Instruction: Generate impression based on findings.

Input: Male, 65 years old, History of 4.4 ascending aortic aneurysm Normal al cardiac size without pericardial effusion. No gross lymphadenopathy.Vasculature: The proximal ascending thoracic aorta measures 4.1 x 3.6 cm.Additional Orthogonal (double oblique) Measurements:Sinus of Valsalva: 3.7 x 3.1 cm Sinotubular Junction: 3.4 x 3.1 cm Proximal aortic arch: 3.5 x 3.7 cm Distal transverse aortic arch: 3.4 x 3.2 cmMid descending thoracic aorta: 2.9 x 2.7 cmUPPER ABDOMEN: Left hepatic lobe well-circumscribed focus, likely a cyst.

Output: Mild ascending thoracic aortic dilatation of 4.1 cm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with a single brain metastasis, planning for stereotactic radiosurgery. A 7 mm enhancing nodule is redemonstrated within the right paracentral lobule showing no significant interval change. Minimal local edema is noted. No new intracranial enhancing lesions are seen. Evidence of multiple scattered white matter lesions is seen compatible with microvascular ischemic disease. No intracranial hemorrhage is detected.

Output: Redemonstration of a single 7 mm metastatic lesion in the right paracentral lobule.


Instruction: Generate impression based on findings.

Input: Ms. Denson is a 39-year-old female with a family history of breast cancer in her mother, maternal aunt, and maternal grandmother. Personal history of benign left breast MR biopsy. She presents today for a high-risk MRI-study 13073B. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Scattered T2 intense cysts are identified in both breasts. 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: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 58 old male with history of TIA a couple of years ago. Patient states frontal headaches for two months. Today the patient had dizziness since 3 a.m., "eclipse" over eyes and sees shadows, left-sided weakness. There is no evidence of intracranial hemorrhage, or mass. Evidence of small lacunar infarct of the left basal ganglia of indeterminate age, unchanged from prior.There is a questionable decreased attenuation in the right posterior parietal region of uncertain clinical significance. If clinically warrented MRI could be done for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1- Questionable decreased attenuation in the right posterior parietal region of uncertain clinical significance. If clinically warrented MRI could be done for further evaluation.2- Old small lacunar infarct are redemonstrated.


Instruction: Generate impression based on findings.

Input: Neck pain right worse than left with bilateral mild leg weakness and hyperreflexia. Evaluate for spondylosis with myelopathy. Examination is technically degraded due to patient motion. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has grossly normal signal characteristics and overall morphology within the limits of motion degradation.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Loss of disc height, small disc osteophyte complex, and ligamentum flavum thickening with minimal spinal canal narrowing. There is uncovertebral hypertrophy resulting in mild left neural foraminal stenosis. No significant right neural foraminal narrowing. C5-6: Loss of disc height, small disc osteophyte complex and ligamentum flavum thickening with minimal spinal canal narrowing. Minimal bilateral neural foraminal narrowing.C6-7: Loss of disc height and disc bulge similar to prior with minimal spinal canal narrowing. There is mild bilateral neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.There is also mild generalized facet arthropathy. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild multilevel degenerative changes in the cervical spine which are similar to prior study from 7/18/2011. There is no high-grade spinal canal stenosis at any level or cord signal abnormality to explain patient's myelopathy. Please see details above.


Instruction: Generate impression based on findings.

Input: 62 year old female with a history of multi-level cervical stenosis. There is loss of the normal cervical lordosis which is likely a combination of positioning and degenerative change. There is also degenerative grade 1 anterolisthesis of C4 upon C5 and grade 1 retrolisthesis of C5 upon C6. No acute malalignment is present. There is preservation of the vertebral body heights with no evidence of acute fracture. However, degenerative endplate changes are present at C3 through C7 resulting in some sclerosis and, at the inferior endplates of C3 and C4, Schmorl's nodes. Anterior osteophytes are noted at several cervical spine levels, most conspicuous at C5/C6 and C6/C7 with associated elevation of the prevertebral muscles. Multilevel degenerative disk disease is present. By level:C2/C3: Right paracentral disk protrusion with associated partial thecal sac effacement. There is mild right and moderate left sided facet arthropathy but no neural foraminal narrowing.C3/C4: There is moderate loss of intervertebral disk height. Note is made of a Schmorl's node indenting the inferior endplate of C3. There is a posterior disk osteophyte complex and mild ligamentum flavum hypertrophy associated with effacement of the dorsal and ventral thecal sac. Additionally, there is moderate bilateral facet arthropathy, moderate uncovertebral hypertrophy, and mild bilateral neuroforaminal stenosis. C4/C5: Grade 1 anterolisthesis of C4 on C5. There is mild loss of the intervertebral disc height with an associated vacuum disk. Note is made of a moderate posterior disk osteophyte complex and ligamentum flavum hypertrophy with resulting dorsal and ventral thecal sac effacement. On subsequent MRI, there was found to be mild cord flattening and cord signal increase at this level. There is also severe right-sided and moderate left-sided facet arthropathy, mild uncovertebral hypertrophy, and mild right-sided neuroforaminal stenosis. C5/C6: There is severe loss of the intervertebral disk height in the context of grade I retrolisthesis and vacuum disk. There is a posterior disc osteophyte complex associated with dorsal and ventral thecal sac effacement. On subsequent MRI, there was found to be mild cord flattening at this level. There is minimal uncovertebral hypertrophy and mild bilateral facet arthropathy. There is no evidence of neuroforaminal stenosis. C6/C7: There is moderate loss of the intervertebral disc height with associated vacuum phenomenon. There is a posterior disc osteophyte complex with associated partial effacement of the dorsal and ventral thecal sac. There is mild uncovertebral hypertrophy and minimal bilateral neuroforaminal stenosis. C7/T1: Minimal bilateral facet arthropathy. No evidence of uncovertebral hypertrophy or disc herniation.There is no exophytic aerodigestive tract mass, but there is noted to be asymmetric fullness of the right lingual tonsil--this region is found to have signal characteristics indistinguishable from lymphoid tissue on the subsequently performed MRI. There is mild mucosal thickening of the sphenoid sinuses. Paraspinal soft tissues unremarkable. There is no enlargement of the cervical lymph nodes by CT criteria. Moderate left greater than right carotid bifurcation calcification.The visualized intracranial contents are unremarkable apart from vascular calcifications of the left cavernous carotid artery are noted. The apices of the lungs are clear bilaterally.

Output: Severe multilevel degenerative changes of the cervical spine most prominent at the levels of C3/C4, C4/C5, C5/C6, and C6/C7. Subsequent MRI identifies thecal sac effacement at these levels with mild cord flattening at C4/C5 and C5/C6 and cord signal increase at C4/C5.Fullness of right lingual tonsil, at MRI found to have signal characteristics similar to surrounding lymphoid tissue. Suggest clinical correlation.


Instruction: Generate impression based on findings.

Input: History of von Hippel-Lindau syndrome. Evaluate change in bilateral renal cysts. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma is replaced by innumerable small cystic lesions. The pancreatic duct is not clearly defined.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral T1 and T2 weighted variable intensity lesions are again noted and are not significantly changed in size. Postcontrast subtraction images demonstrate no enhancing lesion or mural nodule. Please note that the postcontrast axial images do not include the inferior pole of the left kidney. On coronal images the septated cystic lesion is unchanged.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 multiple simple and minimally complex renal cysts without suspicious enhancement. No suspicious renal lesion.2.Stable innumerable pancreatic cysts without suspicious imaging characteristics.


Instruction: Generate impression based on findings.

Input: 77-year-old with altered mental status. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. This examination is essentially within normal limits for patient's stated age of 77. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Calvarium, paranasal sinuses and mastoid air cells are also unremarkable. If clinical concern persists an MRI is recommended.

Output: Normal CT of brain for age.


Instruction: Generate impression based on findings.

