Instruction: Generate impression based on findings.

Input: Gait abnormality, paresthesias. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter. Lesions include one adjacent to the right temporal horn as well as involving the lateral aspect of the middle cerebellar peduncle on the left including the nerve root entry zone of the left trigeminal nerve. Susceptibility effect noted in the left lateral middle cerebellar peduncle and along the lateral pons on the left. Few ovoid lesions perpendicular to the ventricle are also seen. Small focus of susceptibility measuring 4 mm is seen involving the right posterior frontal lobe, compatible with chronic microhemorrhage.No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Mild mucosal thickening in the paranasal sinuses and small maxillary mucous retention cysts are seen . Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Multiple T2/FLAIR hyperintense white matter lesions including few which are ovoid and perpendicular to the lateral ventricles, one lesion adjacent to the right temporal horn, as well as one involving the left lateral aspect of the middle cerebellar peduncle on the left adjacent to the trigeminal nerve root entry zone. Appearance and distribution of these lesions is suggestive although not diagnostic of demyelinating disease.2. 4 mm focus of susceptibility effect in the right posterior frontal lobe as well as multiple foci along the left pons and left middle cerebellar peduncle compatible with chronic microhemorrhages. Left middle cerebellar peduncle/left trigeminal nerve root entry zone lesion described in #1 is in itself suggestive of chronic demyelination; however the presence of chronic hemorrhage would be unusual. As such, superimposed chronic small vessel ischemic disease with chronic hemorrhage including the left pons should also be considered.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is a well-circumscribed, 4 mm, T1 hypointense, T2 hyperintense, nonenhancing focus within the pineal gland consistent with simple renal cyst. The ventricles and sulci are normal in size. Lateral ventricular asymmetry is within acceptable limits of normal anatomic variation. 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:There is subtle increased T2 hyperintensity involving the anterior aspect of the cord extending from approximately C7 inferiorly to T6 without associated enhancement. There are no osseous dysplasias or stenoses. The conus terminates at an appropriate level. There are no findings of tethered cord or fatty filum.

Output: 1.There is subtle increased T2 hyperintensity involving the anterior aspect of the cord extending from approximately C7 inferiorly to T6 without associated enhancement. Given the clinical history of acute onset a sending paralysis, this appearance can be seen in the clinical setting of Guillain Barre.2.4 mm simple pineal cyst, otherwise negative brain MRI.


Instruction: Generate impression based on findings.

Input: Knee pain. Has screws in right proximal tibia. Exam slightly limited due to susceptibility artifact from metallic hardware.MENISCI: Lateral meniscus is grossly intact given limitation of susceptibility artifact. Medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Two metallic screws affix a healed fracture of the tibial plateau in anatomic alignment.LIGAMENTS: Collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Postoperative changes without evidence of hardware complication. No specific findings to account for the patient's knee pain.


Instruction: Generate impression based on findings.

Input: 82 years Female (DOB:1/3/1934)Reason: meningioma growth History: dizzinessPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are multiple punctate-sized foci of signal loss on susceptibility weighted imaging located along subcortical white matter predominantly in the right hemisphere. This has not changed significantly compared to the previous exam. In addition there is a punctate focus of signal loss on susceptibility imaging in the left cerebellar hemisphere just lateral to the left dentate nucleus. This is also stable.There is a gyriform linear signal hypointensity on susceptibility imaging along the surface of the brain adjacent to the right precentral sulcus.There is an extra-axial nodule present adjacent to the right postcentral sulcus measuring 7 mm in size with a broad-based the dura which is unchanged in size compared to the prior exam. It is bright on T1-weighted imaging and is associated with susceptibility effect. It is also identified on the CT from 4/9/2014 where it is calcified.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery appears to be hypoplastic and not readily visualized intracraniallyThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Since the prior exam there does not appear to be any significant change. There is redemonstration of multiple microhemorrhages within the subcortical white matter of the supratentorial brain bilaterally but predominantly in the right hemisphere and also in the left cerebellar hemisphere. This asymmetry is of uncertain significance.2.There appears to be hemosiderin deposition along the left precentral sulcus which was also identified on the prior exam and most likely indicates that prior subarachnoid blood was present at this location.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.There is a stable 7 mm calcified extra-axial lesion present adjacent to the right postcentral sulcus most likely represent a burnt out meningioma.


Instruction: Generate impression based on findings.

Input: Clinical question: ?Parkinsons CBD? Signs and Symptoms: tremor L, hyperreflexia L>R, increased tone Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates patchy foci of cystic encephalomalacia only in the periventricular and subcortical white matter of cerebral hemispheres. Findings are nonspecific however considering patients stated age of 74 they likely represent chronic microvascular ischemic changes.Signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.There is a slight generalized prominence of the cortical sulci which is within expected normal range for patient's stated age. Ventricular system remain in normal and the maintained midline.The signal right overall major intracranial arterial branches are identified.Unremarkable images through the orbits. Extensive opacification of the sphenoid sinus consistent with sinusitis and unremarkable other visualized paranasal sinuses and mastoid air cells.Nonenhanced cervical spine MRI:Examination demonstrate normal anatomical alignment the vertebral column however with mildly reversible of cervical lordosis.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild degenerative changes and unremarkable otherwise.C4 -- C5 demonstrate moderate disk disease and loss of disk height. There is mild left neural foraminal compromise and unremarkable otherwise.C5 -- C6 demonstrate moderate disk disease and loss of disk height, minimal facet and ligamentum flavum hypertrophy, mild left neural foraminal compromise and unremarkable otherwise.C6 -- C7 demonstrate moderate disk disease, loss of disk height, minimal ligamentum flavum hypertrophy, mild left neural foraminal stenosis however without spinal stenosis.C7 -- T1 is unremarkable.There is normal signal intensity and caliber of cervical and uppermost visualized thoracic cord at T4 level.

Output: 1.Nonenhanced brain MRI demonstrate no acute intracranial process. Moderate chronic nonhemorrhagic small muscle ischemic strokes only in the subcortical and periventricular white matter and unremarkable nonenhanced brain MRI otherwise stated age of 74. Extensive chronic sphenoid sinusitis and unremarkable other paranasal sinuses.2.MRI examination of cervical spine demonstrates mild to moderate degenerative changes with resultant mild reversal of cervical lordosis however without spinal stenosis at any level. Multilevel mild neural foraminal compromise as detailed per level above. Normal signal intensity and caliber of the cord.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and recent dislocation ROTATOR CUFF: There is no evidence of full-thickness rotator cuff tear. There is increased signal within the distal bursal surface fibers of the supraspinatus which may indicate mild interstitial tearing or tendinosis. The infraspinatus, subscapularis, and teres minor tendons are intact. The muscles of the rotator cuff are normal in signal and caliber.SUPRASPINATUS OUTLET: There is mild arthrosis of the acromioclavicular joint. There is no significant subacromial subdeltoid fluid. GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. There is flattening of the posterior and superior aspect of the humeral head representing a mild Hill-Sachs deformity. Additionally, there is fracture of the inferior glenoid and labrum representing a bony Bankart lesion. A focal articular cartilage defect of the glenoid is also noted. Additionally, there is loss of the normal fat signal within the rotator interval and poor visualization of the coracohumeral ligament which may indicate a component of adhesive capsulitis.BICEPS TENDON: A small amount of fluid surrounds the biceps tendon representing extension from moderate joint fluid. ADDITIONAL

Output: 1. Sequela of anterior dislocation including Hill-Sachs deformity and bony Bankart lesion.2. Moderate size joint effusion containing small foci of low signal which may represent cartilaginous debris.3. Findings suggestive of mild adhesive capsulitis.4. Mild tendinosis or interstitial tearing of the supraspinatus tendon. Otherwise there is no rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Seizures with history of ESRD on hemodialysis, lung cancer status post left lower lobe resection, diabetes, sarcoidosis. There are postoperative findings related to right frontal cranioplasty. There is less conspicuous subcortical white matter T2 hypointensity with relative cortical T2 hyperintensity in the right precentral gyrus region. There is diffuse cerebral and pontine white matter T2 hyperintensity, which appears slightly more extensive than previously. There is diffuse cerebral volume loss, which is more pronounced than previously. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Diffuse cerebral and pontine white matter T2 hyperintensity, which appears slightly more extensive than previously, is nonspecific, but may represent chronic microvascular ischemic disease. Otherwise, no evidence of acute infarction.2. Less conspicuous subcortical white matter T2 hypointensity with relative cortical T2 hyperintensity in the right precentral gyrus region, which may have been related to seizure activity.3. Diffuse cerebral volume loss, which is more pronounced than previously. 4. No evidence of gross intracranial tumor, although the assessment is limited due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: 18-year-old female with hip pain sports for a year, evaluate for labral tear.. ACETABULAR LABRUM: Curvilinear intermediate signal intensity is present between the anterosuperior acetabular labrum and adjacent cartilage compatible with an anterosuperior labral tear. Otherwise the remaining acetabular labrum appears normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal. Bone marrow signal is normal.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with an anterosuperior acetabular labral tear.


