Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer status post treatment and T2N2b right tonsillar squamous cell carcinoma. There are unchanged post-treatment findings in the neck, but no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. There are mild degenerative changes of the cervical spine. There is fluid within the right middle ear and mastoid air cells.

Output: 1. Post-treatment findings in the neck, but no evidence of measurable mass lesions or significant cervical lymphadenopathy.2. Fluid within the right middle ear and mastoid air cells may represent effusions.


Instruction: Generate impression based on findings.

Input: No diffusion-weighted abnormalities are identified. No evidence of acute intracranial hemorrhage. Scattered T2/FLAIR hyperintensity of the subcortical and periventricular white matter compatible with small vessel ischemic disease. Generalized cerebral volume loss. There are no intracranial masses, mass effect or midline shift. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: No evidence of intracranial metastasis.


Instruction: Generate impression based on findings.

Input: Found down, has right gaze preference and left-sided weakness. MRI: There are extensive areas of swelling with T2 hyperintensity and restricted diffusion in the right middle cerebral artery territory, including portions of the posterior temporal lobe, frontal lobe, basal ganglia, and to a lesser extend parietal and occipital lobes. There is a background of cerebral white matter T2 hyperintensity bilaterally, without restricted diffusion. There is also encephalomalacia in the left pons and corona radiata. There is no evidence of intracranial hemorrhage. There is slight narrowing of the right lateral ventricle. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is paucity of flow-related enhancement in the imaged upper cervical internal carotid artery and throughout the intracranial internal carotid artery, as well as the right middle cerebral artery. Otherwise there is flow-related enhancement of the left internal carotid artery, left middle cerebral artery, and bilateral anterior cerebral arteries. The posterior circulation appears to be intact, aside from mild stenoses of the intradural left vertebral artery.

Output: 1. Extensive recent infarction in the right middle cerebral artery territory associated with significant steno-occlusive disease involving the more proximal extracranial internal carotid artery, but no evidence of hemorrhagic transformation or midline shift. Dedicated neurovascular imaging of the neck is recommended.2. Underlying probable chronic small vessel ischemic disease of the bilateral cerebral hemispheres and chronic left pontine and corona radiata lacunar infarcts.


Instruction: Generate impression based on findings.

Input: Right cerebellopontine angle mass, likely meningioma: vertigo. Internal Auditory Canals: There is a lobulated, partially enhancing, T2 hypointense mass that appears to be dural based in the right cerebellopontine angle cistern with slight extension into the right internal auditory canal, which measures up to approximately 9 mm. There is mass effect upon the right cranial nerve 7 and 8 complex, but no mass effect upon the pons. The left bilateral cranial nerve 7 and 8 complex are intact. The bilateral inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: An unchanged subcentimeter mass in the right cerebellopontine angle cistern with slight extension into the right internal auditory canal, which appears to be dural based, may represent a meningioma.


Instruction: Generate impression based on findings.

Input: 56-year-old female with with abnormal LFTs and increased alkaline phosphatase. Evaluate. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. The left hepatic duct is mildly prominent with subtle ductal irregularity on one MRCP sequence. The additional sequences are suboptimal secondary to respiratory motion. Hepatic and portal veins are patentSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of 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: Findings equivocal for ductal irregularity in the left hepatic ducts.


Instruction: Generate impression based on findings.

Input: Clinical question: 79-year-old female with multiple myeloma, ESRD on HD. Transferred for septic shock. With exposed sacro- bones, evaluate for osteomyelitis. Signs and symptoms: Central decubitus stage IV ulcer. Fever Nonenhanced CT lumbar spine:Axial 3 mm CT images of the entire lumbosacral spine with zero degree angulation of the gantry were obtained.Sagittal and coronal 2-D reformatted images were also obtained for interpretation.Examination demonstrates multiple poorly defined lytic bony changes involving the vertebral bodies and posterior elements of lumbar spine consistent with patient's diagnosis of multiple myeloma. There is no significant interval change when compared with prior MRI examination from 3 -- 14 -- 11. The alignment the vertebral column is within normal limits. There is no detectable extraosseous spread of tumor into the spinal canal. Degenerative changes of SI joints bilaterally with vacuum phenomenon are noted.This examination demonstrates no evidence of findings to suggest osteomyelitis. The very tip of coccyx is not visualized on this exam.Note is made of very heavy calcification of abdominal aorta and bilateral iliac arteries.A large calcific mass in the midline in the pelvis is due to represent fibroid mass of the uterus.

Output: 1.No evidence of osteomyelitis on this exam as clinically is questioned. Recommend MRI if concern for osteomyelitis persists.2.Findings consistent with multiple myeloma with no appreciable change since prior exam from prior months.3.Mild degenerative disk disease and hypertrophic changes of posterior elements.4.Degenerative changes of the SI joints bilaterally with vacuum phenomenon.


