Instruction: Generate impression based on findings.

Input: Clinical question: Ependymoma? AML? Leptomeningeal spread? Signs and symptoms: Right arm weakness. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Mild uniform prominence of cortical sulci and cerebellar-vermian folia and mild prominence of the lateral ventricles for patient's stated age with maintained midline remains similar to prior exam 1-30-2015. No evidence of edema or mass effect and no detectable abnormal parenchymal or leptomeningeal enhancement.Mild to moderately dilated fourth ventricle and postoperative changes of right sided suboccipital craniectomy remain similar to prior exam and without abnormal enhancement.The signal void of major intracranial arterial branches are unremarkable.Unremarkable images through the orbits which includes axial fat sat post enhanced series.Unremarkable images through the paranasal sinuses.Significant interval improvement of opacification of bilateral mastoid air cells since prior study.Pre and post enhanced cervical MRI:There is signal abnormality of the skull base and C2 consistent with prior radiation change.Post operative changes of a chronic suboccipital craniectomy.Normal anatomical alignment of the vertebral column and with no detectable foci of abnormal signal intensity or abnormal enhancement.Normal signal intensity and caliber of the cervical and upper most visualized thoracic cord without abnormal enhancement to suggest metastatic disease.There is a tiny epidural defect at T1-T2 disc level on the left (sagittal T2, T2 STIR image 7 and sagittal T1 pre and post image 6) with questionable enhancement which is believed to represent a small disc/osteophyte. Finding is not associated with spinal stenosis or neural foraminal compromise.

Output: 1.Brain MRI demonstrated no evidence of recurrence of tumor or to meningeal carcinomatosis. Parenchymal volume loss as detailed. Interval significant improvement of bilateral mastoid air cell opacification with minimal residual.2.Cervical MRI demonstrate no evidence of metastatic disease. Small left disc/osteophyte at T1-T2 level. No spinal stenosis or neural foraminal stenosis. Post operative and radiation changes as detailed.


Instruction: Generate impression based on findings.

Input: Reason: Breast CA, new lesion right side of T12 suspicious for a metastasis. Please obtain core biopsies to document tumor. History: Pain at site of left rib fractures. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. No hematoma formation identified on post procedural images

Output: T12 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Known breast cancer patient with metastasis workup. There are multifocal vertebral body lesions likely represent metastasis, specifically, posterior and right side T2 body, T11, L1 body superior endplate, and L2 vertebral body.Nodular and patchy enhancement of conus medullaris, as well as filum terminale on Gad enhanced sagittal scan indicate intra thecal metastasis (series 1501, image 8/15).There is about 10% of chronic vertebral body compression fracture at T7.Spinal cord signal intensity is normal.There is no evidence of spinal canal stenosis or spinal cord compression. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. 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, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. There is a small vertebral body hemangioma at T2 vertebral body.There is about 10mm sized right renal cyst.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. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis.

Output: 1. No evidence of cord compression.2. Multiple vertebral body metastatic lesions as described above (T2, T11, L1 and L2)3. Nodular and patchy enhancement of conus medullaris and filum terminale indicate intra thecal metastasis.4. Old compression fracture, T7


Instruction: Generate impression based on findings.

Input: 32-year-old female, second trimester pregnancy, with concern for placenta accreta on sonography. Evaluate. PELVIS:UTERUS, ADNEXA: Intrauterine pregnancy is noted. There is no evidence of placenta previa. Posterolaterally, the placenta and myometrium is indistinct, raising suspicion for placenta increta (series 4, image 33).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Intrauterine pregnancy with indistinct placenta and myometrium posteromedially raising suspicion for placenta increta.


Instruction: Generate impression based on findings.

Input: 33 years Female (DOB:7/23/1982)Reason: Concern for new vasospasm History: no neuro deficits at this timePROVIDER/ATTENDING NAME: FERNANDO D GOLDENBERG FERNANDO D GOLDENBERG MRI of the brainNo diffusion weighted abnormalities are appreciated.The patient is status post posterior fossa craniotomy for right posterior inferior cerebellar artery aneurysm clip placement. A burr hole is present over where a prior ventriculostomy tube was located.Some punctate foci of susceptibility effect are present along the right half of the splenium of the corpus callosum in linear fashion along a prior ventriculostomy tube tract.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium sized.. The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. The posterior communicating arteries are medium-sized.There is extracranial origin of the left posterior inferior cerebellar artery.

Output: 1.The patient is status post clipping of a right posterior inferior cerebellar artery aneurysm. Please note that local recurrence cannot be evaluated on this exam due to artifacts. There are postsurgical changes present at the craniotomy site.2.There is no evidence for intracranial mass lesion.3.Is no evidence for vasospasm on the prior exam.4.No evidence for acute ischemic cerebral infarction.5.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Patient with metastatic lung cancer with mets to the right femur, status post chemo and radiation therapy. Please evaluate for change.IMAGE ACQUISITIONS: Contiguous noncontrast axial images of the right hip were obtained using routine protocol with coronal and sagittal reformats There is increased density in the medullary cavity of the mid femoral diaphysis measuring approximately 4 to 5 cm in craniocaudal dimension with endosteal scalloping of the posterior cortex consistent with a metastatic lesion. Please note that the current CT likely underestimates the exact craniocaudal extent of the disease as prior MRI study of 10/6/08 demonstrates the craniocaudad extent of metastases to be approximately 15 to 17 cm. A very thin line of contiguous peripheral cortex remains measuring approximately 1 mm, not significantly changed since prior study. There is stable surrounding ring of periosteal reaction.Aggressive demineralization is noted in the distal femur and around the knee joint.Mild osteoarthritis affects the right hip.

Output: Readministration of metastatic focus to the mid femoral diaphysis with large erosion of the posterior lateral endosteal cortex and very thin residual remnant of cortical bone posteriorly, essentially stable since MRI study of 10/6/08. The patient remains at increased risk for pathologic fracture.


Instruction: Generate impression based on findings.

Input: Ms. Oken is a 48 year old female with a personal history of right simple skin sparing mastectomy with immediate implant based reconstruction in 10/2012 for IDC/DCIS. Recently, patient had a benign right axillary lymph node biopsy in 2015. The patient is status post right skin sparing mastectomy with implant based reconstruction. The silicone implants are unchanged in contour and appearance. Minimal parenchymal enhancement is noted on the left. There is heterogeneous amount of fibroglandular tissue.No abnormal enhancement is seen in the left breast or the reconstructed right breast. No abnormal axillary lymph nodes are identified in either axillary region. A hydromark biopsy clip is seen in a right axillary lymph node, at site of recent benign biopsy.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified behavior of brainClinical question: glioma.Signs and Symptoms: glioma. The patient is status post left parietal craniotomy for removal of a left periventricular neoplasm. There is redemonstration of local loss of volume.There is redemonstration of confluent periventricular white matter signal hyperintensities on T2 and FLAIR MRI which have been progressing over time.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination has not changed significantly compared to the prior exam. There is no evidence for local recurrence.2.There is redemonstration and no significant change since the prior exam of periventricular white matter signal changes which are likely treatment related.


Instruction: Generate impression based on findings.

Input: Chronic osteomyelitis Again seen is heterogeneous signal intensity and enhancement within the subcutaneous fat posterior to the sacrum, favored to represent a combination of edema, scar tissue and heterotopic ossification. There is irregularity of the overlying skin, presumably reflecting ulceration. The signal intensity of the underlying sacrum appears normal and we see no findings to suggest osteomyelitis of the sacrum.Again seen is a deep ulcer along the left gluteal fold extending to the left ischium, which was present on the prior MRI as well as a CT scan from 2014. There is mild deformity and signal abnormality of the adjacent ischium reflecting the sequela of long-standing osteomyelitis. There are no findings to suggest disease progression and the signal abnormality is perhaps slightly less extensive than the prior exam. Heterogeneous signal intensity adjacent to the left ischium presumably represents edema, scar tissue and heterotopic ossification, similar to the prior study.An additional sinus tract is again seen extending from the right gluteal fold to the right ischium, but we see no signal abnormalities to suggest osteomyelitis in this region.Postsurgical changes of a right Girdlestone procedure are again seen. We see no abnormal signal intensity in the proximal right femur to suggest osteomyelitis.Again seen is deformity of the left proximal femur with adjacent heterotopic ossification, which appears unchanged from the prior MRI. Signal abnormality within the left femoral head anteriorly has increased from the prior exam and we suspect this is secondary to progression of osteoarthritis. Heterogeneous signal intensity in the soft tissues surrounding the left hip likely represents scar tissue and additional heterotopic ossification, and appears similar to prior.There is ankylosis of the sacroiliac joints, particularly on the right. There is diffuse muscle atrophy. Again noted is mild edema and enhancement of the gluteal and adductor musculature, but we see no findings to suggest an abscess.