Instruction: Generate impression based on findings.

Input: Lesions in T3, T6, 7 T12 suspicious for myeloma. BMBX shows less than 10% plasma cells, visible lesions on skull. There is an enhancing lesion in the left posterior skull that measures up to 5 mm. Previously demonstrated additional punctate posterior skull lesions are no longer conspicuous. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A subcentimeter lesion in the left inferior parietal bone may represent a deposit of multiple myeloma. Previously demonstrated additional punctate posterior skull lesions are no longer conspicuous. 2. No evidence of intracranial tumor.


Instruction: Generate impression based on findings.

Input: Yearly surveillance of meningioma. There is a right frontotemporal dural-based mass that measures up to 12 mm in width versus 20 mm in 12/2014. There is confluent T2 hyperintensity in the underlying brain parenchyma, which likely represent vasogenic edema. There is scattered nonspecific cerebral white matter hyperintensity in the bilateral cerebral hemispheres, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is an unchanged patchy area of enhancement in the left parietal bone.

Output: 1. The right frontotemporal has decreased in size since December 2014.2. No evidence of acute intracranial hemorrhage. 3. Nonspecific, but unchanged patchy area of enhancement in the left parietal bone.


Instruction: Generate impression based on findings.

Input: Family history of breast cancer in sister (diagnosed at the age of 33) and paternal grandmother. Known BRCA2 mutation. She is enrolled in a breast cancer screening study for high risk individuals. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.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: 35-year-old female with history of metastatic breast cancer who presents for evaluation of liver nodules seen on recent CT examination. ABDOMEN:LIVER, BILIARY TRACT: There are innumerable ill-defined hepatic lesions. Some of the lesions have coalesced and demonstrate central necrosis and debris; these are most consistent with tumor response. Some of the lesions demonstrate diffusion restriction and peripheral enhancement; these findings are concerning for active metastatic disease. The reference lesion in the right lobe measures 26 x 20 mm (series 1304, image 249), unchanged. Centrally the bile ducts are narrowed secondary to extrinsic compression. Portal vein is patent.SPLEEN: Subcentimeter T2 hyperintense focus at the periphery of the spleen (series 601, image 27) is nonspecific without evidence of enhancement.PANCREAS: There is interstitial and peripancreatic edema.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Linear T1 and T2 hypointensity of the right kidney without evidence of enhancement is consistent with a scar.RETROPERITONEUM, LYMPH NODES: Reference porta hepatis lymph node measures 20 x 12 mm (series 601, image 27), previously measuring 20 x 13 mm. Reference aortic lymph node measures 13 x 12 mm (series 601, image 15), unchanged.BOWEL, MESENTERY: Partially visualized ascites and diffuse mesenteric haziness. Carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Persistent small right pleural effusion. Bilateral basilar subsegmental atelectasis.

Output: 1.Innumerable ill-defined hepatic lesions. Findings consistent with mixed response with necrosis and active tumor. 2.Findings concerning for acute pancreatitis. Correlation with lipase is recommended.3.Stable porta hepatis lymphadenopathy.4.Centrally bile ducts are narrowed secondary to extrinsic compression5.Stable small right pleural effusion.


Instruction: Generate impression based on findings.

Input: Autoimmune encephalitis: increased headache and balance problem. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There appears to be persistent mild asymmetrically high T2 signal in the right hippocampus. The rest of the brain parenchyma appears unremarkable. There is a punctate focus of susceptibility effect and enhancement in the central pons, which likely represents a teleangiectasia. 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 are bilateral maxillary sinus retention cysts, left larger than right.

Output: Apparent persistent mild high T2 signal in the right hippocampus may be related to the autoimmune encephalitis.


Instruction: Generate impression based on findings.

Input: 55-year-old female presents with altered mental status and a prior CT demonstrating cerebellar infarcts. Examination is mildly motion degraded. No restricted diffusion to suggest acute ischemia. No evidence of acute intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. There is multifocal encephalomalacia in the bilateral cerebellar hemispheres likely related to prior infarcts. There are foci of susceptibility within these regions likely reflecting hemosiderin deposition. There is also a small chronic cortical infarct in the right occipital lobe. Major flow-voids are preserved. There is a partially empty sella. Remainder of the calvarium and extracranial soft tissues are grossly unremarkable

Output: 1. No evidence of acute ischemia.2. Multiple chronic bilateral cerebellar infarcts with foci of susceptibility indicating chronic hemorrhage. There is also a small chronic right occipital cortical infarct.3. Mild chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question:? New metastases. Signs and symptoms: History of pituitary carcinoma now with new onset of right hand tremor No evidence of new hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Changes at the level of the sella consistent with patient's past history of pituitary carcinoma remains is stable. Focal area of enhancing tissue along the medial aspect of right middle cranial fossa also remains a stable. Review of prior MRI examination from 7 -- 22 -- 2009 and CT of brain dated 7 -- 31 -- 2009 demonstrates this lesion and in comparison to the current exam no appreciable change is detected.

Output: No definitive evidence of new findings since prior study of 7 -- 31 -- 2009.


Instruction: Generate impression based on findings.

Input: Right proximal humerus lesion. Evaluate for interval change. Small round lucent lesions with sclerotic margins are again noted in the humeral head and glenoid likely representing degenerative subchondral cysts as seen on prior MRI. Small glenohumeral joint osteophytes are also noted. The distal clavicle is slightly high riding relative to the acromion, which may reflect mild chronic separation, but this is not necessarily of any current clinical significance.

Output: Small round lucent lesions in the humeral head and glenoid likely represent degenerative cysts.


Instruction: Generate impression based on findings.

Input: History of rectal cancer presents for restaging status post chemotherapy. PELVIS:PROSTATE/SEMINAL VESICLES: Heterogeneously enlarged prostate gland.BLADDER: No significant abnormality noted.LYMPH NODES: The perirectal space lymph nodes are markedly decreased in size and restricted diffusion. The reference lymph node at the level of the rectosigmoid junction on the left measures 8 x 5 mm (series 4/13), compared to 1.4 x 0.9 cm previously.BOWEL, MESENTERY: The previously seen intermediate T2-weighted signal intensity solid rectal lesion has significantly decreased in size and is now predominantly markedly low signal intensity on T2-weighted imaging affecting the left posterolateral aspect of the rectum (series 4/40) likely reflecting post radiation scar tissue, measuring approximately 1.6 x 0.9 cm (series 4/40). Interval decrease in restricted diffusion associated with the rectal mass.BONES, SOFT TISSUES: Presacral soft tissue stranding and minimal fluid is likely treatment related.OTHER: No significant abnormality noted.

Output: Interval marked decrease in rectal mass size and decrease in perirectal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left knee was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 20 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 30 seconds.

Output: Fluoroscopic guided injection of dilute gadolinium into the left knee for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: Follow up of a pituitary lesion. There is a cystic lesion within the sella that measures up to 10 mm in height and contains a globular focus of T1 hyperintensity. The pituitary gland is distorted by the lesion, but there is no mass effect upon the optic apparatus or cavernous sinuses. There is an enlarged retrocerebellar cerebrospinal fluid signal space.