Instruction: Generate impression based on findings.

Input: Urothelial cancer with right groin pain The examination is limited motion artifact.Osseous structures: There is mild heterogeneity of the osseous structures but there is no focal area of decreased T1 signal to suggest metastatic disease. There is no evidence of malalignment, fracture, or avascular necrosis. Note that evaluation of the right hip is somewhat limited by motion artifact however there are mild osteoarthritic changes identified.Soft tissues: There is increased fluid signal surrounding the distal aspect of the left gluteus medius. Increased signal on T2 is also noted along the left gluteus minimus adjacent to the iliac wing. The remaining soft tissues and muscles appear normal in caliber and signal. There is increased signal within the pelvis likely relating to prior ileal conduit creation.

Output: 1. No evidence of osseous metastatic disease. The right hip appears normal for patient age.2. Increased signal involving the left gluteus medius and minimus which may reflect partial tearing and/or strain respectively.


Instruction: Generate impression based on findings.

Input: Spinal stenosis Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. Mild ligamentum flavum thickening and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. No spinal canal or neural foraminal stenosis.L4-L5: There is advanced facet arthropathy with grade 1 anterolisthesis, mild disc bulge with central protrusion, and ligamentum flavum thickening which contribute to moderate to severe spinal canal stenosis at this level. There is mild distention of the left facet joint. There is mild right and minimal left neural foraminal stenosis.L5-S1: Mild disc bulge with a left paracentral disc protrusion component which effaces the left lateral recess. There is mild left and minimal right neural foraminal stenosis. No significant central spinal canal stenosis. Bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Degenerative grade 1 anterolisthesis of L4 on L5 with moderate to severe spinal canal stenosis related to facet arthropathy, ligamentum flavum thickening, and central disc protrusion.2. Left paracentral disc protrusion at L5-S1 with partial effacement of the left lateral recess and milder degenerative changes at additional levels as detailed above.


Instruction: Generate impression based on findings.

Input: Female, 68 years old. RLE weakness, eval epidural hematoma. THORACIC SPINE

Output: 1.No evidence of epidural hematoma or other acute abnormality. 2.Mild degenerative changes with mild-to-moderate canal stenosis at T9-10 and T10-11, and moderate right foraminal narrowing at L5-S1.


Instruction: Generate impression based on findings.

Input: Dysarthria. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of cerebral white matter T2 hyperintensity. There is diffuse cerebral volume loss, which is most pronounced in the medial temporal lobes. 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. Nonspecific mild scattered foci of cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease. Otherwise, no evidence of acute infarction.2. Diffuse cerebral volume loss, which is most pronounced in the medial temporal lobes, which may represent Alzheimer disease in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Diagnosis: Pain in unspecified limb Paresthesia of skinClinical question: paresthesias The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Female, 19 years old, with pituitary tumor, assess change in size, on bromocriptine. A hypoenhancing nodule in the left aspect of the pituitary gland has decreased in size relative to the prior exam. This lesion now measures 5 mm AP by 5 mm CC by 6 mm TV, previously 8 x 7 x 9 mm. The superior margin of the gland shows less of a bulging contour and the overall gland is relatively normal in size. The pituitary stalk enhances normally and deviates very slightly to the right but improved from prior. No significant suprasellar or cavernous sinus extension is seen.

Output: Interval reduction in size of a left pituitary lesion.


Instruction: Generate impression based on findings.

Input: Other convulsions [780.39], Reason for Study: ^Reason: concern for PRES History: altered mental status in the context of high blood pressure There is curvilinear high signal intensity lesion on DWI at the left inferior parietal lobule likely on the left supramarginal gyrus which shows partial diffusion restriction on ADC map and left superior frontal gyrus which shows restricted diffusion indicating acute/subacute ischemic infarction. There is no evidence of hemorrhagic transformation.There are however multifocal susceptibility artifacts without surrounding edema on bilateral hemispheres, basal ganglia, brain stem and especially on the left side midbrain indicating prior hemorrhagic foci and chronic petechial parenchymal hemorrhages. No change since prior scan.On FLAIR imaging, extensive patch high signal intensities on periventricular white matter and centrum semiovale bilaterally indicating advanced nonspecific small vessel ischemic disease. No change since prior scan.The ventricles, sulci and cisterns are prominent which could be related to volume loss. There is no mass, mass effect, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute/subacute ischemic infarctions on the left superior frontal gyrus and left inferior parietal lobule without evidence of hemorrhagic transformation.2. No change of multifocal bihemispheric susceptibility artifacts as well as extensive non specific white matter lesions since prior scan.3. No evidence of abnormal enhancement. No evidence of PRES on this scan.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis tremor: preop planning for DBS. There are extensive cerebral white matter T2 hyperintense and T1 hypointense lesions. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Preoperative planning MRI demonstrates extensive demyelinating disease.