Output: Sequela of chronic left ischial osteomyelitis and other findings as described above with no evidence of progression of disease. Increased signal abnormality within the left femoral head likely reflects progression of osteoarthritis.


Instruction: Generate impression based on findings.

Input: Reason: please evaluate the margins of the plexiform neurofibroma of her foot History: plexiform neurofibroma of toes and dorsum that has grown. Markers were placed along the forefoot dorsal to the middle phalanx of the second toe and dorsal to the neck of the second metatarsal. Between the the markers, within the dorsal soft tissues, there is a poorly marginated heterogeneous mass with signal intensity similar to skeletal muscle and fat on T1 weighted images and predominantly high signal intensity on T2 weighted images. The mass abuts the underlying metatarsal, proximal phalanx, and middle phalanx. The inferior aspect of the mass extends inferiorly between the heads of the second and third metatarsals, but the plantar soft tissues are unaffected. The mass measures approximately 3 x 2 cm in greatest transverse dimension and approximately 7 cm in longitudinal dimension. The extensor tendon of the second toe is not well visualized along/within the mass. The underlying proximal and middle phalanges appear ankylosed as seen on prior radiographs. We see no signal abnormality within the bones. We see no additional masses within the forefoot.

Output: Poorly marginated heterogeneous mass involving the dorsal aspect of the second toe as described above. The imaging characteristics are nonspecific; however this is compatible with a plexiform or unusual diffuse-type neurofibroma in a patient with a history of neurofibromatosis.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with severe headaches and family history of aneurysms. Also with neck pain. Assess for disk impingement. Brain:Numerous scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres, largely in a peripheral and subcortical distribution.No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected.No evidence of intracranial hemorrhage or abnormal extra axial fluid collection noted. The ventricles are normal in size and morphology.There is a mucus retention cyst in the right maxillary sinus. Bone marrow signal characteristics are unremarkable.C-spine:There is a slight reversal of the normal cervical lordosis centered at C5-6, unchanged. Alignment is otherwise unremarkable.Vertebral body morphology is within normal limits. Marrow signal characteristics are benign with evidence of mild likely degenerative endplate marrow edema at C5, C6 and C7.Very slight prominence of the central canal of the spinal cord is seen at the C6 and C7 levels measuring no more than 1 mm in diameter and likely within the limits of normal variation. No other areas of cord signal abnormality are seen.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild posterior disk osteophyte with a small superimposed right paracentral extrusion. The extrusion is smaller than on the prior examination. There is minimal flattening of the ventral cord but no cord signal abnormality. No significant generalized canal stenosis is seen. The foramina are patent. C5-6: Loss of disk height. Posterior disk osteophyte formation slightly asymmetric to the left. Mild spinal canal stenosis with slight ventral cord flattening but no cord signal abnormality. Mild bilateral foraminal narrowing. No significant interval changes. C6-7: Loss of disk height. Posterior disk osteophyte formation without cord impingement or significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No significant interval changes. C7-T1: Facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: 1.Numerous scattered small foci of white matter signal abnormality are seen in a predominantly peripheral and subcortical distribution. The differential for this finding is broad and would include chronic sequelae of migraine, vasculitis, or some other inflammatory process.2.No definite evidence of any active or acute intracranial abnormality is seen. Please note that this examination was not tailored for the evaluation of aneurysms. If such assessment is warranted, an MRA or CTA should be considered.3.Level cervical spondylosis is seen most severely affecting the C5-6 and C6-7 levels where there is loss of disk height, posterior disk osteophyte formation and minimal spinal canal narrowing as above. A small disk extrusion seen at C4-5 on the prior examination has become smaller.


Instruction: Generate impression based on findings.

Input: Rectal cancer staging. PELVIS:UTERUS, ADNEXA: Status post hysterectomy. The mass is suspected to involve the vaginal cuff. BLADDER: There is mass effect on the posterior wall of the urinary bladder by the large rectal mass without evidence of frank invasion. The lesion abuts the posterior bladder wall (series 4/21).LYMPH NODES: Locoregional and pelvic lymphadenopathy. 2.5 x 1.9 cm lymph node at the aortic bifurcation (series 3 image 6). Left external iliac lymphadenopathy measuring 2.3 x 1.7 cm (series 3 image 12).BOWEL, MESENTERY: There is asymmetric circumferential thickening of the distal rectosigmoid colon with a large multilobulated exophytic component. The inferior margin is approximately 9 cm from the anal verge and it measures 8.6 x 6.8 cm in cross-section demonstrating T2 weighted heterogeneous signal intensity (series 3/25). In the craniocaudal dimension the mass extends 7.8 cm (series 4 image 19). The mass extends beyond the mesorectal fascia most significantly along the left anterolateral aspect. The mesorectal fascia has nodular soft tissue thickening as well (series 3 image 32). The mass demonstrates a peripheral thick rind of enhancement with central regions of nonenhancement compatible with necrosis and demonstrates marked restricted diffusion.There are numerous adjacent pathologic lymph nodes and regional lymphadenopathy as described above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Distal rectosigmoid colon mass with a large exophytic component with locoregional and pelvic lymphadenopathy. The lesion abuts the posterior wall of the bladder and is suspected to involve the vaginal cuff.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of HCV cirrhosis with HCC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nodular liver contour compatible with cirrhosis. Segment 8/4a lesion measures 1.3 x 0.8 cm and demonstrates low T2 signal abnormality, no restricted diffusion, although rapid enhancement and washout.There are 3 additional subcentimeter segment 7/8 lesions which demonstrate abrupt enhancement which follows blood pool on delayed imaging.Cholelithiasis. Prominent periportal nodes.SPLEEN: No significant abnormality notedPANCREAS: Pancreas divisum.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Segment 8/4a lesion with imaging characteristics compatible with HCC which is stable in size compared to prior when accounting for the change in imaging modalities.2. Indeterminant segment 7/8 lesions are likely perfusional in etiology, however followup is recommended.3. Pancreas divisum.


Instruction: Generate impression based on findings.

Input: Chest wall pain There is indistinctness of the pectoralis major tendon at its insertion with surrounding T2 hyperintense signal consistent with tear. There is some retraction of the musculature medially. The signal of the remaining musculature is normal. The marrow signal of the humerus is normal.

Output: Tearing of the pectoralis major at the myotendinous junction with some medial retraction of the muscle.


Instruction: Generate impression based on findings.

Input: Male 42 years old with elevated bilirubin. Evaluate for biliary obstruction. ABDOMEN: Exam is somewhat limited due to patient motion.LIVER, BILIARY TRACT: Hepatomegaly. No focal liver lesion. There is an increase in signal intensity on out of phase images suggesting the possibility of iron deposition. There is no gallbladder wall thickening or cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate, loculated left pleural effusion with left basilar atelectasis and consolidation.

Output: 1.No biliary obstruction.2.Hepatosplenomegaly.3.Moderate loculated left pleural effusion with left basilar atelectasis and consolidation.


Instruction: Generate impression based on findings.