Output: 1. A cystic lesion within the sella may represent a Rathke cyst or cystic adenoma that contains subacute hemorrhage.2. An enlarged retrocerebellar cerebrospinal fluid signal space may represent an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Severe hip pain. Examination is limited without the contralateral hip for comparison and/or plain film correlation.There is small amount of fluid along with moderate enhancement of the capsule of the right hip. There is joint space narrowing and bone-on-bone apposition with resulting edematous changes of the femoral head and acetabulum. No frank erosions are observed, but plain film correlation may be obtained if clinically warranted. The SI joint is partially imaged and appears within normal limits.

Output: Findings compatible with right hip synovitis with superimposed osteoarthritic changes concerning for, but not definitive of inflammatory arthritis.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for meniscal tear History: pain on medial aspect of the knee MENISCI: There is minimal intrasubstance degeneration of the posterior horn of the medial meniscus. The anterior horn of the lateral meniscus is severely deformed and blunted indicating severe degeneration which extends into the body of the meniscus. There is linear increased signal abnormality within the posterior horn of the meniscus indicating a complex degenerative tearing with a large horizontal component that extends to the femoral articular surface. There is intrasubstance degeneration of the posterior horn of the lateral meniscus as well.ARTICULAR CARTILAGE AND BONE: There is severe articular cartilage degeneration along the lateral tibiofemoral compartment with large areas of the lateral femoral condyle and lateral tibial plateau completely devoid of articular cartilage particularly above the posterior horn of the meniscus. There is bone marrow signal abnormality within the lateral tibial plateau and lateral femoral condyle likely degenerative in etiology.There is focal full-thickness articular cartilage degeneration along the medial femoral condyle above the body of the meniscus. There is subjective thinning of the articular cartilage posteriorly. There is superficial fraying of the articular cartilage along the lateral facet of the patella. There is full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea, centrally. There are tricompartmental osteophytes. LIGAMENTS: The cruciate and collateral ligaments appear intact. There is increased signal abnormality underlying the superficial band of the MCL which may represent a sprain in the correct clinical context. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis of the knee including extensive degeneration and degenerative tearing of the lateral meniscus as well as tricompartmental articular cartilage degeneration, most pronounced along the lateral tibial femoral compartment as described above.2. Moderate size joint effusion with a Baker's cyst. Multiple loose bodies within the joint and Baker's cyst as described above.3. Increased signal abnormality interposed between the superficial band of the MCL and meniscofemoral coronary ligament which may represent a mild MCL sprain in the correct clinical context.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female 72 years old s/p whipple for IPMN in 2009 now w/ MRCP evidence of 2 new cysts (body and tail) increasing in size on last MRCP - please eval for increase in size of cysts. ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes of Whipple are again noted. No focal liver lesion, biliary ductal dilation, or ascites. There is loss of liver parenchymal signal on out of phase imaging indicating hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: Postoperative changes of Whipple are again noted. The pancreatic tail is atrophic. The cystic, nonenhancing lesion within the pancreatic body measures 6 x 3 mm (series 1403, image 202), previously 7 x 3 mm. It again appears to communicate with the main pancreatic duct likely representing a side branch IPMN. The pancreatic tail the lesion also compatible with a sidebranch IPMN is unchanged in size (series 801, image 23).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The reference porta hepatis lymph node measures 1.4 x 1.1 cm (series 901, image 23), previously 1.4 x 1.2 cm. Additional scattered prominent retroperitoneal lymph nodes are stable to mildly decreased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes are again seen in the ventral abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Stable size and appearance of cystic pancreatic lesions compatible with side branch IPMNs.2.Mildly enlarged retroperitoneal lymph nodes are stable to decreased in size.


Instruction: Generate impression based on findings.

Input: 6-month-old male with history intraventricular hemorrhage. Rule out hydrocephalus. Slight decrease in size of extra axial fluid which remains moderate on the left and mild on the right. Slight decrease in size of left porencephalic cyst. Prominent ventricular volumes are stable except in the frontal horn of the left lateral ventricle which has increased in size secondary to ex vacuo dilatation as adjacent left cerebral mass containing internal calcification has decreased in size.No new hemorrhage identified.Within the porencephalic cyst anteriorly (image 29, series 2) there is a rounded density that appears slightly larger than the prior study. This may represent organizing hematoma and can be further evaluated with an MRI. The calvaria and skull base are radiographically normal.

Output: 1. Decrease in size of extra-axial fluid collection, porencephalic cyst, and left cerebral mass representing hematoma2. Rounded density within the anterior aspect of the porencephalic cyst is slightly larger than the prior study and may represent an organizing hematoma. Further evaluation may be performed with a brain MRI.


Instruction: Generate impression based on findings.

Input: Seizures, HIV +. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged encephalomalacia in the anterior left frontal lobe, left anterior temporal lobe, left basal ganglia, left thalamus. There is no abnormal intracranial enhancement. There is unchanged bilateral basal ganglia and deep cerebellar nuclei susceptibility effect, which may represent mineralization. The ventricles and basal cisterns are unchanged in size and configuration, including ex vacuo dilatation of the left lateral ventricle. 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. There is a subcentimeter adenoid retention cyst.

Output: Unchanged encephalomalacia in the anterior left frontal lobe, left anterior temporal lobe, left basal ganglia, left thalamus, but no evidence of intracranial hemorrhage, mass, abscess, or acute infarct.


Instruction: Generate impression based on findings.

Input: Stated history of celiac disease with intermittent diarrhea and abdominal pain. Evaluate for wall thickening for subsequent tissue sampling. ABDOMEN:LIVER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. No suspicious liver lesion. Portal vein and SMV thrombosis with multiple porta hepatis, perisplenic and gallbladder fossa collateral vessels. Gastric and esophageal varices.SPLEEN: Mildly prominent spleen measuring 14 cm in length.PANCREAS: Pancreatic tail cystic lesion measuring 1.6 x 1.5 cm, slightly increased from recent prior study without communication with the main pancreatic duct which is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent small bowel mesenteric lymph nodes are noted.BOWEL, MESENTERY: There is suboptimal small bowel distention by oral contrast. There may be an increased number of folds in the ileum. There is diffuse small bowel wall thickening, predominately of the jejunum, which may be in part due to under-distension. There is no significant asymmetric postcontrast enhancement or restricted diffusion. No significant bowel dilatation. Small volume of abdominopelvic ascites.

Output: 1. Diffuse small bowel wall and fold thickening without significant enhancement or restricted diffusion, increased number of folds in ileum suggested.2. 1.6 cm pancreatic body/tail cystic lesion without definite communication with the normal caliber main pancreatic duct. No suspicious post-contrast enhancement. Given the short-interval development of this cystic lesion a pseudocyst is suggested; however, correlation with the patient's clinical history and follow-up to resolution is advised.


Instruction: Generate impression based on findings.

Input: 70-year-old woman w/ severe PAD w/ h/o right BKA p/w left foot infection/gangrene of left foot. Assess for osteomyelitis Please note that this study is slightly limited as the patient was unable to hold still during the examination, and as such it was terminated early. There is destruction and abnormal signal intensity within the entire distal phalanx of the great toe with complete destruction of the tuft, with a similar appearance within the distal half of the proximal phalanx of the great toe. There is soft tissue irregularity and abnormal signal intensity in this distribution. These findings are compatible with osteomyelitis.

Output: Osteomyelitis of left great toe


Instruction: Generate impression based on findings.

Input: 64-year-old female with complex cystic neoplasm seen on CT 12/2015. Evaluate renal lesion. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal interpolar T2 hyperintense focus measuring 2.4 x 2.3 cm without evidence of enhancement; findings most consistent with a benign cyst. There is a focal area of renal cortex scarring adjacent to this cyst.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: Benign right renal interpolar cyst with focal area of adjacent renal cortical scarring.


Instruction: Generate impression based on findings.