Instruction: Generate impression based on findings.

Input: Reason: 65 yo M with cystic lesion and calcifications in HOP r/o growth, r/o tumor History: 65 yo M with cystic lesion and calcifications in HOP r/o growth, r/o tumor. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Diffuse fat infiltration. Right lobe subcentimeter hepatic cysts, unchanged. Small 1 cm arterially enhancing focus without delayed washout (series 12 image 73). Hepatic vasculature patent.Cholelithiasis. No intrahepatic or extra hepatic biliary ductal dilatation.SPLEEN: Splenomegaly, not significantly changed.PANCREAS: 1.1 x 1 centimeter cystic lesion in the pancreatic head has not significantly changed in size and appears to communicate with the pancreatic duct suggesting an IPMN. Additional punctate IPMNs. No pancreatic ductal dilatation. Nonenhancing foci within the pancreatic head correlate with calcifications seen on CT.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged. Previous identified indeterminate left renal cystic lesion demonstrates signal characteristics of a simple cyst and does not enhance (series 5 image 29).RETROPERITONEUM, LYMPH NODES: Expected regional adenopathy and retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.Cirrhotic morphology. New 1 cm arterial enhancing focus without washout, indeterminate. 2.Stable sidebranch pancreatic head IPMN with additional punctate IPMNs.3.Previously identified indeterminate left renal cyst demonstrates signal and enhancement characteristics of a simple cyst.


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of HCV. ABDOMEN:LIVER, BILIARY TRACT: Micronodular liver contour consistent with cirrhotic morphology. The gallbladder wall is mildly edematous which may be secondary to chronic liver disease. There is no intrahepatic or extrahepatic biliary ductal dilatation. There is an arterial blush in hepatic segment six that does not have definitive washout but rather persists on portal venous phase. Differential includes flash filling hemangioma although there is no expected T2 signal. Attention on subsequent studies is suggested. Trace perihepatic ascites.SPLEEN: Splenomegaly measuring 16 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense focus in superior pole of the kidney likely represents a cyst. There is no hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal, gastrohepatic, and porta hepatis lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesion is evident. Arterial blush in hepatic segment six that persists on portal venous phase. Differential includes flash filling hemangioma although there is no expected corresponding T2 signal, focus is nonspecific. Attention on subsequent studies is suggested.


Instruction: Generate impression based on findings.

Input: 36 years Female (DOB: 6/18/1980)Reason: evaluate for new MS flair History: worsening left sided weaknessPROVIDER NAME: TAO G XIE TAO G XIE MRI brain:There is a mild to moderate degree of periventricular and subcortical white matter lesions present some which are perpendicularly oriented to the lateral ventricles. 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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is reversal of the normal cervical curvature present. There is mild disc desiccation present in the mid cervical spine. There are T2 signal hyperintense ill-defined lesions present in the upper cervical spinal cord extending from the C2 level down to the C3-4 disc space level as well as some patchy T2 signal hyperintense lesions within the lateral aspects of the lower cervical spinal cord bilaterally.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.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 disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. The pattern is consistent with the patient's clinical history of demyelination. Contrast enhanced MRI may help distinguish acute or subacute from chronic lesions.2.Multiple patchy lesions throughout the cervical spinal cord are present without enlargement of the spinal cord. This consistent with the patient's clinical history of demyelinating disorder thyroid is nonspecific and could relate to a different entity such as transverse myelitis for example. Contrast enhanced MRI may help distinguish acute or subacute from chronic lesions.


Instruction: Generate impression based on findings.