Input: Osteonecrosis of the knee MENISCI: There is linear increased signal within the posterior horn of the medial meniscus with extension to the tibial articular surface indicating a horizontal tear. There is globular and linear increased signal throughout the lateral meniscus indicating intrasubstance degeneration but no tear is identified.ARTICULAR CARTILAGE AND BONE: There is fragmentation of the weightbearing articular surface of the medial femoral condyle indicating osteonecrosis with separation of the articular cartilage and subchondral bone plate from the underlying condyle over an AP diameter of nearly 4 cm. There is subchondral cyst formation and edema in the underlying marrow. The articular cartilage of the lateral compartment is intact. There is a small focal full-thickness defect within the articular cartilage of the medial patellar facet with underlying subchondral bone marrow change. Subjectively, there is mild diffuse thinning of the medial patellar cartilage and the articular cartilage of the femoral trochlea is intact.LIGAMENTS: Subjectively, there is thickening of the superficial band of the medial collateral ligament which may be related to prior sprain. The remaining cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: There is bandlike low signal intensity anterior to the patella and distal to the quadriceps tendon which may reflect chronic scarring. Otherwise the extensor mechanism is intact.ADDITIONAL

Output: 1. Advanced subchondral osteonecrosis of the medial femoral condyle with articular fragmentation and subchondral cystic changes.2. Horizontal tear of the posterior horn of the medial meniscus.3. Large Baker's cyst with additional findings described above.


Instruction: Generate impression based on findings.

Input: 74 years Male (DOB:11/21/1941)Reason: history of left cutaneous SCC, now with left neck recurrence s/p resection History: left neck recurrence, postopPROVIDER/ATTENDING NAME: DANIEL HARAF DANIEL HARAF Since the prior exam the left neck mass just behind the left carotid space and lateral to it at the level of the thyroid cartilage previously measuring 56 x 39 mm axial dimensions now measures 41 x 28 mm axial dimensions. On coronal imaging this mass previously measured 46 x 47 mm coronal dimensions and currently measures 37 x 39 mm coronal dimensions. There is associated adenopathy in the left posterior triangle on the left posterior triangle lymph node currently measures 20 x 14 mm axial dimensions and previously measured 7 mm axial dimensions. Another enlarged and nodule is present lateral to the above described mass which measures 22 x 16 mm axial dimensions.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Patient is status post left neck surgery with neck dissection and removal of the left submandibular gland and left parotid gland.Within the visceral space the thyroid gland appears intact.The airway appears patent.Encephalomalacia present along the right frontal lobe which is incompletely assessed on this exam.The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses demonstrate some mucous retention cysts in the right maxillary sinus. The mastoid air cells are clear.The right parotid and the right submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact. The left jugular vein is not presentThe cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: 1.Since prior examination a left neck mass has decreased in size.2.There is new left posterior triangle neck lymphadenopathy present relative to the prior exam3.Status post left radical neck dissection and removal of the left sided salivary glands.4.Encephalomalacia along the right frontal lobe is incompletely imaged on this exam.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:7/27/1952)Reason: 64F w new onset LUE weakness, L eye burliness, decreased sensation to L face History: as abovePROVIDER/ATTENDING NAME: ERIC SHAPPELL MAHESH PADMANABAN 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.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery is very small.Incidental noted is made of partial empty sellaThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

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


Instruction: Generate impression based on findings.

Input: 85 year-old male with metastatic lung cancer status post fall Brain: Previously seen hemorrhagic metastatic lesions in the posterior left parietal lobe and high left frontal lobe slightly smaller than the prior study. Low attenuation lesion in the right parasagittal region superior to the right lateral ventricle most likely representing metastatic disease is also decreased in size. Cerebellar metastatic lesion is not easily appreciated on this noncontrast examination. No new lesions or areas of hemorrhage are identified. The ventricles and basal cisterns are unchanged in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Cervical spine: The cervical spine demonstrates normal alignment. Well-defined lucent areas are seen within the dens and lamina of C2. Additionally, a lucent area is seen in the spinous process of C3 that is less well defined posteriorly and is worrisome for metastatic lesions given the patient's history. An MRI would provide further characterization. Degenerative changes are seen throughout the cervical spine. No evidence for fracture.Thoracic spine: Thoracic spine demonstrates normal alignment. Large left apical mass representing patient's known malignancy is seen. The mass abuts the neural foramen of T2/T3. No definite extension into the canal is seen nor is there any is displacement of the thecal sac. No lesions are seen in the vertebral bodies. No evidence of fracture. Degenerative changes are seen throughout the thoracic spine. Right posterior old rib fractures are identified.Paraseptal emphysema identified in the lungs.Lumbar spine: Lumbar spine demonstrates normal alignment. No vertebral body lesions are seen. No evidence for fracture. Degenerative changes of the lumbar spine. Thickening of the lateral limb of the left adrenal gland again seen.

Output: 1. Reidentification of multiple cerebral metastatic lesions, some of which are smaller on this exam. No new intracranial process is seen.2. Lucent lesions identified in C1- C3, with the C3 spinous process lesion being more ill-defined possibly representing metastatic disease. MRI recommended for further evaluation.3. Degenerative changes seen throughout the spine with no evidence for fracture.4. Large left apical mass abutting the neural foramina of T2/T3 with no definite extension into the spinal canal.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: preop planning for biopsy of brain lesion History: none- planning Multiple fiducial markers are seen on the scalp.Left parietal resection cavity with left fronto-parietal and corpus callosum abnormal high signal intensity on T2 weighted images without significant enhancement on Gad are again demonstrated, no change since prior scan.Lower pontine cavernous malformation again is seen, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst on the right maxillary sinus.

Output: Pre-operative scan with STEALTH protocol has been obtained.No change of left hemispheric lesion as well as lower pontine cavernous malformation since prior scan.


Instruction: Generate impression based on findings.

Input: Right hip pain ACETABULAR LABRUM: Although we see no fluid signal intensity entering the substance of the labrum, there is intermediate signal intensity within the anterior superior labrum extending to the undersurface suggesting mild undersurface fraying/tearing. Tiny osteophytes are noted along the adjacent acetabular rim but we see no subchondral or paralabral cysts.ARTICULAR CARTILAGE AND BONE: Edema is noted within the right femoral head posteriorly which is nonspecific. We see no discrete fracture line. Small foci of signal abnormality within the intertrochanteric region of the left femur may represent small cartilaginous rests and are of doubtful clinical significance. The bone marrow signal of the pelvis and right hip otherwise appears normal. We see no frank CAM deformity of the right hip and the articular cartilage is intact.SOFT TISSUES: The musculature of the hip is normal in signal and caliber. Specifically, there is no evidence of a hamstring tear. The remaining soft tissues of the pelvis also are unremarkable. ADDITIONAL

Output: 1. Edema within the right femoral head posteriorly is nonspecific but possibilities include the presence of an atypical contusion, stress reaction, or femoral acetabular impingement although there are no additional pathomorphologic features of the hip to support this.2. Mild undersurface fraying/tearing of the anterior superior labrum.3. No evidence of hamstring tear.4. Degenerative disc disease of L5-S1. Please refer to MRI of the lumbar spine for further details.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. 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 enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.LUMBAR SPINE

Output: There is no evidence of cord compression or abnormal signal involving the spinal cord. There is no significant spinal canal or neural foraminal stenosis in the thoracic or lumbar spine.


Instruction: Generate impression based on findings.

Input: 61-year-old male patient with 7 mm nonspecific hepatic dome lesion on outside hospital MRI on 4/2015. History of HCV and cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. There are two T2 hyperintense lesions in the liver. One lesion in the hepatic dome in the 4a segment measures 7 mm (series 4 image 10) and the second lesion in segment 2 of the liver measures 9 mm (series 4 image 15). There is no enhancement of the lesions.Cholelithiasis noted. No intrahepatic or extra hepatic biliary ductal dilatation.The hepatic vasculature is patent.SPLEEN: Spleen size is upper limit of normal.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral gynecomastia noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter liver cysts as described above.2.Cirrhotic liver morphology without suspicious lesions. Hepatic vasculature is patent.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of left bronchus or lung [C34.92], Reason for Study: ^Reason: assess for mets History: falls lung ca There is peripheral enhancing intra axial mass with central non enhancing portion with surrounding edema in the right occipital lobe. The size of the mass is measured about 16.3mm (RL) x 20.2mm (AP) x 20.6mm (CC). This lesion is consistent with metastatic lesion.Susceptibility portions within and peripheral aspect of the mass lesion indicate intra-lesional hemorrhages.Previously seen right temporo-occipital bone lesion appears to be stable, unchanged.There is no other enhancing lesion seen on this scan.There is no evidence of acute ischemic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Peripheral enhancing right occipital lobe intra axial mass lesion with intra-tumoral hemorrhage and surrounding edema, consistent with metastatic lesion.Unchanged 2. Unchanged right temporo-occipital bone lesion.3. No evidence of acute ischemic lesion.


Instruction: Generate impression based on findings.