Input: Male 20 years old Reason: Evaluate for abscess vs transverse myelitis History: lower back pain Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. Possible nonspecific mild diffusely decreased T1 bone marrow signal which is nonspecific but can be seen with marrow reconversion. No discrete suspicious osseous lesions. Focal area of low T1 and T2 signal in the right iliac bone which is nonspecific but may represent bone island. Imaged portions of the SI joints are unremarkable. No fluid collection or abnormal enhancement. No abnormal cord signal. T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is no significant compromise to spinal canal or neural foramina.L5-S1: There is no significant compromise to spinal canal or neural foramina.

Output: No evidence of abscess or other findings to account for patient's lower back pain.


Instruction: Generate impression based on findings.

Input: Enureses, numbness, and weakness of the bilateral lower extremities. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1-2 level. There appear to be punctate right L3-4 and L4-5 posterior facet joint synovial cysts. The paravertebral soft tissues are unremarkable.

Output: No evidence of low-lying conus medullaris, spinal canal stenosis or tumors in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Distal esophagus/gastroesophageal junction adenocarcinoma. Now with metastatic; was originally diagnosed in 1/2013 (s/p chemoRT, Ivor Lewis esophagectomy; cT2N1 -stage IIB in 5/2013). Study is at least mildly limited by patient motion. There is mild brain volume loss manifested by expansion of the ventricles and the other CSF-containing spaces. There are punctate T2 hyperintensities without diffusion restriction or mass effect in the frontoparietal white-matter, which are nonspecific but most likely from chronic microvascular ischemia. There is no space-occupying brain lesion. There is no midline shift or herniation. The major intracranial vascular flow voids are preserved, reflecting gross patency. There is no intracranial hemorrhage or abnormal diffusion restriction.There is no gross orbital abnormality. Minimal anterior ethmoid and maxillary sinus mucosal thickening is very nonspecific.

Output: 1.The study is mildly limited by patient motion and inability to complete the examination.2.No evidence of intracranial metastatic disease.3.Mild brain volume loss and trace frontal parietal chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: 23 year old male with history of non-ischemic cardiomyopathy with possible findings of non-compaction on OSH imaging who presents for cardiac MRI to evaluate for etiology of cardiomyopathy and non-compaction. Left VentricleThe left ventricle is moderately enlarged and moderately reduced in systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 125 ml/m2 (normal range: 74+/-15), the LVEDV is 263 ml (normal range 142+/-34), the LV end systolic volume index is 76 ml/m2 (normal range 25+/-9), the LVESV is 158 ml (normal range 47+/-19). There is hypokinesis of the apex and the distal lateral and inferior wall. There is mid-wall late gadolinium enhancement in the mid anterolateral wall. This pattern is atypical for myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.The non-compaction to compaction ratio of the left ventricle at end-diastole in the mid-anterolateral wall on short-axis imaging measures 2.3:1. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately to severely dilated and moderately reduced in systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 145 ml/m2 (normal range 82+/-16), the RVEDV is 304 ml (normal range 142+/-31), the RV end systolic volume index is 98 ml/m2 (normal range 31+/-9), and the RVESV is 205 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 mild 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 dilated in size and measures 31 mm.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately enlarged with moderately reduced systolic function (LVEF 40%). There is a regional wall motion abnormality.2. There is mid-wall late gadolinium enhancement in the mid anterolateral wall, suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The non-compaction to compaction ratio of the left ventricle at end-diastole in the mid-anterolateral wall on short-axis imaging measures 2.3:1. 4. The constellation of findings to include a NC:C ratio of 2.3, LV dysfunction, regional wall motion abnormality, as well as late-gadolinium enhancement supports the imaging diagnosis of non-compaction cardiomyopathy. 5. The right ventricle is moderately to severely dilated and moderately reduced in systolic function (RVEF 33%). 6. The main pulmonary artery is dilated and measures 31 mm.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with squamous cell carcinoma of the left eyebrow. The left supraorbital skin is thickened, irregular and enhancing. This abnormal tissue spans approximately 45 mm across the left forehead.This lesion invades the adjacent frontal bone involving the orbital roof and a small portion of the left frontal sinus. This component of the lesion measures 19 x 12 mm. This lesion completely traverses the left frontal bone and abuts the underlying dura. The dura adjacent to this region of contact is enhancing. No definite intraparenchymal lesions are seen.The lesion mildly encroaches upon the extraconal orbit. The lesion approaches the superior margin of the globe rather closely but there is no evidence of intraocular invasion. No intraconal disease is demonstrated at this time.Elsewhere in the brain, a few scattered foci of nonspecific T2 hyperintensity are demonstrated. No significant mass effect or parenchymal edema is demonstrated. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: A lesion is seen involving the left supraorbital skin compatible with a history of squamous cell carcinoma. This lesion invades the adjacent frontal bone with erosion of the orbital roof and the left frontal sinus.The lesion completely traverses the frontal bone and contacts the underlying dura. The dura adjacent to this region of contact is enhancing, which could represent an inflammatory reaction but the possibility of malignant dural invasion cannot be excluded. No definite brain parenchymal invasion is seen at this time.The lesion does invades the extraconal orbit to a mild degree. Tumor closely approaches and may even contact the superior surface of the globe, but no intraocular invasion is suspected.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of pelvis [C76.3] / Personal history of antineoplastic chemotherapy [Z92.21], Reason for Study: ^Reason: history of sacral teratoma (recurrent), treated with resection, chemotherapy and radiation. History: worsening back pain Subtle enhancing areas of the soft tissue at the level of lower sacral area indicating postoperative scar changes which are not completely included with current scan. In addition, comparing to outside MRI scan performed on July 2, 2016, the low signal intensity lesion around the left obturator foramen is not covered either.Therefore, this scan needs to be repeated without additional charge for complete evaluation of the postoperative status of sacrococcygeal lesion (known as teratoma).For the purpose of this dictation, the vertebral body demonstrates costochondral junction is labeled T12. Inhomogeneous MR signal intensities of sacrum and bilateral iliac bones may represent post radiation changes. There is no evidence of associated soft tissue mass. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. 10mm sized vertebral body hemangioma is seen. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: Minimal bulging of disc, disc dessication. No neuroforaminal narrowing or spinal stenosis.

Output: 1. The scan is incomplete and not include the left sacrococcygeal lesion seen on outside scan. Thus, needs to be repeated.2. Inhomogeneous bone marrow signal intensity of sacrum and bilateral iliac bones indicate postradiation changes.3. No evidence of soft tissue mass on this scan.4. Spinal cord signal intensity is normal.


Instruction: Generate impression based on findings.

Input: 63-year-old man with history of left upper quadrant subcutaneous mass and new right flank mass, not palpable on clinical exam. ABDOMEN:LIVER, BILIARY TRACT: Segment 8 hepatic cyst noted, otherwise the liver is normal in signal and morphology. The patient is status post cholecystectomy. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is atrophic and there is distal ductal dilatation with susceptibility artifact in the tail suggestive of calcification.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple bilateral renal cysts noted. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 9 mm subcutaneous area of susceptibility in the anterior right midabdomen (9/36) which correlates to a punctate metallic fragment on CT. No additional significant soft tissue abnormality is seen, specifically no abnormality in the left upper quadrant or the right flank.OTHER: No significant abnormality noted.

Output: No finding to explain the patient's symptoms, specifically no subcutaneous mass or hernia involving the left upper quadrant or right flank.


Instruction: Generate impression based on findings.

Input: 54-year-old male with history of colon/rectal cancer Large area of vasogenic edema and high convexity left frontal lobe contains an internal area of soft tissue density with central lucency. This finding is believed to represent a necrotic metastatic lesion which measures 28-mm x 26-mm in transaxial dimension (image 18). The edema causes subtle focal mass effect and no evidence of midline shift. No evidence of an additional lesion is detected. Further evaluation with dedicated MRI of brain with infusion is recommended.The bony density of calvarium demonstrates no evidence of metastatic lesions.