Input: Ms. Hild is a 46 year old female with a personal history of bilateral mastectomies with implant based reconstruction in 2015 for left breast IDC. She recently presented in diagnostic clinic for two sites of suspected fat necrosis in the left low axillary area and left breast 9:00 location. Patient is status post bilateral mastectomies with bilateral retropectoral implants. The implants appear intact. In the left upper inner reconstructed breast, approximately 10:00 position, there is an irregular enhancing lesion identified measuring approximately 7 x 9 x 10 mm (AP x ML x SI). This area of enhancement abuts against the anterior aspect of the implant. Given the location (10:00 position), this area of enhancement may not correlate with the hypoechoic area/associated surgical clip seen on prior ultrasound examinations (as this was described in the left breast 9:00 position), nor does this area of enhancement appear to contain macroscopic fat on MRI. No additional abnormal enhancing lesions are identified within the remaining subcutaneous tissues of the breasts.No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Indeterminate enhancing lesion within the left breast at the 10:00 position. Prior ultrasound described an area of fat necrosis with associated surgical clip in the 9:00 position, however, this mass is located in the 10:00 position and appears to be separate from the surgical clip. An MR-directed ultrasound is recommended for further evaluation and management. (2) No MRI evidence of malignancy in the right reconstructed breast. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 47-year-old male. No PMH, positive smoker. Presents with fever, N/V, abdominal pain x 9 days. Liver mass on CT. Requesting triple phase for further evaluation. Evaluate for abscess versus old tumor. ABDOMEN:LUNG BASES: Small pleural effusions bilaterally.LIVER, BILIARY TRACT: 7.8 x 9.7 cm heterogeneous caudate lobe mass with central T2 hyperintensity and diffusion restriction. It shows continuous peripheral thin rim enhancement (series 401, image 27), most consistent with an abscess. It abuts and displaces the IVC, middle and left hepatic vein, and intrahepatic main portal vein, which remain patent.Smooth contour of the liver. Trace perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent pericaval lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large caudate lobe abscess.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with fetal hydrocephalus on ultrasound. The midline structures of the brain are replaced by a very heterogeneous, mixed cystic and solid mass which measures up to 9.8 x 6.0 cm in the axial plane, and 8.3 cm in the sagittal plane. The lesion contains areas of susceptibility and mild patchy T1 hyperintensity which may reflect the present of blood product, calcification, or both. The point of origin of this lesion cannot be determined, but it is quite clearly a midline lesion.The normal midline structures of the brain are not visualized and have either been encompassed by the tumor, or have failed to develop. Surrounding the tumor, there is a thin mantle of cerebral cortex on both sides which tapers posteriorly. Fluid filled spaces in the occipital regions and the posterior fossa may represent dilated components of the ventricular system. In any event, the normal ventricular system is not visualized and may be dilated beyond recognition or just severely deformed. The cerebellum is very small.Prominent fluid is also present external to the thinned cerebral cortex, perhaps in the subdural space. The head is markedly enlarged and the calvarium is thin. The soft tissues of the scalp are thickened and presumably edematous or fluid-containing as well.

Output: A large mixed cystic and solid midline tumor is present with numerous associated abnormalities including lack of normal midline structures, severe thinning and deformation of the cortical mantle, and marked abnormal intracranial fluid which is probably ventricular, extra-ventricular and subdural in location. Statistically, the most likely etiology for a tumor with these characteristics is teratoma. Craniopharyngioma would be a less common entity but one which could present with similar imaging findings. Other histologies remain possible as well.


Instruction: Generate impression based on findings.

Input: History of renal oncocytoma presents with back pain. ABDOMEN:LIVER, BILIARY TRACT: Several liver cysts are noted. No biliary ductal dilatation or vascular abnormality. Normally distended gallbladder with focal adenomyomatosis at the gallbladder fundus, unchanged.SPLEEN: The spleen is normal in size and signal intensity. Stable peripheral simple appearing cyst.PANCREAS: Nonspecific peripancreatic lymph node measuring 1.0 cm in short axis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from left partial nephrectomy. There is loss of posterolateral pararenal fat, unchanged. Simple appearing right renal cyst. No hydronephrosis.Subcentimeter left renal T2-weighted hypointensity is too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sacral perineural/Tarlov cysts.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes from left partial nephrectomy.2.No specific findings to account for the patient's back pain.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with lung cancer and brain metastases, on Erlotinib and Atezo. A focus of enhancement in the right cerebellum continues to measure approximately 3 mm in diameter, similar to the prior examination. The intensity of enhancement appears to have increased, but this could reflect technical differences due to imaging at 3T versus 1.5T.A lobular extra-axial enhancing mass along the left anterior clinoid process with extension along the planum sphenoidale and probable involvement of the left cavernous sinus and sella is unchanged as well. The pedunculated component of this lesion measures 9 x 8 mm, similar to the prior examination.No new intracranial enhancing lesions are seen. Redemonstrated is encephalomalacia of the left inferior frontal lobe with associated susceptibility artifact along the left frontal calvarium, findings which are unchanged and may be postoperative in nature. A focus of encephalomalacia along the left caudothalamic groove is unchanged as well and compatible with a chronic lacunar infarct. A few additional scattered foci of parenchymal T2 hyperintensity are nonspecific and unchanged.No evidence of significant parenchymal edema or mass effect is seen. No acute intracranial hemorrhage is detected. Ventricular size and morphology remain within normal limits.

Output: 1.No definite change in the size of a small right cerebellar metastatic focus. No new intracranial metastases are suspected.2.Stable left paraclinoid enhancing extra-axial mass which may represent a meningioma.


Instruction: Generate impression based on findings.

Input: Tremor and memory loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific periventricular white matter T2 hyperintensity. There are bilateral choroid plexus glomus cysts. There is minimal diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with sellar mass, assess for changes. Again seen is a large heterogeneously enhancing mass occupying the sella and suprasellar cistern with involvement of the left cavernous sinus and perhaps the right as well. The lesion measures 33 mm CC, 38 mm AP and 48 mm transverse which is not significantly changed from the prior exam. As before, there is mass effect on the optic apparatus. Tumour invades the sphenoid sinuses and pneumatized sphenoid wings with obstructive opacification. Redemonstrated is evidence of prior frontal craniotomy with encephalomalacia of the left frontal lobe.