Input: 30 years, Female, new onset headache, evaluate for evidence for idiopathic intracranial hypertension?. Brain parenchyma appears within normal limits. No significant parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Slightly prominent linear structure is seen involving the right occipital lobe which may represent a developmental venous anomaly. Major flow-voids are preserved.Sella and orbits are grossly unremarkable without significant distention of the optic nerve sheaths or significant flattening of the pituitary gland to indicate intracranial hypertension. Cerebellar tonsils are in normal position. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Brain MRI without contrast is within normal limits for age. There is no specific evidence of intracranial hypertension, although if there is high clinical suspicion consider correlation via lumbar puncture.


Instruction: Generate impression based on findings.

Input: Clinical question: 51-year-old female had a new fall, follow-up compression fractures. Signs and symptoms: Left-sided buttock pain. Nonenhanced thoracic MRI:Examination of thoracic spine demonstrate no evidence of an acute fracture or malalignment.Advanced degenerative disc disease and loss of intervertebral disc heights at multiple levels and result in mild exaggeration of thoracic kyphosis remains nearly similar to prior CT of thoracic spine from 2014 study.There is postoperative changes of posterior fusion and including placement of bilateral transpedicular screws at T10, T11 and T 12 levels.There is normal signal intensity and caliber of the thoracic cord.There is no evidence of spinal canal or neural foramina compromise/stenosis at any level.Mild chronic compression deformity of superior endplate of T12 is identical to prior CT examination.Unremarkable paraspinal soft tissues.Nonenhanced lumbar MRI:Examination demonstrates normal anatomical alignment of vertebral column.Mild chronic compression fracture of the superior endplate of L1 similar to prior CT examination from 2014. No evidence of any acute posttraumatic compression fracture.There are multilevel placement of disc space devices at L1-L2, L2-L3, L3-L4 and L4-L5 levels as was noted on prior studies. There is redemonstration of post operative changes of posterior fusion and placement of bilateral transpedicular screws at L3, L4, L5 (only on the left) and S1 on the right.There is no evidence of spinal canal compromise or stenosis at any level. Extensive metallic hardware artifact precludes precise assessment for subtle findings and including neural foramina. Postoperative changes at L5 and L4-L5 disc levels with suggestion of placement of bone and metastatic device within the disc space appears similar to prior study as well. Extensive

Output: 1.Nonenhanced thoracic MRI demonstrate no evidence of acute posttraumatic changes. No evidence of spinal stenosis or neural foraminal compromise at any level. Extensive degenerative disc disease with loss of disc height and mild exaggeration of thoracic kyphosis remains similar to prior exams. Normal signal intensity and caliber of the cord.2.Nonenhanced MRI of the lumbar is severely degraded due to extensive surgical metallic hardware artifact however within this limitation there is no convincing evidence of a acute posttraumatic finding. No evidence of a spinal stenosis at any level. Stable extensive postoperative changes of posterior fusion in the lower lumbosacral spine and disc space prostheses throughout the lumbar spine as detailed above.


Instruction: Generate impression based on findings.

Input: 69-year-old female with lung mass. No with increasing headaches and slurred speech Area of vasogenic edema within the right cerebellum with mass effect and deviation of the fourth ventricle is noted. This is believed to represent edema from a metastatic lesion and should be further evaluated with a dedicated MRI of brain. Within the area of edema a suspect neck right tumor is noted. No evidence of hemorrhage is present.Images through supratentorial brain parenchyma also demonstrates small area of low attenuation in the subcortical white matter of right posterior frontal which also is suspected for edema surrounding a small metastatic lesion.No evidence of hemorrhage or midline shift is detected.Calvarium remains within normal limits. Minimal findings of chronic otitis are noted evident by opacification of few of the mastoid air cells.

Output: 1.Highly suspected necrotic tumor within the posterior fossa on the right with surrounding edema and smaller supratentorial area of vasogenic edema. Both of these regions need to be further evaluated with a dedicated post diffuse MRI of brain.


Instruction: Generate impression based on findings.

Input: 59 years, Female, Reason: Evidence of cancer recurrence History: Bleeding from vaginal cuff. Uterine mucinous adenocarcinoma s/p TAH-BSO, multiple recent vaginal bleeds. Status post IR embolization PELVIS: FemaleUTERUS, ADNEXA: Status post hysterectomy. There is enhancing tissue at the vaginal cuff, most prominent along the left aspect measuring 1.9 x 1.9 cm (1209/355). Enhancing soft tissue also extends along the right aspect of the cuff measures 3.0 x 1.7 cm (1301/78). While there is no definite rectal invasion, there is an indistinct fat plane between the enhancing tissue and rectum on a single slice (1205/380). Enhancing soft tissue also abuts the bladder with loss of the fat plane (1202/357).BLADDER: Foley catheter.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free pelvic fluid.

Output: Enhancing tissue at the vaginal cuff is suspicious for tumor recurrence. The tumor abuts the rectum and bladder and while there is no definite invasion, there is suggestion of loss of the fat planes and early underlying invasion cannot be entirely excluded, further described above.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the single posterior left ethmoid air cell. Minimal fluid signal is noted within left mastoid air cells. The remaining paranasal sinuses and right mastoid air cells are clear. There is no abnormal enhancement within the brain. Degenerative changes of the upper cervical spine from C2 through the superior-most visualized aspect of C5 demonstrate spondylitic changes resulting in degrees of central stenosis and cord deformation.

Output: 1.Mucosal thickening is present within the single posterior left ethmoid air cell. 2.Minimal fluid signal is noted within left mastoid air cells. 3.Degenerative changes of the upper cervical spine from C2 through the superior-most visualized aspect of C5 demonstrate spondylitic changes resulting in degrees of central stenosis and cord deformation. If the patient has symptoms referable to the cervical spine, dedicated cervical spine MRI could better characterize central and foraminal stenoses.4.There are no MRI findings to explain the patient's chronic dizziness.


Instruction: Generate impression based on findings.

Input: Male; 42 years old. Reason: r/o dislocation History: pain. Additional history obtained from clinician indicates history of left rotator cuff repair and distal clavicular resection. No dislocation. Irregularity along the inferior aspect of the glenoid may represent an osseous Bankart lesion. This can be further evaluated with nonemergent MRI if clinically warranted. No additional fracture is identified. Postoperative findings of distal clavicle resection.

Output: No dislocation. Irregularity along the inferior aspect of the glenoid may represent an osseous Bankart lesion which can be further evaluated with MRI if clinically warranted.


Instruction: Generate impression based on findings.

Input: Female 62 years old Reason: pt with AIH/cirrhosis undergoing routine HCC screening at OSH was noted to have fluid collection/cystic mass in the region of the head of the pancreas, recommend additional imaging. Please eval for further clarification/diagnosis History: AIH, Cirrhosis ABDOMEN:LIVER, BILIARY TRACT: There is mild caudate hypertrophy. No focal lesion with arterial enhancement or washout. Hepatic and portal veins are patent. Status post cholecystectomy. Common bile duct measures 6 mm. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology. No cystic or solid lesion is identified. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged portacaval peripancreatic lymph nodes likely sequelae of autoimmune hepatitis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesion.2.No evident cystic lesion in the pancreas.


Instruction: Generate impression based on findings.

Input: Evaluate uterine fibroids. PELVIS:UTERUS, ADNEXA: Anteverted mildly anteflexed uterus. No evidence of a mullerian congenital abnormality.The uterus measures 11.3 x 6.9 cm in the sagittal plane.The endometrium/endometrial canal measures up to 13 mm without a focal abnormality.The endometrial myometrial/junctional zone is poorly defined and thickened up to 15 mm. Multiple punctate cystic foci are noted within the inner and outer myometrium. No T1-weighted hyperintense hemorrhagic foci are evident. Susceptibility artifact suggests old blood products such as from prior c-section. Several small poorly defined hypodense uterine masses are noted which demonstrates enhancement. The largest is in the left uterine body measuring 2.3 x 2.0 cm, likely a small fibroid.The uterine cervical stroma is unremarkable. The parametrial soft tissues are unremarkable.The right ovary measures approximately 3.4 x 2.5 cm it contains several follicles/physiologic cysts.The left ovary measures approximately 2.6 x 1.8 cm it contains follicles/physiologic cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Findings most compatible with diffuse adenomyomatosis.2. Left intramural body 2.3 cm probable fibroid and additional very small fibroids versus focal adenomyomata.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: Minimal disc bulge without stenosis.C5/6: Minimal disc bulge without stenosis.C6/7: Minimal disc bulge without stenosis.C7/T1: Unremarkable

Output: 1.Negative MRI of the brain including gadolinium enhancement.2.Minimal disc bulges of the cervical spine without stenosis. There is no abnormal cervical spine enhancement.