Output: Large necrotic mass with surrounding vasogenic edema in left high convexity frontal lobe consistent with a metastases lesion.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, altered mental status and history of epilepsy.Additional history obtained from the electronic medical record: PMHx of epilepsy (partial complex seizures), previous R MCA ischemic stroke with L side weakness with residual deficit, presenting with encephalopathy and dysarthria over the last 2 days. MRI brain: There are extensive patchy areas of restricted diffusion, compatible with acute infarct in the right anterior inferior frontal lobe, right superior frontal lobe, left posterior frontal lobe and left anterior parietal lobe, including the lateral left pre and post central gyri. There is T2/FLAIR signal abnormality in these regions. Additionally, there is high T1 signal in the anterior frontal lobe gyri, which may be related to petechial hemorrhage or mineralization. There is no large intraparenchymal hemorrhage.Large areas of encephalomalacia are redemonstrated in the right frontal and parietal lobes, as well as the right caudate and periventricular white matter, which is again compatible with chronic infarct. Associated ex vacuo dilatation of the right lateral ventricle is again noted. The ventricles are stable in size. There is evidence of chronic hemosiderin staining in the region of right frontal lobe infarct. Wallerian degeneration of the right cerebral peduncle is also again noted. Small chronic infarcts are redemonstrated in the right cerebellar hemisphere and right paramedian pons.Moderate abnormal T2/hyperintense signal in the periventricular and subcortical white matter is a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease. There is no extra-axial fluid collection, midline shift or herniation. No gross intracranial mass is identified. The major vascular intracranial flow voids are preserved at the skull base, compatible with gross patency. The paranasal sinuses and mastoid air cells are grossly clear.MRA neck: Postcontrast MRA images are nondiagnostic due to patient motion and difficulty with bolus delivery. A noncontrast time-of-flight MRA sequence was attempted. This, however, is also corrected by artifact and not reliable for interpretation.

Output: 1. Findings compatible with acute infarcts in the bilateral frontal lobes and left anterior parietal lobe. Suggestion of petechial hemorrhage or cortical laminar necrosis in the right frontal infarct region without gross hemorrhagic conversion. 2. Large chronic infarcts in the right cerebral hemisphere and multiple small infarcts in the right cerebellar hemisphere and pons are redemonstrated.3. Nondiagnostic MRA of the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 32-year-old female, 31 weeks pregnant, with history of C-section and area of placenta with loss of continuity with the myometrium PELVIS:UTERUS, ADNEXA: Intrauterine pregnancy is present. An anteriorly located placenta is noted. The anterior uterine wall is thinned with thinning of placental-myometrial junction with discontinuity suggested, flow voids seen extending beyond expected junction, as evidenced by disrupted thin T2 hypointense line on sagittal image 37 series 601. No evidence of placenta previa. Please note that this study was not specifically protocoled for evaluation of fetus, refer to fetal ultrasound study for additional findings. Endocervical canal measures 3.6 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction. The appendix is well visualized and within normal limits.BONES, SOFT TISSUES: Ventral abdominal wall musculature thinned.OTHER: No significant abnormality noted.

Output: 1.Findings suggestive of placenta increta. 2.No evidence of placenta previa.


Instruction: Generate impression based on findings.

Input: 13-year-old female with knee pain during sports. Evaluate for ACL tear, MCL tear. MENISCI: Medial and lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. There is T2 edema type signal in the lateral femoral condyle, medial femoral condyle, and lateral tibial plateau.LIGAMENTS: There is complete tear of the anterior cruciate ligament. The PCL is intact. Lateral collateral ligament and medial collateral ligament are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Complete tear of the ACL. Bone contusion of the lateral femoral condyle, medial femoral condyle, and lateral tibial plateau.


Instruction: Generate impression based on findings.

Input: Susceptibility with corresponding areas of T2 hypointensity is again visualized in the basal cisterns symmetrically and along scattered bilateral supratentorial and infratentorial subarachnoid spaces, more prominent along the left greater than right occipital lobes, right temporal lobe, left parietal lobe, right greater than left sylvian fissure, and cerebellar sulci outlining the folia, especially along the superior vermis. There is also prominent susceptibility in the fourth ventricular outflow. Accounting for differences in technique between the T2* at 3T on this exam and GRE on the previous OSH exam, there is no significant change. Findings are more conspicuous on the current SWI images. There is no associated abnormality identified.The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. No diffusion-weighted abnormalities are identified. There is no abnormal enhancement within the brain.

Output: Superficial hemosiderosis of the basal cisterns and scattered supratentorial and infratentorial subarachnoid spaces appearing similar to the prior exam accounting for differences in technique, more apparent on SWI images. No causative abnormality identified.


Instruction: Generate impression based on findings.

Input: 44-year-old female with ankle pain and foot pain evaluate insertional Achilles tendinitis and peroneal tendinitis at the area of the cuboid/os peroneum. TENDONS: The peroneal tendons appear intact. The flexor and extensor tendons appear intact. There is thickening and increased signal abnormality within the distal Achilles tendon consistent with mild to moderate tendinosis. The Achilles tendon appears intact.LIGAMENTS: There is thickening of the anterior talofibular ligament suggestive of prior injury or sprain. The lateral collateral ligament complex and distal tibiofibular syndesmotic complex appears intact. The deltoid ligament appears intact. ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. ADDITIONAL

Output: Findings consistent with mild to moderate Achilles tendinosis without evidence of a tear. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Back pain, urinary incontinence, possible cord compression There is no evidence of acute cord compression or cord signal abnormality on cervical, thoracic and lumbar spine.There is about 5mm x 9.9mm sized ovoid high signal intensity on the right side of L23 facet joint area on STIR images (series 901, image 7/20). This may represent an artifact from adjacent vascular structure especially venous structure but could be an facet joint cyst or subcutaneous cyst. Further evaluation can be obtained with dedicated lumbar spine MRI if clinically indicated.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of T12-L1. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation.

Output: 1. No evidence of spinal cord compression.2. An ovoid high signal intensity lesion likely represent either artifacts or facet joint cyst or subcutaneous cyst as described above. If clinically indicated, dedicated lumbar spine MRI can be considered.


Instruction: Generate impression based on findings.

Input: Metstatic lung cancer treated with WBRT, Erlotinib, and MPDL3280A. There an unchanged enhancing lesion int eh right cerebellar hemisphere that measures 2 x 2 mm. There is no evidence of other There is encephalomalacia within the left gyrus rectus. There is also a chronic lacunar infarct in the left basal ganglia with hemosiderin deposition. There are a few scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage or acute infarction. There is a an unchanged enhancing extra-axial lesion along the left anterior clinoid process region. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is metal susceptibility effect in the left frontal calvarium.

Output: 1. Unchanged punctate metastasis in the right cerebellar hemisphere.2. Unchanged paraclinoid lesion may represent a meningioma.3. Encephalomalacia in the left gyrus rectus.


Instruction: Generate impression based on findings.

Input: Female, 59 days old, with sepsis due to group B streptococcus, assess for abscess or structural abnormality. Presumed meningitis. Corrected gestational age of approximately 36 weeks. Relatively symmetric extensive gyriform T1 and T2 hyperintensity is seen involving the bilateral occipital and temporal lobes with associated diffusion restriction in the occipital lobes. The region demonstrates patchy susceptibility compatible with blood product. Evidence of developing encephalomalacia is also seen, particularly in both occipital lobes and the anterior left temporal lobe.Extra-axial presumably subdural hemorrhage is evident along the anterior lateral right temporal lobe measuring up to 6 mm in thickness. Bilateral subdural hemorrhages are also evident along the cerebellar hemispheres. The sigmoid sinus flow voids are evident but the transverse sinus flow voids are not well seen. Along the right cerebral hemisphere, a subdural hematoma is noted measuring up to 5 mm in thickness with T1 and T2 hyperattenuating material layering dependently.A 10 mm parenchymal hemorrhage is evident at the left caudothalamic groove. Hemorrhage extends from here into the left frontal horn. A small amount of hemorrhage is also evident at the level of the foramen of Magendie. There may be some hemorrhage layering within the occipital horns versus purulent material.Cystic encephalomalacia is seen within the left frontal lobe. The brain parenchyma is generally T2 hyperintense which may represent a combination of edema and immature myelination. Hemosiderin staining is seen along the choroid plexi.On postcontrast imaging, sulcal vascularity is noted, but there are no discretely rim-enhancing fluid collections.