Output: No significant change in the size of a large tumor involving the sella, suprasellar cistern and cavernous sinuses.


Instruction: Generate impression based on findings.

Input: 62-year-old female with right lumbar radicular pain. There is 8 mm of anterolisthesis at L4-L5. There are mild multilevel Schmorl's nodes; otherwise, the vertebral body heights are intact. There is multilevel disc desiccation without significant disc space loss. No abnormal marrow signal. No abnormal signal within the distal cord and conus which ends at L1-L2. At L3-L4, there is mild ligamentum flavum hypertrophy without significant spinal or neural foramen stenosis. At L4-L5, there is a disc bulge, asymmetric to the left, moderate ligamentum flavum hypertrophy, moderate central canal stenosis, and mild bilateral neural foramen stenosis. At L5-S1, there is a mild disc bulge with small annular fissure, mild ligamentum flavum hypertrophy, and mild bilateral neural foraminal stenosis without significant spinal stenosis. There are multiple T2 hyperintense foci on the myometrium of the uterus.

Output: 1. Grade 1 anterolisthesis at L4-L5 and mild degenerative spondylosis in the lower lumbar spine.2. Findings suggestive of adenomyosis. Dedicated pelvic ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 75-year-old female with history of cholelithiasis and cervical cancer. Evaluate for obstructive jaundice and abdominal pain, especially in the right upper quadrant. ABDOMEN:LUNG BASES: Bibasilar atelectasis. Borderline cardiomegaly. Coronary artery calcification.LIVER, BILIARY TRACT: The liver is enlarged and measures 18.3 cm craniocaudally. Hydropic gallbladder is probably filled with sludge. The gallbladder measures more than 12 cm in length and the wall is mildly thickened and edematous. The common bile duct diameter is only 6 mm. No intrahepatic biliary duct dilatation. There are large periportal, hepatic hilar and celiac lymph nodes which have increased in size since the 2007 examination. Findings may be due to acute on chronic cholecystitis. Dedicated multiphase liver CT or MRI exam may be helpful in delineating a subtle neoplastic lesion, although this etiology is less likely. SPLEEN: The spleen is enlarged and measures 14.4 cm. Subcentimeter splenic hypodensities are stable. PANCREAS: No significant abnormality notedADRENAL 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 notedPELVIS:UTERUS, ADNEXA: Uterus and adnexa are present. There are calcific densities in the vicinity of the cervix due to prior therapy. No associated lymphadenopathy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval development of hydropic gallbladder containing sludge with enlargement of celiac, portal and hepatic hilar lymph nodes. Common bile duct and intrahepatic ducts are not dilated. Findings may be due to acute on chronic cholecystitis, but a small neoplasm cannot be excluded.


Instruction: Generate impression based on findings.

Input: Female 92 years old with intrahepatic and extrahepatic dilatation seen on CT in in September. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and contour. No enhancing liver lesion is identified. The hepatic vasculature appears patent.There is a low insertion of the common bile duct. The common bile duct measures 17 mm in diameter and the common hepatic duct measures 13 mm in diameter. There is suggestion of a luminal filling defect within the distal common duct (series 4, image 32). There are a few mildly dilated intrahepatic biliary ducts within the right lobe of the liver.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is dilated in the pancreatic head measuring duct to 8 mm. A smooth area of narrowing seen within the pancreatic body and the pancreatic duct in the distal body and tail is normal in caliber. No discrete pancreatic or ampullary mass is identified. The morphology of the pancreas is appropriate for age.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple bilateral T2 hyperintense, circumscribed, nonenhancing renal lesion consistent with a cysts. No hydronephrosis.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: Dilation of the common hepatic duct, common bile duct, and pancreatic duct as described above suggests obstruction at the level of the ampulla. This may be due to ampullary stenosis. A small filling defect within the distal common bile duct may represent debris. This could be further evaluated with endoscopic ultrasound if indicated based on the clinical symptoms and the patient's age.


Instruction: Generate impression based on findings.