Instruction: Generate impression based on findings.

Input: Left knee osteonecrosis MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Specifically, there is no evidence of osteonecrosis.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of osteonecrosis.2. Findings of suggestive of mild patellar impingement including slight lateral tilt of the patella, shallow appearance of the femoral trochlea, mild patella alta.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, type I. Autism and frontal lobe tumor. Follow-up. The heterogeneous lesion in the left frontal lobe which contains foci of susceptibility and also shows heterogeneous areas of contrast enhancement has not changed since the previous examination. The foci of susceptibility effect may reflect hemosiderin or mineral deposition. There is no significant associated edema or mass-effect. The lesion did not show susceptibility effect on the more remote examination from May 11, 2006. There is an adjacent linear vascular structure which may represent a developmental venous anomaly.The T2-hyperintense lesions involving the globi pallidi related to the diagnosis of neurofibromatosis type I, are not significantly changed. The T2-hyperintense lesions in the right frontal white-matter are unchanged though the associated minimal contrast enhancement is slightly more pronounced. Major intracranial vascular flow voids are preserved. There is no gross orbital abnormality. Focal posterior parietal midline plaque-like scalp thickening has not changed. Along the inferior edge of this scalp thickening, there is a 1.6 cm skull defect. A much smaller skull defect is also present along its superior edge. Both defects are in close proximity to the underlying superior sagittal sinus. This may represent congenital venous malformation, like sinus pericranii. These findings are not significantly changed since the previous examination. Otherwise, there is no destructive skull lesion.

Output: 1.Left frontal lobe lesion remains unchanged since February 2015. Compared to the more remote examination from May 11, 2006, the lesion has shown mild gradual increase in overall size with increased susceptibility which may be related to mineralization or blood products. Finding is most compatible with low grade neoplasm such as astrocytoma.2.Unchanged T2 hyperintense lesions in the globi pallidi compatible with myelin vacuolization/FASI related to neurofibromatosis type I. 3.The right frontal white-matter T2-hyperintense lesions with minimal enhancement are also unchanged. 4.The posterior skull defects which are in close proximity to the underlying superior sagittal sinus may reflect sinus pericranii. Adjacent plaque-like posterior scalp thickening may reflect a small neurofibroma or may relate to the aforementioned adjacent vascular anomaly, but remains unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Back pain following motor vehicle accident On this limited study lateral view of the lumbosacral spine, there is a radiopaque density anteriorly adjacent to the superior aspect of the L4 vertebral body. While this very likely represents bowel contents superimposed over this region, in the setting of trauma additional views would ordinarily be indicated. If this patient is pregnant however a nonemergent, limited noncontrast enhanced ( sagital sequence) MRI can be obtained for complete evaluation. No other obvious acute abnormality is identified.

Output: On this limited study lateral view of the lumbosacral spine, there is a radiopaque density anteriorly adjacent to the superior aspect of the L4 vertebral body. While this very likely represents bowel contents superimposed over this region, in the setting of trauma additional views would ordinarily be indicated. If this patient is pregnant however a nonemergent, limited noncontrast enhanced ( sagital sequence) MRI can be obtained for complete evaluation. No other obvious acute abnormality is identified.


Instruction: Generate impression based on findings.

Input: 36-year-old female with pain in left knee and locking sensation. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is mild fraying and irregularity of the articular cartilage along the femoral aspect of the patellofemoral compartment. The articular cartilage in the medial and lateral compartments is within normal limits. The bones are unremarkable without evidence of fracture or marrow edema.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Mild fraying and irregularity of the patellofemoral cartilage, without acute meniscal or ligamentous pathology identified.


Instruction: Generate impression based on findings.

Input: 88 years, Female, diplopia, assess for leptomeningeal disease. Brain: No restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size. Similar to prior, there are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes. Global parenchymal volume loss is seen commensurate with patient's advanced age. There is again a question of small subdural hygromas in the posterior fossa but unchanged since 9/24/2013 and without mass effect. Unchanged focus of susceptibility in the left frontal lobe compatible with chronic microhemorrhage or calcification. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Again seen is partially empty sella which is common in this age group. Bilateral lens implants again seen. Mild bilateral mastoid air cell opacification. Calvarium and extracranial soft tissues are otherwise grossly unremarkable.Orbits: There are no masses within the orbits or abnormal enhancement. Bilateral optic nerves demonstrate normal signal. Bilateral globes are intact. Bilateral lens implants are seen. Extraocular muscles are unremarkable. Minimal linear enhancement along the posterior aspect of the optic nerve sheaths is favored to be vascular in etiology and of doubtful significance. No suspicious enhancement within the orbits is definitively appreciated.

Output: 1. No evidence of acute ischemia. Moderate chronic small vessel ischemic disease, similar to prior study from 9/24/2013.2. No intracranial or intraorbital mass or abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease. If there is high suspicion for a leptomeningeal process, consider CSF analysis.


Instruction: Generate impression based on findings.

Input: 34 year old man with cardiomyopathy referred to evaluate etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 7%, the LV end diastolic volume index is 224 ml/m2 (normal range: 74+/-15), the LVEDV is 425 ml (normal range 142+/-34), the LV end systolic volume index is 208 ml/m2 (normal range 25+/-9), the LVESV is 395 ml (normal range 47+/-19), the LV mass index is 137 g/m2 (normal range 85+/-15), and the LV mass is 260 g (normal range 164+/-36). There is global hypokinesis. There is septal mid-wall late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is consistent with the patient's history of old myocarditis but is also well described in "classical" dilated cardiomyopathy. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 24%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 201 ml (normal range 142+/-31), the RV end systolic volume index is 80 ml/m2 (normal range 31+/-9), and the RVESV is 152 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 7%). There is mid-wall late gadolinium enhancement of the interventricular septum. This finding most likely represents fibrosis related to either old myocarditis or "classical" dilated cardiomyopathy.2. Normal RV size with severely reduced systolic function (RVEF 24%). 3. Severe left atrial dilation.


Instruction: Generate impression based on findings.

Input: 69-year-old female with lower back pain and right lower extremity pain. Evaluate for lumbar spine pathology. For the purposes of numbering, there are 5 lumbar-type vertebral bodies. There is grade 1 anterolisthesis of L5-S1 but the alignment is otherwise maintained. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Degenerative changes are as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is minimal disc bulge and mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L2-L3: There is minimal disc bulge and mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L3-L4: There is minimal disc bulge and mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L4-5: There is minimal disc bulge eccentric to the right and facet arthropathy but no significant compromise to spinal canal or neural foramina.L5-S1: There is advanced facet arthropathy and disc uncovering as well as a mild disc bulge. There is mild effacement of the right lateral recess. There is mild to moderate right and mild left neural foraminal stenosis. There may be impingement on the right L5 nerve root. There is no central spinal canal stenosis.

Output: Mild degenerative changes of the lumbar spine particularly at the L5-S1 level where there is advanced facet arthropathy, grade 1 anterolisthesis, and mild to moderate right neural foraminal stenosis with possible impingement of the exiting right L5 nerve root.


Instruction: Generate impression based on findings.

Input: cT4a N2c right oral tongue squamous cell carcinoma treated with induction chemo on protocol 12-1712. There is an ill-defined lesion centered in the right oral tongue, with slight extension across the midline, which measures approximately 25 x 30 mm in axial cross-section, previously 30 x 45 mm. There is also interval decrease in size of a necrotic left level 1B lymph node, which measures 10 x 12 mm in axial cross-section, previously 14 x 17 mm, a left level 4 lymph node measures 7 x 10 mm, previously 9 x 12 mm, and a right level 2A lymph node measures 10 x 24 mm, previously 11 x 25 mm., for example. There is a punctate left thyroid cyst. The salivary glands, orbits, and imaged intracranial structures are unremarkable. There are small posterior disc-osteophyte complexes at C5-6 and C5-6 and reversal of the usual cervical lordosis.