Output: 1.Abnormal gyriform signal is seen within the occipital and temporal lobes with evidence of restricted diffusion in the occipital lobes. Some but not all of this parenchyma demonstrates susceptibility indicating the presence of blood product . Findings possibly represent a combination of ischemic injury with some laminar necrosis and superimposed hemorrhagic staining. The presence of purulent material could also potentially contribute to these findings.2.Evidence of developing encephalomalacia is seen in both occipital lobes and the anterior left temporal lobe. Cystic encephalomalacia is present in the left frontal lobe.3.Subdural fluid collections are present along the right lateral temporal lobe and along the right cerebral hemisphere. Blood product is seen layering along the cerebellar hemispheres adjacent to the transverse sinuses. The transverse sinus flow voids are not well visualized which could represent obscuration or compression from adjacent blood product. However, the possibility of sinus thrombosis or occlusion cannot be excluded.4.A germinal matrix hemorrhage is demonstrated on the left with intraventricular extension. Blood product is seen within the left frontal horn, and at the foramen of Magendie. Blood product and/or purulent material may also be present layering within the occipital horns. 5.Most or all of the above findings can be accounted for by a combination of prematurity and intracranial infection. No definite rim-enhancing collections are seen to suggest abscess.


Instruction: Generate impression based on findings.

Input: 24 year old man with history of polysubstance abuse, found to have new biventricular failure and referred for cardiac MRI to evaluate for possible etiologies of his cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 181 ml/m2 (normal range: 74+/-15), the LVEDV is 301 ml (normal range 142+/-34), the LV end systolic volume index is 152 ml/m2 (normal range 25+/-9), the LVESV is 254 ml (normal range 47+/-19). There is global hypokinesis with regional variation. There is no evidence of LV thrombus seen. There is significant late gadolinium enhancement present as a mid myocardial stripe in the septum, and patchy, non-transmural involvement in the basal-mid anterolateral and basal inferolateral wall. Pattern is atypical for ischemic disease.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is severely dilated. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 98 ml (normal range 54+/-17).Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV systolic dysfunction with significant delayed enhancement in a mid-wall and patchy pattern which spares the endocardium.3. RV systolic dysfunction3. No LV thrombus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Encounter for examination for normal comparison and control in clinical research programClinical question: metastatic breast cancer r/o brain mets prior to starting on a clinical trial The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an ill-defined focus of enhancement present on the left half of the pons measuring 10 x 8 mm sagittal dimensions and 10 x 10 mm coronal dimensions which is predominantly high signal on T2, relatively subtle high signal on FLAIR and low signal on susceptibility imaging. On susceptibility imaging there appear to be serpiginous flow-voids associated with this. This is also identified on the CT scan from 3/2/2015 No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a punctate focus of signal loss on susceptibility imaging located in the left temporal lobe subcortical white matter along the left inferior temporal gyrus without any associated contrast enhancement.

Output: 1.There is a lesion present within the left pons. It is suspected to represent capillary telangiectasia, however, given the patient's clinical history of metastatic breast cancer a follow-up exam to further evaluate this would be prudent to ensure this doesn't represent an unusual metastatic focus.2.Left temporal lobe microhemorrhage in isolation is of unknown significance.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: No significant abnormality noted. Specifically menisci are well visualized and normal signal throughout. Properly anchored posteriorlyARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Specifically no focal defects or marrow signal abnormalityLIGAMENTS: No significant abnormality noted. Specifically the ACL and MCL are intact and well visualized EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal


Instruction: Generate impression based on findings.

Input: Redemonstrated are 2 brain enhancing lesions, presumed metastases, one involving the right parietal lobe and the other in the left cerebellar hemisphere, unchanged in appearance (changes in the appearance of contrast enhancement are likely technical in nature). There are no other new metastases. Associated vasogenic edema and mass effect are stable. Fiducials are in place. Midline shift and ventricular sizes are stable. The paranasal sinuses and mastoid air cells are essentially clear. Expected vascular flow voids are demonstrated.

Output: Redemonstrated are 2 brain enhancing lesions, presumed metastases, one involving the right parietal lobe and the other in the left cerebellar hemisphere. Fiducials are in place.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There is encephalomalacia in the medial inferior right cerebellar hemisphere. There is mild periventricular and subcortical white matter T2 hyperintensity which is nonspecific, likely representing chronic microvascular ischemic changes. There are chronic lacunar infarcts in the left caudate and along the basal ganglia bilaterally. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a mucus retention cyst or polyp in the left maxillary sinus. The skull and extracranial soft tissues are unremarkable.

Output: Mild chronic microvascular ischemic changes and scattered chronic lacunar infarcts and old right inferior cerebellar hemispheric infarct. No acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Planning for deep brain stimulator placement. Enhanced head CT:80 cc of Omnipaque 350 is administered for this exam.Stealth Enhanced head CT for surgical planning protocol is utilized.Minimal periventricular low attenuation of white matter is nonspecific and unchanged since prior head CT.There is evidence of a deep brain stimulator on the left side entering the calvarium from left paramedian frontal bone, traversing the left frontal lobe, entering the left lateral ventricle and with the tip of the stimulator at the level left cerebral peduncle. The appropriateness of this positioning should be decided by referring clinical physician.There is mild I. location of cortical sulci and ventricular system for patient's stated age of 34 similar to prior study. There is no evidence of any abnormal enhancement.A very small thin isodense subdural measuring approximately 2 mm in the frontal -- parietal region is again noted. Compared to prior MRI exam from 9 -- 8 -- 2011 there is interval decrease in the size of the subdural.

Output: 1.No evidence of acute intracranial findings.2.No evidence of abnormal enhancement.3.Left-sided deep brain stimulator with no change in position since prior study.4.A smaller residual left-sided frontal -- parietal subdural since prior MRI exam.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis complex: intractable epilepsy and autism. There is no significant interval change in size of the lobulated enhancing mass with areas of susceptibility effect in the left lateral ventricle, which measures up to 32 mm, previously also 32 mm. There is persistent mild vasogenic edema in the surrounding brain parenchyma. There is also an enhancing mass within the right lateral ventricle, which measures up to 8 mm, previously also 8 mm. There is slightly decrease prominence of the lateral ventricles, which are mildly dilated, and slightly increased diffuse periventricular white matter T2 hyperintensity. There is no significant interval change in numerous foci of subcortical T2 hyperintensity, some of which demonstrate enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. The left tympanomastoid fluid has resolved.

Output: 1. No significant interval change in size of bilateral lateral ventricular subependymal giant astrocytomas, left larger than right.2. Other stigmata of tuberous sclerosis are also not significantly changed.3. Interval resolution of the left tympanomastoid fluid.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: pre-opSigns and Symptoms: aphasia MRI of the brainThere is diffusion restriction involving the left frontal and parietal lobes as well as the insular cortex and the posterior superior aspect of the left temporal lobe predominantly in the territory of the superior division of the left MCA but including angular artery territory as well. There is a microhemorrhage present along the left parietal lobe within the area of infarction.There is midline shift present with 2mm shift of the septum pellucidum towards the right. There is mild displacement of the uncus medially.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Incidental note is made of cavum septum pellucidum and cavum vergaeNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, right middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is a paucity of vasculature in the left middle cerebral artery territory.The visualized portions of the paranasal sinuses demonstrate some scattered opacities in the mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Examination is mildly compromised due to patient motion.MRA brain:MRI examination is mildly degraded due to motion artifact.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, right middle and posterior cerebral arteries. There is occlusion of the left MCA at the bifurcation with sparing of the left anterior temporal artery and left prefrontal artery.There is no evidence for intracranial aneurysm.The left vertebral artery is hypoplastic distal to the origin of the left posterior inferior cerebellar artery.The anterior communicating artery is identified. There appears to be fetal origin of the right posterior cerebral artery with a hypoplastic right P1 segment and a medium sized left posterior communicating artery.