Input: 58-year-old female with left arm numbness and lower back pain. Cervical Spine:Craniovertebral junction appears within normal limits. There is mild retrolisthesis at C5-6 and reversal of the cervical lordosis. The cervical vertebral bodies are appropriate in height. Bone marrow signal is within normal limits without focal lesions identified. Ventral effacement of the thecal sac is noted between C5 and C7 but the dorsal thecal sac is patent at all levels. Normal cord caliber without concerning areas of signal abnormality. No paraspinal soft tissue mass.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Moderate loss of disc space height and posterior disc osteophyte complex. Mild central canal narrowing. Uncovertebral joint hypertrophy causes moderate left and mild right neuroforaminal narrowing.C6-7: Posterior disc osteophyte complex and superimposed central disc extrusion causes mild central canal narrowing with minimal indentation of the spinal cord. Minimal left foraminal narrowing due to uncovertebral joint osteophytes. No right foraminal narrowing.C7-T1: Minimal left foraminal narrowing due to uncovertebral joint osteophytes. No central or right foraminal narrowing.T1-2: No significant compromise to the spinal canal or neural foramina.Mild posterior disc bulge at T2-3 seen on sagittal images only. Lumbar Spine: Five lumbar type vertebral bodies are presumed to be present. Alignment and vertebral body heights are preserved. High T2 signal within the anterior L5 vertebral body likely represents focal fat or an intraosseous hemangioma; the bone marrow signal is otherwise within normal limits. The conus medullaris is normal in position at the level of L1. The visualized thoracic cord is normal in caliber and signal. Paraspinous soft tissues are within normal limits.Mild facet arthropathy and disc bulges are seen at all levels, but there is no high grade spinal or neuroforaminal narrowing. There is minimal right foraminal narrowing at L2-3 and minimal left foraminal narrowing at L3-4.Just above the right L4 nerve root in the neural foramen, there is a linear structure with identical signal that may represent a vessel or conjoined nerve root. Contrast may be used to differentiate but finding is of doubtful clinical significance.Small right foraminal disc protrusion causes mild neuroforaminal narrowing at L5-S1, best appreciated on axial images.

Output: 1.Multilevel degenerative changes in the cervical spine, most pronounced at C5-6 and C6-7 as described above. Most notably, there is moderate stenosis of the left neural foramen at C5-6 which may be impinging on the left C6 nerve root.2.Mild scattered degenerative changes in the lumbar spine, as detailed above, without high grade spinal or neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 66 years old. Left hip pain, evidence of pathologic fracture A lesion within the left femoral neck measures approximately 2 cm x 2 cm x 5 cm, has decreased signal on T1 and increased signal on T2 weighted images. Increased signal within the lesion on T1 fat sat precontrast images is likely artifactual, but precludes evaluation for lesion enhancement. There is a small amount of surrounding edema outside the lesion. An associated nondisplaced pathologic fracture is more readily evaluated on recent CT imaging.Partially imaged pelvic masses may reflect uterine fibroids. The imaged soft tissues are otherwise unremarkable.

Output: Lesion within the left femoral neck as detailed above. Given the imaging appearance and the patient's age, this likely represents a solitary plasmacytoma or metastasis of unknown origin- statistically most likely lung or renal primary.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with history of tuberous sclerosis and renal angiomyolipoma on Afinitor therapy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is normal. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: Within the tail of the pancreas, there is an 8 mm T2 hyperintense cystic focus (7/19) which is unchanged in size from the prior CT. The pancreatic duct is nondilated and the remaining parenchyma appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable bilateral fat-containing renal cortical masses are seen, not significantly changed in size and without definite evidence of malignant transformation. For reference, the largest lesion on the right (7/22) measures 69 x 53 mm, previously 81 x 67 mm on the CT from 2/2016.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Very small left pleural effusion.

Output: Overall slightly smaller to stable size of innumerable bilateral renal angiomyolipomas.


Instruction: Generate impression based on findings.

Input: Episode of transient altered mentation in 6/2015 with unclear etiology. New onset seizures and possible meningioma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. There is prominent ossification along the anterior falx cerebri. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease, but no evidence of seizure foci. 2. Prominent ossification along the anterior falx cerebri, but no evidence of meningioma.


Instruction: Generate impression based on findings.