Input: 69-year-old female. Chronic low back pain. Rule out degenerative disk disease, facet arthropathy. Nonenhanced CT of lumbar spine:CT examination of the lumbar spine cannot evaluate for herniation of disk material. If acute herniated disk is suspected an MRI examination should be performed.A bony density of vertebral column is unremarkable. Minimal grade 1 antral listhesis at L4 -- L5 is noted and the alignment the vertebral column is otherwise unremarkable.Advanced degenerative disk disease at L1 -- L2 with vacuum phenomenon and to a lesser degree degenerative disk disease throughout the rest of lumbar spine is noted.T12 -- L1.Mild degenerative disk disease and hypertrophic changes of posterior elements. No central spinal stenosis or neural foramina compromise.L1 -- L2.Advanced degenerative disk disease and vacuum phenomena. Hypertrophic changes of the articulating facets more pronounced on the left with vacuum reading the left facet complex is present. No detectable central spinal stenosis. I suspect compromise of the neural foramina secondary to asymmetric hypertrophic changes of posterior elements.L2 -- L3.Mild degenerative disk disease and shallow broad-based bulge of disk material. No central spinal stenosis. Hypertrophic changes of posterior elements appears slightly more prominent on the left with resultant mild left neural foramina compromise. No central spinal stenosis.L3 -- L4. Mild degenerative disk disease and hypertrophy changes of posterior elements which appears a slightly more pronounced on the right. No central spinal stenosis. No definitive neural foramina compromise.L4 -- L5.Mild to moderate degenerative disk disease. Minimal grade 1 grade anterolisthesis.Moderate to advanced hypertrophic changes of posterior elements which is more prominent on the left and with vacuum from. There is no central spinal stenosis. No definitive neural foramina compromise.L5 -- S1.Mild to moderate degenerative disk disease with loss of disk height and vacuum phenomenon. Extensive hypertrophic changes of posterior elements on the right and minimally on. No central spinal stenosis. Mild broad-based bulge of disk material. Possible mild compromise of bilateral neural foramina.

Output: 1.Degenerative disk disease and hypertrophic changes of posterior elements throughout the lumbar spine as detailed.2.Discrepancy in the degree of hypertrophic changes of posterior elements between the two sides at multiple levels as detailed. No detectable scoliosis is present.3.No central spinal stenosis at any level.4.Mild neural foramina compromise as detailed per level above.5.This examination cannot evaluate for herniated disk is clinically questioned. If concern for herniated disk exist an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Dysarthria and vomiting. Evaluate for posterior circulation stroke. Brain MRI: There is an area of diffusion restriction and increased T2 signal in the right cerebellar hemisphere that measures up to 16 mm. There is also a punctate focus of diffusion restriction in the superior right postcentral gyrus. There are a few tiny scattered T2 hyperintense foci in the cerebral white matter that most probably reflect mild chronic microvascular ischemia. There is no evidence of intracranial mass lesions or hemorrhage. There is no midline shift or ventricular dilatation. The orbits and paranasal sinuses are unremarkable. The skull and scalp soft tissues are also grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions. The right internal carotid artery has a retropharyngeal course.

Output: 1. Foci of diffusion restriction in the right cerebellar hemisphere and right postcentral gyrus are compatible with acute infarcts. 2. No evidence of significant steno-occlusive lesions in the head and neck arteries.


Instruction: Generate impression based on findings.

Input: 15-year-old female with a history of ACL repair 6 months ago presents with left knee pain. Evaluate ACL. Suboptimal examination secondary to patient motion artifact.MENISCI: There is blunting of the posterior horn of the lateral meniscus which may represent post operative changes of prior partial meniscectomy. No signal abnormality is identified within either meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of osseous tunnels and metallic susceptibility artifact in the distal femur and proximal tibia consistent with the patient's history of prior ACL repair. There is severe articular cartilage degeneration along the lateral facet of the patella with irregularity and articular cartilage degeneration affecting the medial facet of the patella.LIGAMENTS: Postsurgical changes of prior ACL repair. The ACL graft appears intact. There is low signal intensity abnormality identified along the anterior aspect of the ACL graft which is suspicious for arthrofibrosis (cyclops lesion). The collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings consistent with anterior arthrofibrosis as described above, which may restrict terminal knee extension. The ACL graft appears intact. 2. Articular cartilage degeneration as described above.3. Blunting of the posterior horn of the lateral meniscus may represent postoperative changes from prior partial meniscectomy.


Instruction: Generate impression based on findings.

Input: The patient presents for a short term follow-up MRI for a benign appearing small mass in the left breast at lower outer quadrant. History of surgical excision of a benign papilloma the left breast in June 2009. History of benign biopsy of the right breast. Family history of breast cancer in her mother at age 49. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A small enhancing mass is unchanged in the lower outer left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 47 year-old male with new diagnosis of CHF with reduced EF. MRI to evaluate for myocarditis Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 146 ml/m2 (normal range: 74+/-15), the LVEDV is 275 ml (normal range 142+/-34), the LV end systolic volume index is 103 ml/m2 (normal range 25+/-9), the LVESV is 194 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 127 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is subepicardial late gadolinium enhancement involving the basal inferolateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process and could be consistent with old myocarditis.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 136 ml/m2 (normal range 82+/-16), the RVEDV is 259 ml (normal range 142+/-31), the RV end systolic volume index is 91 ml/m2 (normal range 31+/-9), and the RVESV is 172 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild-moderate mitral regurgitation. This may be underestimated.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsRound well-circumscribed mass noted in the spleen. Further characterization suggested using dedicated imaging. 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.The left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 29%. There is global hypokinesis with regional variation. There is subepicardial late gadolinium enhancement involving the basal inferolateral wall which could be consistent with old myocarditis.2.The right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 33%3.At least mild-moderate mitral and tricuspid regurgitation4.Moderate biatrial enlargement


Instruction: Generate impression based on findings.

Input: 52-year-old female presents for screening MRI. She is BRCA1 positive. She Has a family history of prostate and lung cancer in her father, ovarian cancer in her aunt and cousin. Known fibroadenoma in the right breast. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.The 5 mm round focus with a dark septation is again noted in the inferior and anterior aspect of the right breast and remains stable from the prior. This is most compatible with a fibroadenoma, which is benign. No additional abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable 5 mm benign fibroadenoma in the anterior right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: Right-sided radiculopathy. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is mild anterolisthesis at L5-S1 and exaggeration of lower lumbar lordosis.T11-T12 is unremarkable.T12-L1 demonstrate mild degenerative disease without spinal stenosis or neural foraminal compromise. L1-L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild degenerative changes, mild loss of disc height, moderate right and mild left ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in mild central spinal stenosis and moderate bilateral (right greater than left) neural foraminal compromise.L4-L5 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. A tiny disc extrusion in the midline is present. No spinal stenosis however moderate bilateral neural foraminal compromise is present.L5-S1 demonstrate moderate disc disease and loss of disc height, moderate to severe right facet hypertrophic changes and including facet fusion and mild left facet degenerative changes. There is resultant mild grade 1 anterolisthesis at this level. No evidence of central spinal stenosis however moderate left and moderate to severe right neural foraminal compromise is present.

Output: 1.Degenerative changes at L3-L4 results in mild central spinal stenosis.2.Degenerative changes at L5-S1 in particular asymmetric significant right facet hypertrophic changes resulting in significant right and moderate left neural foraminal compromise and mild grade 1 anterolisthesis.3.No spinal stenosis at other levels however there are neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Clinical question: History of epilepsy status post ablation. Signs and symptoms: Surveillance scan of ablation. Pre-and post-enhanced brain MRI:No diffusion weighted abnormality.Examination demonstrates a focus of T2/flair hyperintensity along the mesial aspect of right temporal lobe with evidence of internal susceptibility signal changes (blood product) representing the site of tracer activation. This focus measures approximately 23 mm in AP axis and 7-mm in transverse axis measured on axial T2 series 4 image 11. There is slight dilatation (ex vacuo) of the tip of right temporal horn adjacent to this finding. A thin linear band of susceptibility extends from this region posteriorly two right posterior temporal calvarium likely representing the track of previously removed DBS.Similar susceptibility linear changes are also noted extending from the medial aspect of the left temporal lobe posteriorly to the left posterior temporal -- occipital inner table of skull. Additional smaller similar finding is in the right frontal lobe extending from right frontal horn to the inner table of the skull. There is significant interval improvement of this finding since prior exam. There is residual tiny focus of flair hyperintensity representing small focus of encephalomalacia.There is generalized mild prominence of cortical sulci for patient's stated age of 21 without change since prior exams.There is also mild prominence of lateral ventricles without change since prior study. Post-enhanced images demonstrate patchy rim enhancement along the sites of right mesial temporal laser ablation. Compared to prior exam there is suggestion of interval decreased size of lesion a combination and the decreased extent of enhancement indicating interval improvement. There is also significant two near complete resolution of rim enhancement in the right frontal lobe at the level of the burr hole for surgical approach.Post-enhanced images also demonstrate a tiny left frontal developmental venous anomaly.