Output: Interval decrease in size of the right oral tongue squamous cell carcinoma and associated lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 65-year-old male with fever and elbow swelling. Evaluation is limited due to patient motion artifact, patient body habitus, and inability to optimally position the patient. The elbow joint is distended with heterogeneous material of both increased and decreased signal intensity on T2-weighted images. There is also enhancement of the joint margins indicating a synovitis. There are rounded foci of abnormal signal intensity within the lateral aspect of the capitellum as well as within the olecranon that could represent cysts or erosions. There is mild edema within the distal humerus. There is edema and enhancement of much of the proximal forearm musculature. There is edema and enhancement of the visualized distal triceps musculature indicating inflammation. There is also mild edema and enhancement of the distal brachialis. These findings suggest inflammation. There is also diffuse subcutaneous edema and skin thickening.

Output: Extremely limited study due to the patient's body habitus, motion artifact, and inability to optimally position the patient showing diffuse inflammation of the subcutaneous fat and musculature of the elbow as well as a synovitis of the elbow joint with a heterogeneous joint effusion. Please note we cannot exclude the possibility of septic arthritis, although the joint effusion is nonspecific and could represent gout or other noninfectious etiologies. These findings were discussed during the joint rheumatology-radiology conference today.


Instruction: Generate impression based on findings.

Input: 62 years Female (DOB:8/26/1954)Reason: Bowel incontinence history of MS History: Unstable gaitReferring Attending: THOMAS J. KELLY 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. No abnormal enhancing lesions are appreciated in the lumbar spine. There is some multilevel disc desiccation.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a large cyst present along the superior pole of the right kidney measuring 49 x 52 mm axial dimension on the superiormost axial image. On the most lateral sagittal imaging measures 41 x 61 mm. Please note that cyst is not inflated. This exam.. It is also identified on a CT of the abdomen from 12/27/2010 where it measured 56 x 50 mm axial dimensions. Subcentimeter cysts are present in the left kidney. There is a 14 mm cyst inferior pole of the right kidney which can also be identified on the 2012 CT. At that time it measured 14 mm as well.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.No abnormal lesions are identified within the lumbar spinal canal or in the conus medullaris.3.Multiple renal cystic lesions. The largest is in the right kidney but is not entirely included on this exam.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate rotator cuff. ROTATOR CUFF: There is a full-thickness tear of the anterior fibers of the supraspinatus tendon at its insertion on the greater tuberosity, with just under 1 cm of retraction of the bursal surface fibers. The tear predominantly involves the anterior portion of the tendon, measuring approximately 1 cm in AP dimension. Mild thickening and increased signal intensity of the remainder of the supraspinatus tendon indicates mild tendinosis. The supraspinatus muscle is within normal limits. There is mild interstitial tearing along the myotendinous junction of the infraspinatus, but I see no full-thickness infraspinatus tendon tear. There is mild fatty atrophy along the myotendinous junction of the infraspinatus. The teres minor tendon and muscle appear intact. There is thickening and increased signal intensity of the subscapularis tendon indicating tendinosis. Furthermore, the undersurface fibers of the superior half of the tendon do not clearly contact the lesser tuberosity, and there is medial subluxation of the tendon of long head of the biceps along the lesser tuberosity, indicating at least undersurface tearing of the subscapularis. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint, with mild impression upon the superior fibers of the supraspinatus. There is a small amount of fluid within the subacromial/subdeltoid bursa extending along the posterior fibers of the supraspinatus muscle.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Apparent detachment of the anterior superior labrum from the underlying glenoid may represent a normal variant, as the remainder of the labrum appears normal given the limitations of a non-arthrogram study. There are small cysts in the greater tuberosity likely secondary to the overlying aforementioned rotator cuff pathology.BICEPS TENDON: As stated previously, there is medial subluxation of the tendon of the long head of the biceps on the lesser tuberosity. The tendon otherwise appears intact.

Output: Rotator cuff tears, medial subluxation of the tendon of long head of the biceps, and acromioclavicular joint osteoarthritis as described above.


Instruction: Generate impression based on findings.

Input: 50 year old male patient with restaging appendiceal cancer. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post cholecystectomy. Scattered punctate T2 hyperintense foci are too small to characterize, but likely cysts. No suspicious hepatic lesion is identified. The hepatic vasculature is patent. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral percutaneous nephrostomy tubes with stable mild hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post right hemicolectomy. Mild peritoneal surface thickening without discrete nodular enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No measurable solid disease seen in the abdomen or pelvis.2.Decrease in size of a fluid pocket within the rectovesical pouch with wall enhancement; this is favored to represent continued evolution of a postoperative collection.3.Redemonstration of peritoneal surface and serosal bowel wall surface thickening and pelvic small bowel mesentery haziness but no discrete nodular enhancement. Differential includes postsurgical changes from extensive peritoneal surface stripping although residual tumor is not excluded.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with brain metastases from primary salivary gland adenocarcinoma status post stereotactic radiosurgery to a left occipital lesion. A linear focus of intrinsic T1 hyperintensity and minimal if any superimposed enhancement is seen at the site of a treated lesion at the left occipitotemporal junction. Minimal residual T2 signal abnormality is seen in this area similar to prior.No new enhancing lesions are seen. A few scattered foci of white matter T2 hyperintensity are redemonstrated, unchanged and nonspecific. No evidence of parenchymal edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology. Trace fluid signal is seen in the left mastoid air cells.

Output: Stable findings are seen related to treatment of a left occipitotemporal junction metastasis. No findings are seen to suggest any new intracranial metastases.


Instruction: Generate impression based on findings.

Input: Right hip pain ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Normal MR arthrogram of the right hip..


Instruction: Generate impression based on findings.

Input: Reason: 39 y/o male with a PMHx of melanoma, coming in with severe right sided headache and c/f bell's palsy vs. Other autoimmune etiology vs. Clot vs. vasculitis. Need to eval History: headache, bell's palsy. MRIThere are prominent linear branching pattern enhancement on bilateral centrum semiovale, periventricular white matter and basal ganglia indicating enhancement of vascular structures such as medullary veins. These findings suggest possible generalized inflammatory process. However, there is no nodular or mass like enhancement on brain parenchyme, nor dural enhancement.The right side internal auditory canal especially right facial nerve shows enhancement. Bilateral oculomotor nerves and trigeminal nerves also show diffuse enlargement and enhancement. The left cerebellar hemisphere especially anterior superior folia shows linear and gyral pattern enhancement.There are several hyperintense foci seen on FLAIR images, which are nonspecific. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is well marginated, smooth and confined enhancing pineal gland lesion which likely represent pineal cyst.Ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. MRVSuperficial and deep venous drainage system appear to be normal. In particular, the superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.IACThere is abnormal asymmetric enhancement of the right proximal cranial nerve VII especially meatal segment. In addition, the right facial nerve's labyrinthine segment including the right geniculate ganglion, and mastoid segment show asymmetric enhancement. There is also bilateral enhancement of cranial nerve III and the V2 segments of the trigeminal nerves. Especially for bilateral extending into the foramen ovale and an additional enhancing focus within the left cerebellar folia. The trigeminal nerves are abnormally thickened bilaterally.Lower cranial nerves also show subtle enhancement but did not show evidence of thickening. The brainstem, cerebellum, vermis and tonsils are normal. The inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. This constellation of findings including prominent small vascular enhancement on bilateral deep white matter (possible medullary veins enhancements), leptomeningeal enhancement (cerebellar folia enhancement) and multifocal cranial nerve enhancements are non specific thus differential diagnosis include neoplastic process such as leptomeningeal metastasis from the patient's known melanoma, inflammatory or immunologic responses due to immuno/chemotherapeutic agents such as Ipilimumab usage, other granulomatous lesions such as sarcoidosis or tuberculosis or combined neoplastic (leptomeningeal carcinomatosis) and associated meningitis.

Output: 1. No evidence of acute ischemia, hemorrhage, mass effect, or edema.2. Multifocal cranial nerves and leptomeningeal enhancements, differential diagnosis include leptomeningeal carcinomatosis, inflammatory or immune response due to immuno/chemotherapy such as Ipilimumab use, granulomatous disease such as sarcoidosis or combined leptomeningeal carcinomatosis and leptomeningitis. 3. Normal brain MR venogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pain, numbness in legs Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign including a small T1 hyperintense focus involving the L2 vertebral body most compatible with a hemangioma. The conus medullaris is normal in position. There is fibrofatty infiltration involving the filum terminale which measure less than 2 mm in thickness and of doubtful clinical significance.Multilevel degenerative changes are seen, as described below:L1-L2: No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge. Previously seen right lateral disc extrusion is no longer seen. There is no significant spinal canal or neural foraminal stenosis. L4-L5: Mild disc bulge. No spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy, worse on the left and similar to prior.L5-S1: Loss of disc height and fatty endplate marrow signal changes are again seen. There is bilateral facet arthropathy as well as mild disc bulge similar to prior. There is resulting mild bilateral neural foraminal stenosis. Paraspinous soft tissues are within normal limits. Right renal cysts again noted.