Input: 66 year old woman with AML, LV dysfunction and NSVT, referred for stress CMR for further evaluation of underlying etiology of cardiomyopathy. MEDICATIONS: amiodarone, coreg, lasix, losartan, crestor, aldactone First Pass PerfusionDuring hyperemia, there is a possible small perfusion defect in the mid inferolateral wall with a corresponding perfusion defect score of 6% (2/32).Viability/ Myocardial ScarThere is a small line of mid myocardial late gadolinium enhancement in the basal septum ("mid wall stripe"). This pattern is often seen in non-ischemic dilated cardiomyopathies. The presence could also suggest an underlying fibrosing, infiltrative, or inflammatory process. In addition, there is a second small area of late gadolinium enhancement in the mid inferolateral wall, the significance of which is uncertain. The remaining myocardium is viable. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 136 ml/m2 (normal range: 65+/-11), the LVEDV is 243 ml (normal range 109+/-23), the LV end systolic volume index is 86 ml/m2 (normal range 18+/-5), the LVESV is 154 ml (normal range 31+/-10), the LV mass index is 60 g/m2, and the LV mass is 108 g. LV dysfunction is global with regional variation.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). 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. The leaflet tips appear thickened. There is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern (normal variant).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a small perfusion defect in the mid inferolateral wall with a corresponding perfusion defect score of 6% (2/32).2. There is a small line of mid myocardial late gadolinium enhancement in the basal septum ("mid wall stripe"). This pattern is often seen in non-ischemic dilated cardiomyopathies. The presence could also suggest an underlying fibrosing, infiltrative, or inflammatory process. In addition, there is a second small area of late gadolinium enhancement in the mid inferolateral wall, the significance of which is uncertain. The remaining myocardium is viable3. The left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%.4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%.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, 21 years old, history of epilepsy, planning for laser fiber placement Multiple intracranial electrodes are redemonstrated in stable position. This includes two which traverse the right frontal lobe, three which traverse the right temporal lobe from a lateral approach, one which traverses the right medial temporal lobe from a posterior approach, and one which traverses the left medial temporal lobe from a posterior approach.Aside from mild dural enhancement which is likely reactive to instrumentation, no pathologic intracranial enhancement is seen. No evidence of significant parenchymal edema or mass effect is detected. The ventricular system is stable and normal in size.

Output: Selected sequences for surgical planning are provided which redemonstrate multiple intracranial electrodes in stable position.


Instruction: Generate impression based on findings.

Input: Male 30 years old with persistent right shoulder pain after physical altercation on 5/18/16. Evaluate for internal arrangement. ROTATOR CUFF: The muscles and tendons of the rotator cuff are normal in appearance with no evidence of tear.SUPRASPINATUS OUTLET: There is increased edema type signal within the distal clavicle which may be secondary to trauma or chronic stress such as weightlifting. The acromioclavicular joint is normal in appearance. There is no fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. The glenoid labrum is intact given the limitations of a nonarthrogram exam.BICEPS TENDON: The tendon of the long head of the biceps is normal in appearance and located normally within the bicipital groove. ADDITIONAL

Output: 1.Edema type signal within the distal clavicle may be secondary to trauma or chronic stress from an activity such as weightlifting.2.No rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Clinical trial. PELVIS:PROSTATE:Prostate Size: 3.0 x 4.1 x 3.2 cmPeripheral Zone: There has been continued involution of the right mid peripheral zone, in the region of the prior laser ablation of prostate carcinoma. No new suspicious foci of abnormal signal or enhancement are identified.Central Gland: The transition zone is heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular 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: Continue expected evolution of the ablative changes in the right mid peripheral zone, without evidence of tumor recurrence. No new suspicious foci identified.


Instruction: Generate impression based on findings.

Input: 20 year old woman with history of Turner's syndrome, referred for cardiac MRI to evaluate for concomitant congenital heart disease. General: Cardiac situs is normal. Cardiac position is normal. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 109 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10). 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. No LVH.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 99 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The aortic valve is tri-leaflet.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, arch and descending aorta are normal in size. There is no evidence of aortic coarctation. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is a persistent left superior vena cava and a dilated coronary sinus.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%.3. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root, arch and descending aorta are normal in size. There is no evidence of aortic coarctation. 4. The aortic valve is tri-leaflet and opens widely with no significant aortic regurgitation.5. There is a persistent left superior vena cavaI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 11 year old girl with left knee pain and instability. Evaluate for patellar instability. Please calculate TT-TG distance. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema within the medial aspect of the patella, and to a lesser degree, within the lateral aspect of the lateral femoral condyle reflecting prior transient dislocation of the patella. There also appears to be a tiny avulsion fracture fragment which measures approximately 5 mm in greatest dimension along the medial aspect of the patella. The femoral trochlea is shallow, particularly superiorly where it is flattened indicating trochlear dysplasia. The TT-TG distance is 12, within normal limits. We see no fluid-filled articular cartilage defect.LIGAMENTS: The ACL and PCL are intact. EXTENSOR MECHANISM: The Insall-Salvati ratio is between 1.4 and 1.5 indicating patella alta. There is slight lateral patellar tilt. There is also edema within the soft tissues medial to the patella at the site of the small avulsion fracture. We cannot exclude injury to the patellar attachment of the medial patellofemoral ligament. ADDITIONAL

Output: Patellar instability with femoral trochlear dysplasia and patella alta and bone contusions indicating prior transient dislocation of the patella. The TT-TG distance is normal.


Instruction: Generate impression based on findings.

Input: There is redemonstration of a subcentimeter cystic pineal gland. There is no evidence of intracranial hemorrhage or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening within the maxillary sinuses.

Output: Unchanged subcentimeter pineal cyst.


Instruction: Generate impression based on findings.