Output: 1.Small focus of hemorrhagic encephalomalacia in the mesial aspect of right temporal lobe at the site of laser ablation with patchy linear enhancement which demonstrates interval improvement since prior exam.2.Interval resolution of focus of enhancement in the right frontal lobe under a frontal burr hole representing track of surgical approach.3.Multiple tracts of hemosiderin deposition along the previously placed and removed DBS electrode and laser ablation device.


Instruction: Generate impression based on findings.

Input: 43 years, Male, chronic left-sided headache, mild left Horner's. Rule out structural lesion. Brain: Multiple sequences are mildly motion degraded. There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. There are two small foci of T2 hyperintensity in the right cerebellar hemisphere favored to represent chronic infarcts. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella is grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Orbits: Multiple sequences are mildly motion degraded. No abnormal mass or abnormal enhancement is seen. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable. Cavernous sinuses are also unremarkable.

Output: 1. No evidence of acute infarct, hemorrhage, or intracranial mass effect.2. Two small foci of T2 hyperintensity and volume loss in the right cerebellar hemisphere favored to represent small chronic infarcts. Brain parenchyma is otherwise unremarkable for age.3. MRI of the orbits is also unremarkable.


Instruction: Generate impression based on findings.

Input: Ms. Reilly is a 39-year-old female with BRCA mutation and family history of breast cancer in her mother and sister and a paternal aunt. She presents for high-risk breast screening MRI. No current breast related complaints. The patient had a an involuntary cough during acquisition of these images, creating mild motion artifact, which particularly affects the right breast.On postcontrast images, mild parenchymal enhancement is seen 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: 59 years, Male, Reason: cirrhosis History: Screen for HCC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT:Right liver morphology. Cholelithiasis.T2 hyperintense lesion within the right hepatic lobe which is isointense on postcontrast images is unchanged and likely represents a hemangioma (4/15).Subcentimeter enhancing focus seen only on arterial phase images is stable.There is a punctate focus of delayed enhancement (11/44) corresponding to a 7 mm lesion seen previously which is less apparent than the prior exam.SPLEEN: Borderline enlarged spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal 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: 1.Enhancing right hepatic lobe lesion is less apparent on the prior exam and remains nonspecific. No new suspicious hepatic lesions.2.Cirrhotic liver morphology.


Instruction: Generate impression based on findings.

Input: 77-year-old woman with history of left lower extremity ataxia. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged clusters of fluid signal in the inferior basal ganglia bilaterally. There are also scattered foci of cerebral white matter T2 hyperintensity bilaterally. There is mild diffuse cerebral and cerebellar volume loss. There are scattered, punctate foci of susceptibility artifact, which likely represent hemosiderin deposition or mineralization from prior microhemorrhages. There is no midline shift or herniation. There are postoperative findings in the left frontal sinus with osteoplastic flap and trapped secretions. There are lens implants bilaterally. MRA: There is no evidence of significant steno-occlusive lesions. There is no evidence of cerebral aneurysms or vascular malformations.

Output: 1.No evidence of acute cerebral infarct or hemorrhage.2.Diffuse cerebral white matter T2 hyperintensity may represent chronic small vessel ischemia. Otherwise, unchanged clusters of fluid signal in the inferior basal ganglia bilaterally likely represent prominent perivascular spaces. 3.No evidence of significant cerebral artery steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: History of hepatitis C. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Early arterial phase limits evaluation. Several hepatic cysts with the largest in the right hepatic dome. No suspicious arterially enhancing or washing-out lesion. No lesion corresponding to the abnormality seen on the prior ultrasound is seen. Normal hepatic morphology. No intra or extrahepatic biliary ductal dilatation. The gallbladder.SPLEEN: Normal size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing left renal cyst. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious liver lesion with several simple appearing cysts. No lesion corresponding to the abnormality seen on the prior ultrasound is seen.


Instruction: Generate impression based on findings.

Input: 65-year-old male with cerebellum dysfunction and recent fall There is a focus of hypodensity involving the right precentral gyrus white and gray matter corresponding to the area of restricted diffusion seen on prior MRI and likely represents an evolving subacute infarct. Subtle hyperdensity is seen along the precentral gyrus cortex which may represent laminar necrosis versus punctate petechial hemorrhage.A few hypoattenuating foci are seen in the periventricular region which is nonspecific but may represent small vessel ischemic disease of indeterminate age. There is no mass-effect, midline shift or edema. The ventricles and basal cisterns are normal in size and configuration.Minimal soft tissue swelling seen overlying the right parieto-occipital region without underlying fracture. The calvaria and skull base are radiographically normal. Partial opacification of the left maxillary sinus containing high density material which may represent inspissated mucus versus fungal sinusitis, grossly unchanged. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Findings consistent with an evolving right precentral gyrus subacute infarct as seen on the prior MRI. CT is insensitive for the early diagnosis of acute nonhemorrhagic infarct. MRI brain can be considered if clinically indicated.2. Redemonstration of left maxillary sinus sinusitis containing high density material which may represent inspissated mucus versus fungal sinusitis.


Instruction: Generate impression based on findings.

Input: Right knee pain, persistent. History of rheumatoid arthritis and sarcoid. Need to evaluate for synovitis from rheumatoid arthritis or other cause. Due to the patient's body habitus, the high-resolution knee coil could not be used. An alternative coil was used instead which results in slightly suboptimal image quality.There is mild intrasubstance degeneration of the menisci, but I see no discrete meniscal tear. Vertically-oriented intermediate signal intensity within the posterior horn of the lateral meniscus likely represents the interface with the meniscofemoral ligament of Wrisberg.There is marked degeneration of the articular cartilage of the patella, with the lateral facet essentially devoid of articular cartilage. There are small subchondral cysts. There is relatively mild degeneration of the articular cartilage of the femoral trochlea. Subjectively, the articular cartilage of the medial tibiofemoral compartment appears diffusely thinned. There is also a full-thickness defect of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus. I see no bone marrow edema or definite erosions.The cruciate and collateral ligaments are intact. There is a collection of peripherally-enhancing near-fluid signal intensity deep to the tibial collateral ligament suggesting a medial collateral ligament bursitis.The extensor mechanism is intact.There is a small amount of fluid within the joint extending posteromedially into a small Baker's cyst. There is enhancement of mildly thickened synovium indicating a mild synovitis.

Output: 1.Cartilage degeneration most severely affecting the patella.2.Mild synovitis.3.Collection of near-fluid signal intensity deep to the tibial collateral ligament suggesting a bursitis.4.Other findings as above.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, 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 hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 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: 54 seconds

Output: Successful injection of dilute gadolinium into the left hip for subsequent MR arthrography.


Instruction: Generate impression based on findings.