Output: 1. Mild degenerative changes in the lumbar spine with no significant spinal canal stenosis at any level. There is mild neural foraminal narrowing at L5-S1 bilaterally. No higher grade neural foraminal stenosis. Compared to 7/8/2013, right-sided L3-L4 disc extrusion has resolved.2. Facet arthropathy at the L4-L5 and L5-S1 levels, which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Evaluate for avascular necrosis or other cause of chronic wrist pain, particularly at the scaphoid.EXAMINATION: MRI of the right hand/wrist without contrast 9/22/2015, 1206 Ligaments: Normal.TFCC: Normal.Tendons: Normal.Bones: There is a fracture lucency within the mid waist of the scaphoid. There is T1 hypointensity and T2 hyperintensity involving the proximal and mid scaphoid, consistent with avascular necrosis. There is peri scaphoid T2 hyperintensity, compatible with edema. The scapholunate interval is normal.Other: None.

Output: Scaphoid waist fracture with avascular necrosis of the proximal scaphoid and mid pole, with mild adjacent edema.


Instruction: Generate impression based on findings.

Input: 3 month follow up for a residual pituitary tumor. There are postoperative findings related to right frontal craniotomy and transsphenoidal surgery, with right frontal lobe encephalomalacia. There is an unchanged enhancing mass in the left aspect of the sella with suprasellar extension that measures up to 13 mm in the craniocaudal dimension. There is mild protrusion of the lesion into the left cavernous sinus and perhaps slight mass effect upon the adjacent left optic nerve. There is also unchanged mild optic apparatus atrophy. There is persistent scattered paranasal sinus mucosal thickening.

Output: Postoperative findings with unchanged residual pituitary tumor.


Instruction: Generate impression based on findings.

Input: Newly diagnosed base of tongue cancer status post bilateral tonsillectomy, biopsy: staging. There is an infiltrative heterogeneously enhancing mass centered in the right tongue base that measures up to approximately 45 mm. The tumor also extends into the oral tongue, floor of mouth, and across the glossotonsillar sulcus into the tonsillar fossa, perhaps slightly across the midline. There is no gross invasion of the pterygoid musculature or perineural tumor. There is an irregular right level 2A lymph node that measures 12 x 15 mm in axial cross-section. A right level 3 lymph node measures 9 x 14 mm. The left cervical lymph nodes are not particularly enlarged. The salivary glands are unremarkable. The osseous structures are intact. There is a subcentimeter left maxillary sinus retention cyst. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. An infiltrative heterogeneously enhancing mass centered in the right tongue base that measures up to approximately 45 mm is compatible with squamous cell carcinoma. The tumor also extends into the oral tongue, floor of mouth, and across the glossotonsillar sulcus into the tonsillar fossa, perhaps slightly across the midline, although biopsy effects can confound the extend of disease. 2. At least one suspicious right cervical lymph node suspicious for metastatic disease and extracapsular extension, but no definite left cervical lymphadenopathy. PET may be useful for further staging.


Instruction: Generate impression based on findings.

Input: 65-year-old male with prostate cancer. Gleason 6, left mid lateral PELVIS:PROSTATE:Prostate Size: 5.1 x 3.8 x 5.3 cm.Peripheral Zone: Striated T2 hypointensities and T1 hyperintensity in the peripheral zone may reflect post-biopsy blood product. Please note that this precludes the detection of small foci of malignancy. Focus of T2 hypointensity in the left mid gland peripheral zone with corresponding diffusion restriction measuring approximately 8 x 9 mm (series 1001, image 7).Central Gland: Moderate degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy. Scattered subcentimeter external iliac and inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of post-biopsy hemorrhage throughout the peripheral zones preclude detection of small foci of malignancy. Within these limitations, there is a suspicious focus ot T2 hypointensity with corresponding ADC restriction in the left midgland peripheral zone as described above.


Instruction: Generate impression based on findings.

Input: Reason: 43 yo male with history of multiple hepatic hemangiomas as well as right nephrectomy for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: There is a diffuse decrease in hepatic parenchymal signal intensity on out of phase images consistent with fatty infiltration. There is a lobulated, well-circumscribed lesion within the right hepatic lobe (series 7, image 23) measuring 10.5 x 10.5 cm, previously 10.4 x 10.7 cm. The lesion demonstrates mild T1 hypointensity peripherally with more pronounced T1 hypointensity centrally as well as mild T2 hyperintensity peripherally and more pronounced T2 hyperintensity centrally. The lesion demonstrates discontinuous, peripheral, nodular enhancement on arterial phase images with some centripetal fill-in on delayed images compatible with a benign giant hemangioma. A well-circumscribed lesion within segment 2 of the liver (series 7, image 10) measures 2.8 x 2.9 cm, previously 2.5 x 2.9 cm. The lesion is homogeneously T2 hyperintense and T1 hypointense. The lesion demonstrates discontinuous peripheral nodular enhancement with progressive filling in on more delayed images and is compatible with a benign hemangioma. An additional lesion, also in segment 2 (series 7, image 8) measures 1.9 x 2.4 cm, previously 1.6 x 2.2 cm. The lesion is mildly T2 hyperintense and T1 hypointense, previously demonstrated peripheral nodular enhancement with fill-in on delayed images, and is compatible with a benign hemangioma.There is a an additional subcentimeter T2 hyperintense structure in the right hepatic dome (series 7, image 10) which appears unchanged compared to the 2015 examination but is too small to characterize.Gallbladder is surgically absent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of residual or recurrent disease in the surgical bed.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.Benign hepatic hemangiomas stable to minimally increased in size. Additional subcentimeter T2 hyperintense lesion within right hepatic dome unchanged compared to 2015 but too small to characterize. No new hepatic lesions.2.No evidence of local recurrence of renal cell carcinoma.3.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 46 year old female with acute onset of mental status changes; evaluate for mass lesions or bleed There is a hypodense lesion in the right periventricular white matter extending to the centrum semiovale which is nonspecific and age indeterminate. The lesion could be vascular related or may be related to demyelination. MRI may be obtained for further characterization if clinically warranted. There is no evidence of acute intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Nonspecific hypodense lesion in the right periventricular white matter which is age indeterminate. No evidence of acute intracranial hemorrhage or mass. CT is insensitive for the diagnosis of nonhemorrhagic CVA. MRI may be obtained for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with history of pituitary adenoma status post resection with visual field changes. A hypoenhancing lesion involving the right sella with extension to the cavernous sinus measures 14 mm AP x 5 mm TV x 5 mm SI, previously 15 mm x 8 mm x 9 mm.Heterogeneous tissue involving the left aspect of the sella and left cavernous sinus likewise appears similar to prior. No new intrasellar lesions are seen.The pituitary infundibulum deviates mildly toward the left which is unchanged. No large suprasellar masses are seen. The optic chiasm and optic nerves do not appear to be impinged.Sequelae of prior transsphenoidal sellar surgery is seen with residual mucosal thickening in the sphenoid sinuses, not significantly changed.

Output: Mild interval reduction in the size of a soft tissue lesion involving the right sella and cavernous sinus. Tissue in the left aspect of the sella and cavernous sinus show no significant interval change. No suprasellar tumor extension is seen, and there is no obvious impingement of the optic chiasm or optic nerves.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 30 years old. Reason: thyroid cyst, pls assess for changes History: thyroid cyst RIGHT LOBE MEASUREMENTS: 1.5 x 1.4 x 4.3 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.4 x 5.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous echotexture, without focal lesion.LEFT LOBE: The previously described lower pole cystic nodule has significantly decreased in size, now only with residual solid component measuring 0.6 x 0.5 x 0.7 cm, hypoechoic, without significant internal vascularity. An additional small well marginated upper pole nodule measures 0.3 x 0.2 x 0.4 cm, hypoechoic, noncalcified, without significant internal vascularity.ISTHMUS: Homogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant interval decrease in size of the left lower pole cystic nodule, with residual subcentimeter solid component.


Instruction: Generate impression based on findings.