Output: 1.Subacute infarction along the left MCA territory associated with mild midline shift, mild uncal displacement medially and a couple microhemorrhages.2.Occlusion of the left MCA at the bifurcation with sparing of the left anterior temporal artery and left prefrontal artery.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Examination is mildly degraded on some of the sequences due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Pituitary tumor surveillance and history of prior infarcts. Pituitary: There are postoperative findings related to transsphenoidal surgery. There is an enhancing mass arising from the pituitary that measures up to 19 mm in craniocaudal dimension, previously 16 mm. The tumor protrudes into the left cavernous sinus, but there is no encasement of the carotid artery flow voids. There is also thickening of the infundibulum, which measures up to 6 mm in width. The tumor abuts the right prechiasmatic optic nerve. There is mild mucosal thickening in the sphenoid sinuses.Brain: There are subcentimeter foci of encephalomalacia in the right pons and basal ganglia. There is also an area of encephalomalacia in the right cerebellar hemisphere. There is a background of scattered T2 hyperintense foci in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration, with a cavum septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval increase in size of the pituitary macroadenoma.2. Chronic right pons, right cerebellar hemisphere, and right basal ganglia lacunar infarcts superimposed upon a background of chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 34 years Male (DOB:1/15/1982)Reason: hx GBM preop planning for resection History: none- preopPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI There is a heterogeneously enhancing lesion associated with cystic components located within the left frontal lobe which involves gray and white matter and associated with mass effect and involvement of the corpus callosum. Compared the prior exam of 7/20/2016 there is no significant change.The patient status post left frontal craniotomy.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Redemonstration of a left frontal lobe lesion which involves the corpus callosum suggestive of neoplasm. This does not appear to have changed since 7/20/2016. Please note the exam was performed for the purpose of stereotactic guidance during surgery and is limited.


Instruction: Generate impression based on findings.

Input: 28-year-old female. ACL repair in 2006. Medial knee pain instability. Evaluate for meniscus tear. MENISCI: Globular signal abnormality in the posterior horn of a diminutive posterior horn of the medial meniscus, likely representing degenerative tearing. The lateral meniscus is intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Fraying of the patellar cartilage at the apex with partial thickness defects. Tibiofemoral compartment cartilage is intact.LIGAMENTS: Postsurgical findings of ACL repair; the graft is not visualized at its femoral attachment consistent with a tear. PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. ACL graft tear.2. Degenerative tearing of the posterior horn of the medial meniscus.3. Chondromalacia of the apex of the patella with partial thickness defects.


Instruction: Generate impression based on findings.

Input: Headache. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum, but display rounded morphologies. The posterior fossa capacity appears to be relatively small. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum, but display rounded morphologies, and the posterior fossa capacity appears to be relatively small. MRI with CSF flow study may be useful for further evaluation of potential Chiari I malformation.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Shoulder pain. Evaluate for labral tear or rotator cuff tear ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Possible adhesive capsulitis. Otherwise negativee


Instruction: Generate impression based on findings.

Input: Reason: 52-year-old male followup PV thrombosis and SV thrombosis, HCC screening History: hepatitis B cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Superior mesenteric vein thrombosis is again seen near its confluence with the splenic vein. This thrombus is nonocclusive, appearing similar to the prior study. The portal vein is patent.Several subcentimeter liver cysts are again noted. Cirrhotic morphology of the liver is unchanged. Gastroesophageal varices are unchanged. No suspicious liver lesion is identified. Cholelithiasis without evidence of acute cholecystitis. Multiple prominent porta hepatis lymph nodes. SPLEEN: Splenomegaly is again noted with spleen measuring up to 17.5 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Nonocclusive thrombus of the SMV, unchanged from prior study.2.Cirrhotic liver morphology without suspicious masslesion.3.Gallstones without evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:8/10/1950)Reason: Please eval strokes and age of strokes History: Comatose patientPROVIDER/ATTENDING NAME: JASON T POSTON JASON T POSTON There is abnormally increased signal on T2 and FLAIR MR involving the lateral aspect of the right temporal lobe as well as the right parietal lobe. This is predominantly high signal on ADC map.There is a small focus of encephalomalacia in the left inferior frontal lobe gyrus.The susceptibility weighted imaging is substantially degraded due to patient motion. Many of the other pulse sequences are degraded to a lesser degree due to patient motion. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are opacified. The visualized portions of the orbits are intact.

Output: 1.Abnormal lesion involving the lateral aspect of the right temporal lobe and the right parietal lobe. Lack of diffusion restriction associated with cerebral swelling suggests that this does not represent a subacute infarction. It is possible this represents another entity such as gliomatosis cerebri or cerebritis. Please correlate with the clinical course.2.A small focus of encephalomalacia is present within inferior frontal gyrus. Most likely this is related to prior vascular insult.3.The exam is somewhat compromised due to patient motion which make sure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Female 56 years old Reason: asses for pancreatic mass History: family hx of pancreatic cancer LUNG BASES: Bilateral breast prostheses in situ.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Unremarkable appearance of the pancreas with no evidence of pancreatic mass. No pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild right pelvic caliectasis. Unremarkable appearance of the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Unremarkable appearance of the pancreas and pancreatic duct.


Instruction: Generate impression based on findings.

Input: 35-year-old with family history of breast cancer in her mother at age 34. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. A few benign enhancing foci are present bilaterally. No abnormal lymph nodes are identified in either axillary region. Normal lymph nodes in each axilla are present, correlating with mammograms.

Output: No MRI evidence for malignancy. Mammography screening will be due in December 2016.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Left eye ptosis with recurrent metastatic breast cancer. Rule out intracranial metastases. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Partially empty sella incidentally noted. Orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal is heterogeneous which is nonspecific; no focal destructive osseous lesions.

Output: No evidence of intracranial metastatic disease


Instruction: Generate impression based on findings.

Input: Lateral joint pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the knee.


Instruction: Generate impression based on findings.

Input: History of 3+4 adenocarcinoma in the left lateral apex. Patient used prophylactic antibiotics before and after the procedure asprescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500 mg bidstarting the night before the procedure. He took 2 tablets of Ciprofloxacin 500 mg beforethe procedure and will take two tablets after the procedure. Following the discussion ofthe risks, benefits, and alternatives of the procedure with the patient, informed consent was obtained forthe procedure. The procedure was performed under moderate conscious sedation.MRI focus in the left apex peripheral zone suspicious for patient's known cancer waslocalized with T2 weighted MR images. Following sterile preparation, Visualase laserablation template was placed on the patient's perineum and localized on MR images andregistered to the MR images where prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were insertedinto the left side of the prostate. Upon confirmation of the tip of the needle on theside close to the known lesion, laser ablation in the left apex was performed with15-W, 90 % power. This was repeated several times to adequately ablate the left apex peripheral zone. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images are obtained before and after administration of 14 ccMultiHance, upon completion of the procedure. On MR images of ablation defect was notedwithin and around the apical peripheral zone.COMPLICATIONS: None.

Output: Successful MR guided laser ablation of the left apex of the prostate.PLAN: The patient returned to the post-procedure area for monitoring. The patient will be discharged once he voids. If the patient is unable to void a Foley Catheter will be placed and the patient will follow-up with the Urology service.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post tumor resection. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Diffusion weighted images demonstrate expected tiny foci of restricted diffusion of the surgical cavity wall.Examination is to status post right posterior temporal -- occipital craniotomy. A serosanguineous field surgical cavity and with small post procedural air is identified. The cavity measures approximately a 21 x 46-mm in transaxial dimensions. Residual vasogenic edema surrounding the surgical cavity is identified with resultant subtle mass effect on the right lateral ventricle and adjacent cortical sulci.Post enhanced images demonstrate tiny interrupted linear muscular enhancement along the surgical cavity wall. There is however a thin irregular serpiginous enhancement present along the medial and superior aspect of surgical cavity which is highly suggestive of a small residual focus of tumor. This finding was within the region of tumor on preoperative study. Further follow-up with MRI is recommended. This finding measures approximately 1 at 15 x 21 mm in transaxial dimensions measured on axial post enhanced series 12 image 23.Postoperative subarachnoid air in the right frontal region is noted. No detectable additional foci of parenchymal signal abnormality or enhancement is noted. A tiny developmental venous anomaly of the right frontal cortex however is detected. This finding was present on prior exams and including the first MRI exam from 10 -- 13 -- 14 without change.