Input: History of major concussion, changes in memory. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Incidental note is made of xanthogranulomatous cysts. There is mild supratentorial and infratentorial volume loss including the superior cerebellar vermis. No particular volume loss involving the hippocampi.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1.Mild chronic small vessel ischemic changes. No intracranial hemorrhage or mass effect.2.There is mild global volume loss which appears within normal limits for age. There is mild relative increased volume loss involving the superior cerebellar vermis which is nonspecific but can be seen with chronic alcohol use. Examination is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: History of left breast cancer status post lumpectomy. Currently treated for stage 3 ovarian cancer. BRCA1 carrier. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. In the right upper outer breast, there is a peripherally enhancing area with central fat density. Based on it's position, this correlates to the area of dystrophic calcifications/fat necrosis. The lumpectomy site in the left outer breast is well seen, but there is no suspicious nodular or mass like enhancement near this site. A normal blood vessel is seen adjacent to the posterior aspect of the lumpectomy bed. Elsewhere, a few bilateral scattered non-uniquely enhancing foci are present.No abnormal lymph nodes are identified in either axillary region. Post operative change is seen in the left axilla. Port-a-cath noted in the right upper medial chest wall.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for growth of AA. Status post surgery, RT/TMZ. Now off all treatment. Signs and symptoms:AA. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Diffuse focus of flair hyperintensity in the high convexity left posterior frontal and parietal region is again identified and extends from the cortex to the ventricular wall of the left lateral ventricle. The extent of findings remains identical to prior exam. Within this region there is an irregular thin linear and focus of enhancement which appears nearly identical to prior exam. This focus of enhancement measures 27-mm in its longest AP axis and 22-mm in transverse axis identical to prior study. There is no appreciable mass effect with the above findings. There is mild expansion of trigone of left lateral ventricle similar to prior exam. There is no detectable pneumatosis RAO parenchymal signal abnormality or abnormal enhancement.

Output: Stable left hemispheric large focus of flair hyperintensity and internal irregular thin linear enhancement at the site of previously treated tumor.


Instruction: Generate impression based on findings.

Input: Abnormal movements: involuntary muscle spasms and convulsions diagnosed with PANDAS and Sydenham chorea. There is extensive inhomogeneity artifact that obscures and distorts the anterior portions of the head to variable degrees depending upon the particular sequence. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the basal ganglia, appears unremarkable. There is no abnormal intracranial enhancement. The lateral ventricles are perhaps on the larger end of the normal spectrum, but the sulci are not enlarged. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial tumor.


Instruction: Generate impression based on findings.

Input: Bitemporal hemianopia. There is no evidence of pituitary or other sellar region lesions. The infundibulum is intact and positioned in the midline. The optic apparatus and cavernous sinuses are intact. There is a small left maxillary sinus retention cyst.

Output: No evidence of sella region mass lesions.


Instruction: Generate impression based on findings.

Input: Female 61 years old Reason: abnormal exam History: none RIGHT LOBE MEASUREMENTS: 1.7 x 1.8 x 7.3 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.7 x 6 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal thyroid study.


Instruction: Generate impression based on findings.

Input: 24 years Female (DOB:6/6/1991)Reason: hx Chiari malformation and known cervical syrinx. Eval for changes, eval spine for syrinx length, History: headachesPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cerebellar tonsils are pointed inferiorly and extend 5 mm below the level of the foramen magnum.There is basilar invagination present associated with at least partial atlanto-occipital assimilation. The odontoid extends 12mm above Chamberlain's line and 15mm above McGregor's line. The C2-C3 disk space is small. The CSF space is effaced at the level of the foramen magnum and the cervicomedullary junction is deformed. The clivus is foreshortened.There redemonstration of a syrinx extending from C5 inferiorly into the thoracic spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge associated with mild disk dessication at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a very small right paramedian disk protrusion at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small right paramedian disk protrusion at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is very small relative to the right vertebral artery.MRI thoracic spine:There is a syrinx present extending from the C5 level to the T6-7 disk space level. Its maximum diameter is 2x5mm at the T4 vertebral level. There is a levocurvature to the thoracic spine.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.There is a compensatory dextrocurvature to the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Basilar invagination associated with suspected atlanto-occipital assimilation. CT of the cervical spine may be of further benefit in evaluating this. There is associated stenosis at the level of the foramen magnum with deformation of the cervicomedullary junction.2.The cerebellar tonsils are low lying (likely as a result of basilar invagination) giving a Chiari I malformation.3.Spinal cord syrinx extending from the mid-cervical to the mid-thoracic spine. Although the portions visualized on the prior exam appear stable compared to the current, There is no comparison thoracic spine MRI to assess progression.4.Sigmoid curvature to the thoraco-lumbar spine.5.The LVA appears hypoplastic.6.Mild degenerative changes are present in the cervical spine.


Instruction: Generate impression based on findings.

Input: 14-year-old with history of rhabdomyosarcoma of the cervix. One year off therapy. Evaluate for recurrence. No suspicious enhancing lesion identified. The uterus is normal in appearance measuring 4.4 x 4.5 x 5.0 cm. The ovaries are not well-visualized. Foci of T1/T2 low signal intensity within the vagina, likely represent foci of air. Bowel loops are normal in caliber, without evidence bowel obstruction. No osseous abnormality. Normal appearing subcentimeter inguinal lymph nodes. No lymphadenopathy.

Output: No evidence of recurrent disease. Remaining findings are unchanged.


Instruction: Generate impression based on findings.

Input: Enlarged thyroid. History of nodule. RIGHT LOBE MEASUREMENTS: Right lobe measures 4.0 x 1.5 x 1.3 cmLEFT LOBE MEASUREMENTS: The left lobe measures 6.3 x 2.2 x 2.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: The right lobe is heterogeneous with scattered calcifications. There is a 0.8 x 1.0 x 0.4 cm hypoechoic well marginated nodule adjacent to the isthmus.LEFT LOBE: The left lobe appears to be entirely replaced by a large heterogeneous nodule containing cystic areas as well as small calcifications. By patient history, this nodule was biopsied at an outside hospital. It measures approximately 6.3 x 2.2 x 2.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enlarged heterogeneous partially calcified mass replacing the left lobe of the thyroid as described; by patient history, this was biopsied at an outside hospital. Subcentimeter nodule in the right lobe, nonspecific but generally benign-appearing.


Instruction: Generate impression based on findings.

Input: 87-year-old female with basal ganglia lesion seen on recent head CT. Please further evaluate. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are subcentimeter areas of high T2 signal in the bilateral basal ganglia and right thalamus distinct from accompanying prominent perivascular spaces (etat crible). There is mild scattered T2 hyperintensity in the periventricular and subcortical white matter. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The right periorbital contusion has resolved.

Output: 1. Findings suggestive of chronic infarcts in the bilateral basal ganglia and right thalamus superimposed upon mild probable chronic small vessel ischemic white matter disease. 2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke. Structural lesions. Signs and symptoms: Memory issues, dizziness. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates minimal nonspecific foci of flair hyperintensity only in the subcortical and periventricular white matter bilateral cerebral hemispheres. Although nonspecific considering patient's stated age of 75 this appearance likely representing chronic small vessel ischemic strokes of mild degree. There is no significant change of this finding when compared with prior MRI exam from Morris Hospital dated 2 -- 6 -- 14.There is a slight generalized prominence of cerebral cortical sulci which although could be within upper limits of normal for patient's stated age of 75 mild underlying parenchymal bladder loss cannot be entirely excluded. This appearance is also stable since prior MRI exam. Ventricular system remains within normal size and maintained midline and without change since prior exam.Signal voids of major intracranial branches are identified and unremarkable.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses, mastoid air cells and orbits.Post enhanced images fail to demonstrate any abnormal enhancement of the brain parenchyma, leptomeninges, calvarium or the orbits. There is normal signal intensity of intracranial venous sinuses with normal pattern of enhancement.Nonenhanced brain MRA:Patent and unremarkable bilateral intracranial vertebral arteries, basilar artery and its branchespatent and unremarkable bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries. There is suggestion atherosclerotic disease of distal MCA branches in particular on the right with regions of mild sternum and compromise and without detectable distal vascular occlusion.