Input: 15-year-old female with left knee pain and instability. Evaluate for ACL tear. MENISCI: The lateral and medial menisci are intact and normal in appearance.ARTICULAR CARTILAGE AND BONE: There is focal abnormal high T2 bone marrow signal intensity within the lateral femoral condyle anteriorly. The remaining bone marrow signal intensity of the knee is normal. The articular cartilage is intact. LIGAMENTS: Anterior and posterior cruciate ligaments are intact. Medial collateral ligament and lateral collateral complex are intact. EXTENSOR MECHANISM: Quadriceps tendon and patellar tendon are intact.ADDITIONAL

Output: Contusion of the lateral femoral condyle anteriorly.


Instruction: Generate impression based on findings.

Input: There is an elongated non-enhancing T2 hyperintense lesion that measures up to 14 mm in length and 5 mm in width within the anterolateral left larynx, centered in the region of the laryngeal vestibule. There is associated surrounding mild edema and enhancement with mild narrowing of the airway. Otherwise, there is no evidence of soft tissue mass or significant cervical lymphadenopathy in the neck. There is nonspecific fluid in the bilateral mastoid air cells. The osseous structures are otherwise unremarkable. The airways are patent. There is mil d prominence of the subarachnoid spaces anterior to the bilateral temporal lobes. The orbits are unremarkable.

Output: A cystic lesion in the left anterolateral larynx measures up to 14 mm and is associated with mild airway narrowing. The imaging characteristics are nonspecific and the evaluation is somewhat limited without an available preoperative comparison study. Nevertheless, differential considerations include residual congenital saccular laryngeal cyst and perhaps less likely a branchial apparatus anomaly or lymphatic malformation. Apparent mild surrounding inflammatory changes may be reactive or postoperative in nature, although superimposed infection cannot entirely excluded.


Instruction: Generate impression based on findings.

Input: Left arm numbness. No evidence of acute ischemic or hemorrhagic lesion on the scan.Bilateral asymmetric high signal intensities on basal ganglia specifically globus pallidi on FLAIR images are seen. There is another lesion on the right side of cerebral peduncle which extends caudally to the level of upper pons. Interestingly, there is no imaging evidence of mass effects from these lesions except the left globus pallidus lesion.Those lesions do not show any restricted diffusion or susceptibility artifacts on gradient echo images.These findings are non specific thus the list of potential diagnosis could be very long.The differential diagnosis of these lesions include; demyelinating disease, inflammatory disease such as Neuro-Behcet disease, chronic toxic lesion such as carbon monoxide or methanol, metabolic lesions such as chronic liver disease or diabetes related non ketonic hyperglycemia or post infectious lesion such as post acute demyelinating encephalomyelopathy. Gadolinium enhanced MRI with clinical correlation might be helpful to narrow down the differential diagnosis.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Non specific bilateral globus pallidi as well as right cerebral peduncle, mid brain and upper pontine high signal intensity lesions on FLAIR images as described above. Gad enhanced MR images with clinical correlation are recommended. 2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: MRI brain: There are postoperative findings related to prior left occipital lobe GBM resection. There has been interval evolution of the resection cavity and postoperative blood products. There is dural enhancement related to postsurgical changes, unchanged. Since the prior exam dated 3/4/2016, there has been marked interval increase in the irregular heterogeneous enhancement surrounding the resection cavity in the occipital lobe extending to the posterior parietal lobe. There is linear enhancement which extends to the ependymal lining of the left occipital horn, as seen on prior exam. There is unchanged mass effect on the left lateral ventricle. There are additional areas of more nodular enhancement seen superiorly to the resection cavity, which appears slightly more prominent compared to prior. There has been increase in the extent of T2/FLAIR hyperintensity in the left occipital lobe extending to the temporal lobe. There is no evidence of acute ischemia. No hydrocephalus. No midline shift or herniation. Incidental note is made of normal variation of slight medial extension of a portion of the right occipital lobe likely through a small tentorial defect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniovertebral junction are within normal limits. There is mild mucosal thickening in the right maxillary sinus.MRA brain:The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. Bilateral posterior communicating arteries are present. The right vertebral artery is dominant. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: 1. No evidence of acute ischemia. Since prior postoperative study from 3/4/2016, there has been significant increase in heterogeneous enhancement surrounding the left occipital resection cavity highly suspicious for progression of known high-grade glial neoplasm. There is also increase in surrounding edema. No midline shift or herniation.2. No significant stenosis in the intracranial circulation or the extracranial circulation in the neck.


Instruction: Generate impression based on findings.

Input: 63-year-old female patient with history of colon cancer presents for preoperative planning. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. No suspicious enhancing lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Complex cystic lesion with enhancing thick septations and solid components measures 5.3 x 5.4 x 3.9 cm (series 801 image 26 and series 501 image 27) in the left kidney. No evidence of renal vein invasion.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: There are numerous bilateral prominent lymph nodes in the pelvis. For reference, a left external iliac lymph node measures 1.5 x 1.2 cm (series 1602 image 53).BOWEL, MESENTERY: There is an eccentrically located mass that appears to be arising from the sigmoid colon that measures 8.1 x 6.9 x 6.6 cm (series 1502 image 53 and series 1302 image 14) that is heterogenously enhancing with central necrosis. There is loss of the fat plane between the mass and the uterus posteriorly as well as invasion into the bladder dome. Additionally, the lesion appears to invade into the left rectus abdominis muscle. There is thickening of the sigmoid colon that the lesion appears to be arising from.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mass that appears to be arising from the sigmoid colon with invasion into the bladder, to the uterus, and anterior abdominal wall. Enlarged pelvic lymph nodes.2.Mass in the left kidney most compatible with renal cell carcinoma with small retroperitoneal lymph nodes without evidence of renal vein invasion.


Instruction: Generate impression based on findings.

Input: Clinical question: Back pain radiating to both legs, numbness, weakness, please evaluate for cord compression. Signs and symptoms cord low back pain radiating to both legs and weakness. Nonenhanced total spine MRI:Examination demonstrate normal signal intensity and alignment the vertebral column.There is normal signal intensity and caliber of cervical, thoracic cord and conus without evidence of mass effect.Examination at L4 -- L5 demonstrate moderate degenerative disk disease, loss of disk height and a large disk extrusion with resultant moderate to severe central spinal stenosis. Unremarkable images through the lumbar spine otherwise.The finding in the lumbar spine will be followed with a pre-and post enhanced lumbar MRI for further assessment.Unenhanced lumbar MRI:The examination was terminated by patient after acquisition of a sagittal T2 and axial T2-weighted series of the lumbosacral spine.Examination demonstrate moderate disk disease and loss of disk height at L4 -- L5 level and mild to moderate bilateral ligamentum flavum hypertrophy. In addition there is a large central and rightward disk extrusion with mild superior migration behind the vertebral body of L4 in the right paramedian location. Above changes results in significant central spinal stenosis and moderate right neural foraminal compromise.Examination at T12 -- L1 through L3 -- 4 and at L5 -- S1 levels are unremarkable.Findings and concern on this exam were discussed with the ED staff DR, Cosban Travispager # 2678 at the time of review of exam.

Output: 1.Nonenhanced total spine MRI demonstrate normal signal intensity and caliber of the cord and conus without mass effect. No detectable degenerative changes of the spine, no detectable abnormality and no detectable spinal canal or neural foraminal compromise.2.Limited nonenhanced MRI of the lumber spine demonstrate a large central and rightward disk extrusion with partial superior migration behind the body of L4 and right paramedian location. This finding in addition the degenerative changes results in significant central spinal stenosis and moderate right neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: History of treated pituitary adenoma in 1990's: abnormal visual field. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Pituitary: The pituitary gland is not enlarged. The posterior pituitary bright spot and infundibulum are intact. There is no evidence of mass lesions. The imaged portions of the brain parenchyma, optic apparatus, and cavernous sinuses are unremarkable.

Output: 1. No evidence of recurrent pituitary tumor.2. Mild scattered T2 hyperintensity in the cerebral white matter is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Vertigo, headache, and small cell lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount secretions in the left sphenoid sinus.

Output: No evidence of intracranial metastasis or acute cerebral infarction.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: r/o stroke History: right hand weakness and numbness, transient aphasia Brain MRI:There band like restricted diffusion area on the left fronto-parietal operculum, most likely left subcentral lobule without evidence of hemorrhage, indicating acute ischemic stroke.Underlying brain shows scattered multifocal high signal intensities on FLAIR images on bilateral periventricular white matter indicate non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.3D 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. Acute ischemic infarction without hemorrhagic transformation on the left fronto-parietal operculum, most likely subcentral lobule.2. Non specific small vessel ischemic disease.3. Normal brain MRA and normal neck MRA.


