompressed in September 2011, including a vascularized rotational muscle flap at the same procedure to obliterate the extradural dead space and chronic pseudomeningocele. The patient had had a previous resection of a giant spinal intradural and extradural schwannoma involving the C1-C2 area in 2008, and there had not been any hint of residual or recurrent tumor. There are chronic postoperative findings related to Chiari malformation surgery. There is an unchanged syrinx in the upper cervical spinal cord that measures 5 x 14 mm in axial cross-section. There is also an unchanged 1 mm linear band of T2 hyperintensity in the left hemicord that extends inferiorly from the syrinx to the level of C5. There is intact cerebrospinal fluid flow across the anterior neo-foramen magnum, but deficient flow posteriorly. There is an unchanged prominent extra-axial cerebrospinal fluid space that spans the posterior neo-foramen magnum associated with deformity of the adjacent upper spinal cord and medulla. There is no evidence of intraspinal mass lesions. The paraspinal and occipital scalp soft tissue are unchanged and there is no evidence of pseudomeningocele. The vertebral body heights and alignments are intact. There is an unchanged multilevel degenerative cervical spondylosis that is most pronounced at C3-4, where a posterior disc-osteophyte complex results in mild spinal canal narrowing and mild to moderate right neural foraminal narrowing.

Output: 1. Post-treatment findings related to Chiari malformation surgery with an unchanged upper cervical syrinx, adjacent left hemicord myelomalacia, and what appears to be encysted cerebrospinal fluid spanning the posterior neo-foramen magnum, perhaps due to adhesions.2. No evidence of recurrent cervical spine schwannoma.3. Unchanged multilevel degenerative cervical spondylosis that is most pronounced at C3-4, where a posterior disc-osteophyte complex results in mild spinal canal narrowing and mild to moderate right neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with encephalopathy. Follow-up for prior read of possible PRES. The previously seen focus of restricted diffusion within the right parietal white matter is still visible though it is less intense and less distinct. However, there is a new focus of diffusion hyperintense signal in the right frontal subcortical white matter. Curvilinear diffusion hyperintense signal along the margin of the left thalamus is of questionable validity.Fairly extensive confluent periventricular T2 hyperintensity without mass effect is again seen, appearing similar to the prior examination. Vague signal abnormality is also demonstrated in the brain stem and cerebellum, similar to prior. Again seen are scattered chronic lacunar infarcts within the basal ganglia and thalami bilaterally.Multiple scattered punctate foci of susceptibility effect are seen in the cerebral hemispheres, particularly in the basal ganglia and medial thalami, brainstem and cerebellum. Most or all of these are accounted for on the prior examination though they are better seen on the present study likely due to imaging at 3T. No evidence of acute intracranial hemorrhage is seen. No abnormal extra-axial fluid collections are detected.

Output: 1.A focus of acute ischemia seen previously in the right parietal lobe appears less distinct compatible with expected evolution.2.A new focus of acute ischemia is suspected within the right frontal subcortical white matter. Curvilinear diffusion hyperintense signal along the left thalamus is of questionable validity and could be artifactual.3.Extensive T2 hyperintense white matter lesions are again seen without significant interval change from the prior examination. No evidence of any significant associated edema or mass effect is seen which would argue against an ongoing acute process.4.Numerous scattered foci of microhemorrhage are also unchanged from the prior exam. No acute intracranial hemorrhage is seen.


Instruction: Generate impression based on findings.

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

Output: Normal brain MRI.