Output: 1.Pre-and post enhanced brain MRI demonstrate acute intracranial process. Findings suspicious for minimal chronic nonhemorrhagic small vessel ischemic strokes as detailed. Mild generalized prominence of cortical sulci may be at the upper limits of normal for age however mild underlying volume loss cannot be entirely excluded. There is no significant change of the findings since prior MRI exam from 2 -- 6 -- 14.2.Nonenhanced brain MRA demonstrate patent all major intracranial arteries. There is evidence of atherosclerotic disease more noticeably of the distal right MCA branches with resultant mild vascular lumen compromise and no vascular occlusion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Abdominal pain, other specified site. Backache, unspecifiedClinical question: evaluate for lumbar pathology for lower back pain and left sided abdominal painSigns and Symptoms: left sided pain and back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There are perineural cysts present at the S2-S3 level within the sacral spinal canal eccentric towards the right side. There is some mild disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height, disc desiccation and a diffuse disc bulge at this level associated with endplate reactive changes which are right on T2 and bright on T1. The endplate reactive changes are eccentric towards the right side.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height at this level associated with a very minor disc bulge.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: stenosis of RICA, right PCA, and moderate stenosis of left ICA noted, as well as the 6 mm saccular basilar tip aneurysm. History: yearly surveillance Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Focal tissue loss on the right posterior inferior thalamus with the susceptibility artifacts is again seen, unchanged since prior scan.Scattered FLAIR/T2 high signal intensity on periventricular white matters indicating nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Mucosal thickening on the right maxillary sinus is again seen, unchanged since prior scan.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 6 mm sized the basilar tip aneurysm, grossly unchanged since prior scan. The distal right vertebral artery is diminutive indicating decreased flow comparing to that of left side.Multifocal intracranial arterial luminal irregularity and less than 50% of narrowing are seen especially at the left ICA cavernous sinus segment and bilateral PCAs, grossly unchanged since prior scan.Although the signal intensity of intracranial arterial system appears to be lessen especially areas of luminal irregularities and narrowings. However, this is more likely related to different scanner, especially current scan was performed at 1.5 Tesla wire prior scan was performed at 3 Tesla motion instead of lesions progression. There is no evidence of other intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic tissue loss with hemosiderin deposition on the right thalamus, unchanged.3. 6mm sized basilar tip aneurysm, unchanged.4. Unchanged multifocal intracranial arterial luminal narrowings (less than 50%).


Instruction: Generate impression based on findings.

Input: Elevated PSA and prostate nodule. No prostate biopsy results available. PELVIS:PROSTATE:Prostate Size: 2.8 x 5.2 x 4.3 cmPeripheral Zone: There is a 1.4 x 1.2 cm lesion in the right lateral mid-gland demonstrating low T2-weighted signal intensity (series 1301/17), restricted diffusion (series 1404/264) and with early enhancement , suspicious for adenocarcinoma. Additional 6 mm lesion of abnormal T2 weighted hypointensity with restricted diffusion (series 1404/244, series 1301/17) in the left lateral mid-gland.4-5 mm T2-weighted hypointense foci in the left lateral apex and left lateral base (series 1301/13 and 19). Right medial apex lesion measuring 5 mm (series 1404/144). Central Gland: No significant abnormality noted.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The dominant right mid gland lesion has a broad base of abutment with the capsule which is mildly bulged in appearance.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple suspicious foci in the peripheral zone as described above with a 1.3 cm dominant lesion in the right lateral mid gland with broad-based involvement of the capsule which is mildly bulging, but no definite extraprostatic extension.2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Metastatic lesion, 3 month follow-up. Again seen are postsurgical changes of left frontal and left temporal craniotomy for tumor resection. There is encephalomalacia involving the left frontal lobe with T2/FLAIR hyperintensity compatible with gliosis which is unchanged. There is extra-axial dural based thickening in the surgical bed measuring 11 x 25 mm in the axial plane and up to 11 mm in the cranial caudal dimension which remains unchanged. Again seen is an area of increased T2/FLAIR signal in the cortex and subcortical white matter of the left anterior temporal lobe corresponding to site of prior tiny ring enhancing lesion, and is unchanged from the prior exam. No new mass or mass-effect. No abnormal parenchymal or abnormal meningeal enhancement elsewhere in the brain is seen. No hydrocephalus. No evidence of acute ischemia or hemorrhage. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear.

Output: 1.Stable postoperative changes related to resection of a metastatic lung cancer lesion with stable areas of encephalomalacia/gliosis in the anterior left frontal lobe. Adjacent extra-axial enhancing area remains unchanged and likely represents scarring.2.No new enhancing foci to suggest disease recurrence or new metastatic lesion. 3.Unchanged T2/FLAIR hypointensity in the anterior left temporal lobe, in location of a previously ring enhancing lesion.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.0 x 5.0 x 5.2 cmPeripheral Zone: Punctate round focus of restricted diffusion in the lateral left peripheral zone (series 704/304) which may represent site of carcinoma.Central Gland: 1.4 x 1.0 cm lesion within the left anterior apex demonstrating low T2 weighted signal, restricted diffusion (series 704/224) and early arterial enhancement, suspicious for carcinoma.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extra capsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.4 cm lesion in the left anterior apex.2.4 mm left mid gland suspicious focus.


Instruction: Generate impression based on findings.

Input: 11-year-old female with blunt trauma and multiple thoracic spinal fractures on CT. Limited complete spine: There is increased T2 signal within the thoracic spinal cord from T8 to T10. There is redemonstration of numerous previously described acute thoracic spine fractures with associated bone marrow edema. Please see dedicated thoracic spine MRI findings below and CT of the entire spine reports for additional details. The vertebral bodies are otherwise appropriate in the overall alignment and height. The cervical and distal spinal cord has normal signal characteristics and overall morphology through the cervical and lumbar spine. Thoracic spine: There is a fracture through the anterior, middle and posterior columns of the T8 vertebra (Chance fracture) with approximately 8 mm distraction of the spinous process. There is a displaced cortical osseous fragment within the right T8-T9 neural foramen. There are mildly displaced comminuted fractures through the anterior, middle and posterior columns at T9 with approximately 50% compression and 3 mm of retropulsion. An associated moderate acute kyphosis is centered at the T8-T9 level with spinal canal stenosis and compression of the spinal cord. Abnormally increased T2 signal is present within the thoracic spinal cord from the level of T8 to T10. There is mild depression of the superior endplates of T3, T4, T6, T7, T10, and T11 with associated diffuse edema in these vertebrae. There is a minimally displaced fracture involving the right pedicle and transverse process of T10. There is edema and indistinctness of the cortex suggesting possible microfractures at the spinous processes of T3 and T4 and inferior facet articulation of T4. There is intermediate T1 signal and high T2 signal within the dorsal epidural space of the thoracic spine from the T1 level through approximately T11 with effacement of the ventral thecal sac and mild mass effect on the spinal cord. There are enlarging moderate bilateral pleural effusions. There is significant diffuse paravertebral soft tissue swelling or hemorrhage. There is also prominent soft tissue swelling in the posterior soft tissues of the upper back.

Output: 1. Acute spinal canal stenosis at T8-T9 with compression of the spinal cord and spinal cord edema from T8 to T10 suggestive of traumatic spinal cord contusion and unstable fractures at T8 and T9, as well as a displaced cortical osseous fragment within the right T8-T9 neural foramen. Furthermore, mild depression of the superior endplates and what may represent diffuse bone contusion involving T3, T4, T6, T7, T10, and T11. Neurosurgical consultation was suggested.2. Acute posterior epidural hematoma from the level of T1 through likely T11 with mild mass effect on the spinal cord.3. Paravertebral and posterior paraspinal soft tissue swelling/hematomas.4. Enlarging moderate bilateral pleural effusions.5. No acute fracture or subluxation of the cervical spine.6. No acute fracture or subluxation of the lumbar spine.Dr. Masse discussed preliminary findings with Dr. Omar Usman of the emergency department on 9/25/2016 at 0130 hours. Dr. Sorensen discussed additional findings with Dr. Jason Choi of the neurosurgery service on 9/25/2016 at 0927 hours.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiply recurrent atypical meningioma, now on Avastin. There are postoperative findings related to parieto-occipital craniotomy. There are multiple foci of extra-axial tumor along the posterior falx cerebri and tentorial leaflets, with invasion of the superior sagittal sinus, which are perhaps slightly larger than in October 2015. For example, the dominant parafalcine mass measures The 46 AP x 27 RL x 45 SI mm, previously 44 AP x 25 RL x 37 SI mm. The associated extensive vasogenic edema in the adjacent brain parenchyma bilaterally appears to be similar in extent as before. However, there is now cystic encephalomalacia in the medial right occipital lobe with thin enhancement along the parenchymal margins and there has been evolution of the enhancement more laterally along the parenchymal margins of the left occipital lobe resection site with areas of apparently restricted diffusion and susceptibility effect. There is no large acute territorial infarct. There is ex vacuo dilatation of the right lateral ventricle and overall prominence of the left lateral and third ventricles. There is mild left sphenoid sinus mucosal thickening. The orbits are unremarkable. There are changes in the posterior scalp related to interval hardware removal.