Instruction: Generate impression based on findings.

Input: 60 year old male with a history of three vessel coronary artery disease, congestive heart failure, Hypertension, Diabetes, and CVA. DES placed in RCA in October 2014. Referred for cardiovascular MRI to evaluate for function and scar burden. Left VentricleThe left ventricle is normal in size with severely reduced systolic function. There is dyssynergy with a regional wall motion abnormality and myocardial thinning in the basal and mid inferolateral and lateral walls. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 62 ml/m2 (normal range 25+/-9), the LVESV is 138 ml (normal range 47+/-19), the LV mass index is 71 g/m2 (normal range 85+/-15), and the LV mass is 159 g (normal range 164+/-36). There is late gadolinium enhancement > 50% wall thickness seen in the basal and mid inferolateral and lateral walls. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 142 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 83 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 IVC is normal sized.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV systolic dysfunction2. Inferolateral and lateral wall motion abnormality with > 50% transmural extent c/w non-viability.


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with multiple sclerosis, assess for progression. Accounting for differences in technique, numerous scattered small foci of parenchymal T2 hyperintensity show no significant change in size. There may be one small new lesion within the left splenium of the corpus callosum, but otherwise the number of lesions appears grossly unchanged as well. None of the lesions demonstrates evidence of pathologic enhancement. The lesions show at most mild to moderate T1 hypointensity. No evidence of parenchymal edema or mass effect is seen. Brain parenchymal volume is relatively preserved. Ventricular size and morphology are within normal limits.

Output: There may be one small new lesion within the left splenium of the corpus callosum. Otherwise, accounting for differences in scan technique, no significant interval change is seen.


Instruction: Generate impression based on findings.

Input: Clinical question: 66 year old male with history of orthostatic hypotension, gait disorder, parkinsonism, suggestive of Multisystem Atrophy. Signs and symptoms: Status ataxia, orthostasis. Pre and post enhanced brain MRI:Unremarkable diffusion-weighted images. Examination demonstrates symmetrical bilateral mild prominence of cortical sulci slightly more pronounced in the parietal region for patient's stated age.Few punctate foci of FLAIR hyperintensity in the subcortical and periventricular white matter is a nonspecific finding however in proper clinical setting could represent minute chronic small vessel ischemic disease. There is no detectable signal abnormality of brain parenchyma otherwise on any of the MRI sequences and there is no detectable abnormal enhancement of brain parenchyma or the meninges.Calvarium and images through the orbits are unremarkable and without abnormal enhancement.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No acute intracranial process.2.Mild prominence of cerebral cortical sulci slightly more conspicuous in parietal lobes for age.3.Few punctate nonspecific FLAIR hyperintensity only in the periventricular and subcortical white matter.4.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Female, 19 years old, history of recurrent disseminated glio-neuronal tumor status post chemotherapy and radiation. Brain:Redemonstrated are findings related to left temporal craniotomy and tumor resection. The size and morphology of thickened T2 hyperintense tissue within the operative region has not significantly changed. Also unchanged is mild encephalomalacia effecting the pars orbitalis, and periventricular T2 hyperintensity along the left lateral ventricle, both likely related to prior treatment. Ex vacuo dilatation of the left lateral ventricle is unchanged.On postcontrast images, enhancing tissue along the left cavernous sinus, with extension into the prepontine and suprasellar cisterns, has not significantly changed in size or extent measuring 26 x 8 mm. More mild lobular enhancement which extends laterally into the left middle cranial fossa is also unchanged.Diffuse leptomeningeal enhancement persists including along the undersurface of the frontal lobes, the paramedian frontal sulci, left greater than right sylvian fissures, along the superior medullary vellum and vermian fissures, as well as along the ventral surface of the brainstem. Enhancement within the internal auditory canal, and along the cisternal optic nerves, is likewise unchanged.Spine:Areas of leptomeningeal enhancement along the right central cord at C2, and dorsally at C7-T1, are unchanged. No spinal cord edema is seen.Multiple areas of leptomeningeal enhancement in the thoracic region are also unchanged, including a plaque-like area along the right dorsal cord at T3, spinal root enhancement at T6, nodular right posterior cord enhancement at T12, and multiple smaller questionable areas of leptomeningeal enhancement from T8 through L1. No spinal cord edema is seen.Enhancement of vascular structures anterior and posterior to the conus is somewhat more prominent than on the prior examination, but this could also be technical. Thick enhancement within the central spinal canal and nerve root sheaths is not appreciably changed.A left paracentral disk protrusion at L5-S1 is stable. Mild bulging disk at C3-4 is also unchanged. No areas of significant canal or neuroforaminal stenosis are seen.Spinal alignment is unremarkable. Vertebral body morphology and signal characteristics are normal.

Output: 1.Intracranial findings are stable including areas of lobular soft tissue thickening within the left middle cranial fossa operative region, and fairly diffuse leptomeningeal enhancement.2.Stable leptomeningeal disease in the spine.


Instruction: Generate impression based on findings.

Input: Ms. Doyle is a 52-year-old female with a personal history of left breast lumpectomy in 2012 for IDC/DCIS treated with radiation. She has a family history of breast cancer in her mother, diagnosed at the age of 56. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.There are innumerable new rim-enhancing lesions seen bilaterally, many of which have internal fat density. When comparing to the same-day mammogram, these likely correspond to faint densities seen throughout both breasts, one of which is partially calcified in the left inferior breast. Stable postsurgical changes are identified in the left upper outer breast and left axillary region, consistent with patient's prior surgical history. Stable postsurgical changes of the left axilla are seen. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Multiple new rim-enhancing lesions seen bilaterally, many of which have internal fat density and probably correspond to faint densities seen on the same day mammogram. These findings likely represent new fat necrosis/oil cyst formation. Recommend confirmation of these findings with a bilateral breast ultrasound. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: U - Ultrasound Study Needed - No Letter.


Instruction: Generate impression based on findings.

Input: MRI thoracic spine: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. MRI lumbar spine: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1 level.T12-L1, L1-L2, L2-3, L3-L4: There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.  L4-L5: There is facet hypertrophy and mild disc bulge with resultant mild bilateral neural foramina narrowing. There is no spinal canal stenosis.L5-S1: There is right more than the left facet hypertrophy. Minimal disc bulge with severe right and mild left neural foraminal narrowing. There is no spinal canal stenosis.

Output: 1. MRI of the thoracic spine is unremarkable.2. Degenerative disc changes in the lumbar spine worst at L5-S1 with resultant severe right and mild left neural foraminal narrowing. There is no spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Assess for possible lesion in left optic nerve detected on brain MRI. Mass in the right parotid. Orbits: There is no evidence of intraorbital optic nerve lesions. The globes, lacrimal glands, extraocular muscles, and orbital fat are unremarkable. However, there is an infiltrative, enhancing mass that involves the right parotid and parapharyngeal spaces, with extension into the right jugular foramen and hypoglossal canals, projecting slightly into the cerebellomedullary junction. Brain: There is swelling and enhancement of the bilateral prechiasmatic and intracanalicular optic nerves, measuring up to 6mm on the left and 4 mm on the right. There are patchy foci of T2 hyperintensity within the brainstem, medial cerebellar hemispheres, and inferior left basal ganglia region. There is also a subcentimeter probable right peritrigonal perivascular space. There is no evidence of intracranial hemorrhage or acute infarct. There is prominence of the medial left middle cranial fossa subarachnoid space associated with mild deformity of the adjacent sphenoid bone. 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. Findings compatible with small prechiasmatic and intracanalicular optic nerve gliomas, left larger than right, which can be associated with neurofibromatosis type 1.2. An infiltrative, transpatial right facial mass with extension into the right jugular foramen and hypoglossal canals may represent a peripheral nerve sheath tumor, such as a plexiform neurofibroma, which can be associated with neurofibromatosis type 1.3. Patchy foci of T2 hyperintensity within the brainstem, medial cerebellar hemispheres, and inferior left basal ganglia region may also represent stigmata of neurofibromatosis type 1. 4. Suggestion of mild left sphenoid dysplasia, which can be associated with neurofibromatosis type 1.Discussed with Dr. Baroody at 1:30 PM on 2/24/16.