Output: 1.Status post resection right posterior temporal -- occipital tumor.2.Small focus of linear irregular enhancement along the medial -- superior aspect of the surgical cavity highly suspected of residual tumor as detailed/measured above.3.Residual peritumoral vasogenic edema and with regional mass-effect.4.Tiny focus of cortical and subcortical enhancement in the right frontal lobe highly suggestive of a tiny developmental venous anomaly remains stable since multiple prior studies and including first brain MRI exam from 10 -- 13 -- 14.


Instruction: Generate impression based on findings.

Input: Recurrent events suggestive of brainstem ischemia. Most recently double vision for two weeks. Enhanced CTA of intracranial circulation :65 cc of Omnipaque 350 is administered.3-D reformatted images were obtained utilizing an independent workstation and where utilized for interpretation.There are patent and normal appearing bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery, posterior cerebral arteries and superior cerebellar arteries.There is normal anatomical variation of the left superior cerebellar artery arising from proximal left posterior cerebral artery.There are also patent bilateral internal carotid arteries across the skull base. The supraclinoid components of internal carotid arteries are unremarkable. Both anterior and middle cerebral arteries are visualized. There is focal slight ectasia of the proximal A2 components of the left anterior cerebral artery. The exact etiology of this finding is not clear. There is also no evidence of any additional foci of muscular cavitation. The finding could be secondary to atherosclerotic disease. Recommend follow-up.CTA of neck:Limited view of lower tic arch and the origins of the major vessels are unremarkable. There is anatomical variation a bovine arch evident by left common carotid artery arising from the cephalic branch.There are normal bilateral common carotid arteries, internal carotid arteries and including their origins.There is also normal appearing bilateral vertebral arteries and including their origins.Nonenhanced head CT:There is no detectable intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns all remain within normal limits. There are bilateral parietal subtle linear low attenuation that are suspected for perivascular spaces. Remote possibility of small vessel ischemic disease cannot be ruled out.Considering provided clinical data recommend an MRI examination for better evaluation.

Output: 1.Non-infused head CT is unremarkable. Considering provided clinical data and patient's symptomatology recommend brain MRI examination for further assessment.2.Unremarkable CTA of neck.3.CTA of intracranial circulation demonstrates a focal segmental dilatation of proximal left A2 segment of anterior cerebral artery. The exact etiology of this finding is not clear. Finding however could represent atherosclerotic disease. Recommend further follow.4.Unremarkable CTA of intracranial circulation otherwise.


Instruction: Generate impression based on findings.

Input: 67 year old male with a history of prostate cancer. Status post prostatectomy, now with biochemical recurrence and a palpable nodule on digital rectal examination. PELVIS:PROSTATE:Prostate Size: Surgically absent.Peripheral Zone: Surgically absent.Seminal Vesicles: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No evidence of lymphadenopathy. Note is made of multiple small, nonpathologically enlarged inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Postoperative changes of prior prostatectomy without evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Ms. Brown is a 45-year-old female with a strong family history of breast cancer in her mother, sister, and maternal grandmother. She presents today for MR imaging as part of her high risk protocol. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Stable enhancing mass in the left central breast, present on mammograms dating back to 2012. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Trace right pleural effusion present.

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


Instruction: Generate impression based on findings.

Input: 15-year-old girl with history of medial knee pain for 3 years. MENISCI: The medial and lateral meniscus are normal without evidence of tear.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. The articular cartilage of the patellofemoral and tibiofemoral compartments is intact without of focal thinning or fissure.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. The popliteus muscle and tendon are intact.EXTENSOR MECHANISM: The extensor mechanism is normal. The patella appears normal.ADDITIONAL

Output: Normal left knee.


Instruction: Generate impression based on findings.

Input: seizure, R frontal contusions vs AVM vs mass. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a somewhat lobular appearing mass present centered in the lateral aspect of the left orbital gyrus adjacent to the left inferior frontal gyrus measuring 20 x 12 mm axial dimensions which has a surrounding low signal rim on T2 and FLAIR MRI and blooming on susceptibility weighted imaging. Centrally it is high signal on T1 and T2 and FLAIR. In general has a popcorn-like appearance.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate air-fluid levels in the maxillary sinuses and scattered opacities in the ethmoid air cells with air-fluid levels in the sphenoid sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a left frontal lobe lesion present which is suspicious for a cerebral cavernous malformation with recent hemorrhage based on its imaging characteristics.2.Opacification of the paranasal sinuses and nasal cavity. There is suspicion for acute sinusitis. Please correlate with clinical symptoms and history.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with right hip and low back pain radiating down the posterior right leg. Bone marrow signal intensity is diffusely low on all sequences including T2 and STIR. Superimposed are small areas of bright T2 signal within the left aspect of the L1 and L3 vertebral bodies though this signal does suppress partially on STIR images.A grade 1 anterolisthesis of L4 relative to L5 is seen. Vertebral body alignment is otherwise unremarkable. Vertebral body heights are preserved.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable.Loss of disc height and disc T2 signal is seen at L4-5 and L5-S1. Additional level specific findings are as follows:T12-L1: Mild bulging disc. No significant spinal canal or foraminal stenosis.L1-2: Unremarkable. L2-3: Facet hypertrophy. Minimal laterally bulging disc. No significant spinal canal or foraminal stenosis. L3-4: Facet hypertrophy with small facet effusions. Minimal laterally bulging disc. No significant spinal canal or foraminal stenosis. L4-5: Facet hypertrophy and ligamentum flavum thickening. Disc bulging and disc uncovering. Moderate spinal canal narrowing. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy. Bulging disc. No significant spinal canal stenosis. Mild right foraminal narrowing.

Output: 1.Diffusely abnormal low marrow signal intensity is seen which would be compatible with anemia, excess iron deposition perhaps from blood transfusions, or other marrow infiltrative processes.2.Focal areas of bright T2 signal which suppresses on STIR images in L1 and L3 probably reflect either hemangiomas or focal fatty sparing.3.Relatively mild degenerative findings are seen. These are most notable at the L4-5 level where spondylolisthesis, disc bulging and posterior element hypertrophy contribute to produce a moderate spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, 21 weeks gestational age, with abnormal prenatal ultrasound, neck teratoma suspected. A multiloculated, T2 hyperintense, predominantly cystic-appearing lesion is evident centered on the right parotid and masticator spaces. This lesion measures up to 27 x 23 x 18 mm. The lesion extends up to the floor of the middle cranial fossa but does not invade the intracranial space. There may, however, be some invasion of the temporal bone structures. Inferiorly, the lesion extends into the submandibular space. Medially, the lesion does appear to enter and encroach upon the nasopharynx. It is difficult to determine how much of the nasopharynx may be occupied by the lesion. The trachea is visualized and does not appear to be directly compressed or invaded by the lesion.

Output: A multiloculated, predominantly cystic appearing lesion is evident with the largest component centered on the right parotid and masticator spaces. Smaller lesion components are seen within the submandibular space, and it does appear that the lesion encroaches to some degree on the nasopharynx. It does not appear that the trachea is directly compressed by this lesion, but some degree of obstruction at the level of the pharynx cannot be excluded.Given the predominantly cystic appearance of this lesion, and its trans-spatial distribution, the differential diagnosis would include a lymphatic or veno-lymphatic malformation. Teratoma would also be reasonable consideration, though these typically show more discrete areas of solid tissue.


Instruction: Generate impression based on findings.

Input: Possible Chiari malformation, headaches, and back pain. The cerebellar tonsils are minimally low-lying, extending up to 3 mm inferior to the foramen of magnum. The cerebellar tonsils display a normal morphology and there is intact CSF flow across the foramen magnum. The spinal cord displays normal signal and morphology, without evidence of syrinx. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Minimally low-lying cerebellar tonsils with intact CSF flow across the foramen magnum and no evidence of cervical spinal cord syrinx.