Output: Post-treatment findings in the posterior cranium with overall slight increase in size of multiple foci of recurrent meningioma along the posterior falx cerebri and tentorial leaflets with associated extensive vasogenic edema in the adjacent bilateral cerebral hemispheres since October 2015. Evolution of enhancement along the medial margins of the bilateral occipital lobes associated with encephalomalacia and perhaps necrosis may be treatment-related.


Instruction: Generate impression based on findings.

Input: 4-year-old male with lethargy and altered mental status. There is a well-defined focus of hypodensity in the right centrum semiovale, which was seen on 2010 MRI of brain; this is consistent with a prominent perivascular space. There is no evidence of intracranial hemorrhage, mass, edema, hydrocephalus, or midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Sphenoid sinuses and ethmoid air cells are opacified. The mastoid air cells are normal in appearance.

Output: 1.No acute intracranial abnormality. 2.Sinus opacification.


Instruction: Generate impression based on findings.

Input: Knee pain following injury MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a 1 cm full-thickness defect of the articular cartilage of the medial patellar facet best seen on series 801 image 20. Within the joint space are ovoid foci of intermediate signal intensity (series 801 images 21 and 25) which may represent fragments of articular cartilage. There is a mild amount of presumed marrow edema within the inferior pole of the patella. The articular cartilage of the medial lateral compartments is intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: There is a small focus of high signal intensity within the patellar tendon near its attachment upon the inferior pole which may represent an area of tendinosis or partial tearing however the tendon itself otherwise appears intact.ADDITIONAL

Output: 1. Full-thickness articular cartilage defect of the medial patellar facet measuring approximately 1 cm with marrow edema of the inferior pole of the patella.2. Small focus of abnormal signal intensity within the patellar tendon insertion which may represent an area of focal tendinosis or partial interstitial tearing however the tendon otherwise appears intact.


Instruction: Generate impression based on findings.

Input: 57 years Female (DOB:5/20/1959)Reason: 57 F with LLE numbness and claudication, minimal sensory loss on exam History: 57 F with LLE numbness and claudication, minimal sensory loss on examPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is mild disc desiccation present lower lumbar spine.The lesion within the T12 vertebral body which is high signal on T1 and suppresses on the inversion recovery images most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with superimposed central disc protrusion. There is a moderate degree of bilateral facet and ligamentum flavum hypertrophy at this level. There are some effacement of the fat at the lateral recess bilaterally at this level. There is mild crowding of the nerve roots within the thecal sac at this level and overall a moderate degree of spinal stenosis. At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate bilateral facet hypertrophy at this level. There is a mild disc bulge at this level. There is partial effacement of the fat at the lateral recess bilaterally at this level. There is some encroachment of the left-sided exiting nerve roots within the neural foramen due to disc material. There is crowding of the nerve roots within the thecal sac and overall a moderate degree of spinal stenosis. There is a mild degree of anterior subluxation of L4 and L5.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.A 9 mm round well-circumscribed cystic appearing lesion in the left kidney probably represents a renal cyst

Output: There are multilevel degenerative changes present in the lower lumbar spine with moderate spinal stenosis at L4-5 and at L5-S1 as well as encroachment of the left-sided exiting nerve roots within the neural foramen at L4-5


Instruction: Generate impression based on findings.

Input: 57 year old male with ICM s/p orthotopic heart transplant in 2003, new CHF, no significant coronary occlusion on cath. Referred for cardiac MRI to assess regional hypoperfusion. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%. The LVEDV is 205 ml (normal range 142+/-34), the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVESV is 70 ml (normal range 47+/-19) and the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9). The LV mass is 161 g (normal range 164+/-36) and the LV mass index is 68 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is a moderate elevation in the native myocardial T1-relaxation time at the basal inferior wall. There is, additionally, increased T2-signal, increased native T1-relaxation time, and early gadolinium enhancement of the RV free wall. This area, however, does not have evidence of late gadolinium enhancement. These findings could suggest the presence of an early inflammatory process. There is no myocardial iron overload.Left AtriumThe left atrium shows changes consistent with cardiac transplant. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 61%. The RVEDV is 211 ml (normal range 142+/-31), RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVESV is 83 ml (normal range 54+/-17), and the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, 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 a mild, eccentric jet of 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. Left upper pulmonary veins form a common confluence with left lower pulmonary veins before draining into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a mass (4.5cm x 3.3cm) around the first sternal wire of unclear etiology. 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.The left ventricle is normal in size with normal systolic function (LVEF 66%). There is a moderate increase in native myocardial T1-relaxation time along the basal inferior wall, which could be due to subtle inflammation, fibrosis or infiltration. The T1 time throughout the rest of the myocardium is within normal limits. There is additionally no late gadolinium enhancement in the left ventricle. 2.The right ventricle is mildly dilated with normal systolic function (RVEF 61%). The free wall of the RV has evidence of increased T2-signal, increased T1-times, and early gadolinium enhancement. There is no late gadolinium enhancement in the RV free wall. These findings might be seen during the early phases of inflammation. 3.There is a mass (4.5cm x 3.3cm) around the first sternal wire of unclear etiology. Consider dedicated imaging if finding not explained by physical exam. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with history of T4 N2 cM0 squamous cell carcinoma of the oral tongue, left base of tongue and floor of mouth status post induction chemotherapy. Since the prior examination, there has been a substantial reduction in the size of the previously demonstrated extensively infiltrating tumor involving the left oral tongue, base of tongue and floor of mouth. A maximal lesion measurement in the coronal plane yields 39 mm (image 24 series 12), previously 75 mm. Reference lesion measurements in the axial plane yield 28 x 18 mm (image 26 series 11), previously 60 x 35 mm.The tumor component which was previously seen to cross to the right of midline at the base of tongue is no longer clearly visualized. Likewise areas of suspected tumor involvement of the supraglottic larynx are no longer clearly appreciated. The airway remains patent.A reference right level II lymph node measures 20 x 11 mm (image 44 series 6), previously 22 x 16 mm. A reference left level Ib lymph node now measures 12 x 7 mm (image 31 series 6), previously 22 x 15 mm. Multiple left intraparotid lymph nodes have also decreased in size and no new or growing pathologic nodes are detected.The salivary glands and thyroid are otherwise unremarkable. The osseous structures of the spine show normal signal characteristics. A lobular homogeneously enhancing tumor involving the left IAC and CP angle is redemonstrated showing no definite change in size.

Output: 1.Significant interval reduction in the size of the previously demonstrated left oral tongue, base of tongue and floor of mouth tumor.2.Interval reduction in the size of several reference pathologic lymph nodes.3.Grossly stable left IAC and CP angle tumor which is favored to represent an incidental vestibular schwannoma. Dedicated MR imaging of the brain can be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 18 seconds.

Output: Successful fluoroscopic guided right wrist arthrogram for MRI.


Instruction: Generate impression based on findings.

Input: 48 year-old male with a right frontal WHO grade II diffuse astrocytoma. He initially presented in 2014 with seizures. He had tumor resection on 3/24/2016 and has been seizure free since surgery. The previously described extra-axial fluid collection and postsurgical pneumocephalus have resolved. The area of residual T2 hyperintense gyral thickening along the right precentral gyrus, consistent with residual tumor, has decreased in size, presumably related to the radiation therapy. The resection cavity has largely cleared, and the fluid within it is now nearly completely FLAIR suppressing. Ill-defined T2/FLAIR hyperattenuation along the medial aspect of the resection cavity is nonspecific. Thin, discontinuous enhancement along the margin of the resection cavity most likely represents postoperative change. No new mass lesion is evident. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1.The area of residual T2 hyperintense gyral thickening along the right precentral gyrus, consistent with residual tumor, has decreased in size. 2.Expected resolution of acute postoperative findings, with remaining post-treatment changes as described above. 3.No new mass lesion is evident.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is a mild degree of degenerative bone marrow signal alteration at the endplates of T11-T12, T12-L1, L4-L5, and L5-S1. The vertebral bone marrow signal is otherwise unremarkable. The distal spinal cord and conus medullaris display normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from dependent edema. There is prominence of the epidural fat throughout the lumbar spine.L1-L2, L2-L3, and L3-L4: There are mild disc bulged, bilateral facet arthropathy, and ligament flavum thickening, without significant spinal canal or neural foraminal stenosis.L4-L5: There is a moderate disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening. There is resultant mild spinal canal stenosis and moderate to severe neural foraminal narrowing bilaterally. There appears to be mild impingement on the exiting L4 nerve roots.L5-S1: There is a mild disc bulge, bilateral facet arthropathy and ligamentum flavum thickening. There is resultant mild spinal canal and moderate bilateral neural foraminal stenosis.There is marked left hydronephrosis and atrophy of bilateral kidneys.

Output: 1. Multilevel lumbar spondylosis, which is most pronounced at L4-L5, with resultant mild spinal canal and moderate to severe bilateral neural foraminal stenosis with impingement of bilateral exiting nerve roots.2. Epidural lipomatosis, which contributes to spinal canal narrowing, particularly int he lower lumbar and sacral regions.3. Marked left hydronephrosis and atrophy of bilateral kidneys.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 24 year old male with severe acne, newly heard murmur, decreased RV function on TTE. Referred for cardiac MRI to rule out ARVC. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%. The LVEDV is 187 ml (normal range 142+/-34), the LV end diastolic volume index is 104 ml/m2 (normal range: 74+/-15), the LVESV is 83 ml (normal range 47+/-19) and the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9). The LV mass is 73 g (normal range 164+/-36) and the LV mass index is 41 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with mildly depressed systolic function. It is compressed by a lower sternal pectus excavatum deformity accounting for its unusual shape. The overall RV ejection fraction is 45%. The RVEDV is 217 ml (normal range 142+/-31), RV end diastolic volume index is 120 ml/m2 (normal range 82+/-16), the RVESV is 119 ml (normal range 54+/-17), and the RV end systolic volume index is 66 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a pectus excavatum. 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.Normal LV size and systolic function (LVEF 56%).2.No late gadolinium enhancement. 3.Mildly dilated RV with mildly depressed systolic function (RVEF 45%). 4.There is a pectus excavatum deformity that compresses the right ventricle at the level of the body. This accounts for the unusually shaped RV. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer with liver metastasis. Back pain. Rule out cord compression. There are numerous T1-hypointense, T2-hyperintense lesions involving the anterior and posterior elements throughout the spine, which are compatible with metastasis. None of the lesions is associated with significant osseous expansion or pathologic fracture; the vertebral bodies are preserved in height and the spinal canal is preserved other than mild narrowing caused by cervical intervertebral discs. The bone marrow signal from T2 through T9 is relatively fatty than the other levels, with less extensive metastatic involvement, which likely reflects previous radiation treatment. Alignment of the spine is anatomic. There appears to be high T2 signal in the spinal cord extending from C2 through C7 levels. The rest of the spinal cord otherwise appears unremarkable. The paravertebral soft tissues are unremarkable. However, there are multiple liver lesions.

Output: 1. Extensive metastatic disease involving the imaged axial skeleton, but no evidence of associated pathologic fracture or significant spinal canal stenosis. 2. Apparent high T2 signal extending from C2 through C7 levels may represent artifact or perhaps myelomalacia related to the adjacent degenerative spondylosis. Dedicated imaging of the cervical spine may be useful for further characterization if clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0] / Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: 3T Scanner, Please screen for cerebral AVMs, HHT History: HHT Brain MRIThere is a prominent vascular structure likely represent a cortical vein at the post-central sulcus draining toward superior sagittal sinus across the right superior parietal lobule. The lesion is also connected to a prominent medullary vein which drains toward ependymal surface of the right lateral ventricle.There is no evidence of adjacent brain parenchymal enhancement or evidence of enlarged arterial structure on this scan.Constellation of these findings may suggest cortical located micro AVM most likely fistulous type thus those enlarged vascular structures are superficial and deep drainages or could represent normal cortical vein and medullary vein. However, it would be unusual to see the connection of a medullary vein and cortical vein without vascular pathology.There is no evidence of acute ischemic or hemorrhage lesion.There is no abnormal enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic leison.2. Prominent cortical vein and medullary vein located at the post-central sulcus as described above. There is no evidence of abnormal brain parenchymal staining. This may indicate micro AVM. 3. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Worsening altered mental status unclear etiology. History of CLL treated with SCT with lymphadenopathy. There are multiple enlarged bilateral upper neck lymph nodes with low diffusivity, including within the parotid glands and retropharyngeal space. There is diffuse patchy cerebral white mater T2 hyperintensity bilaterally. There is a subcentimeter prominent left basal ganglia prominent perivascular space. There is no evidence of gross intracranial hemorrhage, mass, or acute infarct. The ventricles, sulci, and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Multiple enlarged bilateral upper neck lymph nodes may represent a manifestation of leukemia or post-transplant lymphoproliferative disorder, for example. 2. Diffuse patchy cerebral white mater T2 hyperintensity bilaterally is nonspecific, but may represent small vessel ischemic disease and/or treatment effects. 3. No gross evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain, possible meniscus injury MENISCI: There is abnormal T2 hyperintense signal in the articular surface of the posterior horn of the medial meniscus, consistent with a radial tear best seen on series #1101/10. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the lateral and medial facets of the patellar cartilage. There is a small bone island in the lateral tibial plateau.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Radial tear through the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: 36-year-old male with torn posterior tibial tendon. Also, comment on the talar head and neck sclerosis on recent CT examination. Is this a stress fracture or anatomic variant? TENDONS: There is a longitudinal split tear of the posterior tibialis tendon affecting the distal 5 cm of the tendon. The posterior tibialis tendon appears thickened with intermediate signal abnormality consistent with tendinosis. There is circumferential fluid within the tendon sheath which may reflect a mild tenosynovitis. The remainder of the flexor tendons appear intact. The peroneal tendons appear intact. The extensor tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: There is increased signal abnormality about a poorly visualized ATFL consistent with partial thickness tearing. There is increased signal abnormality in the subcutaneous soft tissues in the surrounding area. The lateral collateral ligament complex otherwise appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: Note is made of linear low signal abnormality within the head and neck of the talus corresponding to sclerosis seen on recent CT examination. No increased signal abnormality is identified to suggest an acute process/stress reaction of the talus. There is increased signal abnormality within the anterior and lateral aspect of the tibial plafond which may represent a subchondral fracture versus bone contusion. No articular cartilage defects are identified. The tibiotalar joint alignment is anatomic. There is sclerosis and osteophyte formation about the talonavicular joint consistent with osteoarthritic changes.ADDITIONAL

Output: 1. Longitudinal split tear of the posterior tibialis tendon.2. No evidence to suggest an acute stress reaction of the talus as clinically questioned.3. Subchondral fracture versus bone contusion of the anterolateral tibial plafond.4. Near complete rupture of the ATFL.