Input: Dysarthria and anarthria [R47.1] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: pre-op planning for OR History: new brain lesion No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. There are mild mucosal thickening on bilateral maxillary sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: Normal brain MRI and MRA.


Instruction: Generate impression based on findings.

Input: Elevated white count with sacral ulcers. Sepsis. Check for osteomyelitis. Exam limited given patient pain and motion, preventing completion of the study.Induration and inflammation of the overlying sacral soft tissues is evident, however other than very shallow ulceration, no deep soft tissue defects are observed. No findings to suggest an abscess or abnormal fluid collection. Mild abnormal signal throughout markedly atrophic gluteal muscles, mildly more extensive and asymmetric involving the left gluteal. Specifically the ischium bilaterally and coccyx are observed in grossly intact with normal signal pattern for the sequences obtained.The underlying osseous structures are grossly intact without discrete abnormal suspicious signal on either the T1 or T2 images providedVisualized portions of the lower pelvis and surrounding upper thighs are unremarkable other than atrophy and similar mild diffuse edema-like changes, again without discrete focal fluid collections or evidence of an abscess. No lymphadenopathy.

Output: Diffuse muscular atrophy and edema without discrete focal evidence of osteomyelitis or superimposed focal infection such as an abscess. Please see limitations described


Instruction: Generate impression based on findings.

Input: 58 years Male (DOB:9/7/1958)Reason: preo planning for Met brain . #6876 for fiducials History: preop planningPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI There is redemonstration of a 28 x 36 mm mass in the left temporal lobe which is associated with a ring enhancement pattern.There is a 9 mm enhancing lesion present along the left occipital lobe exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Ring-enhancing lesions are present. One larger one in the left temporal lobe non-small along the left occipital lobe. Stable compared with previous exam.2.Please note this examination was performed for the purpose of stereotactic guidance.


Instruction: Generate impression based on findings.

Input: A 65 year old male with multiple myeloma, chronic kidney disease and suspected amyloid was referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 223 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 91 ml (normal range 47+/-19), the LV mass index is 79 g/m2 (normal range 85+/-15), and the LV mass is 181 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is diffused concentric hypertrophy with a maximal diameter of 23mm at the basal anterior septum. T1-mapping analysis showed ranges of times up to 1120 ms at the basal anterior septum. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 190 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 83 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 59%. There are no regional wall motion abnormalities present. 2. There is diffused concentric hypertrophy with a maximal diameter of 23mm at the basal anterior septum. T1-mapping analysis showed ranges of times up to 1120 ms at the basal anterior septum. Despite that this is a limited study because of the lack of contrast, there is suspicion of cardiac amyloid.3. The right ventricle is normal in size with normal systolic function, the RVEF is 57%.4. The left atrium is mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 37-year-old male with history of right nephrectomy complains of diffuse back pain. Urinalysis shows moderate blood. Fever. Rule out infected stone. ABDOMEN: This examination is limited by the absence of oral and intravenous contrast.LUNG BASES: Mild bibasilar dependent atelectatic changes. No acute infiltrates or effusions.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The left adrenal mass has increased in size and currently measures 4.6 x 6 cm and axial image 56/181.KIDNEYS, URETERS: Status post right nephrectomy. Minimal left perinephric fat stranding. No renal calculus. No hydronephrosis. There is a left posterior mid pole circumscribed hyper density at axial image 65/21 which measures approximately 2.7 cm in diameter. This was seen on the prior examination and may represent a hemorrhagic cyst or solid neoplasm. Characterization with intravenous contrast-enhanced CT or MRI exam may be helpful for further evaluation, if indicated.RETROPERITONEUM, LYMPH NODES: The retroperitoneal mass seen in the prior examination has increased in size and now measures 6.6 x 8.8 cm and axial image 93/181. There is extensive retroperitoneal lymphadenopathy, which was present on the prior examination, but has diffusely increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There has been interval development of numerous retroperitoneal mass and left adrenal mass consistent with metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Interval increase in the retroperitoneal mass, lymphadenopathy, left adrenal mass. These findings are compatible with progression of known metastatic disease. No hydronephrosis. No nephrolithiasis.


Instruction: Generate impression based on findings.

Input: Syncope. History of meningioma and breast and thyroid cancer. The small left posterior temporal meningioma remains unchanged compared to the previous examinations, as remote as November 2009. It measures up to 11 mm, craniocaudally. No parenchymal signal abnormality. Remainder of the brain parenchyma appears unremarkable for age. No restricted diffusion is seen. No new lesions. No intracranial mass effect, midline shift, or herniation. Ventricular size is normal. Major flow-voids are preserved.

Output: Stable left posterior temporal meningioma with unchanged size since MRI studies dated September 5, 2015 and November 2, 2009. Remainder of the brain parenchyma appears within normal limits for age.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with history of spinal stenosis and return of low back pain. A grade 1 anterolisthesis of L4 relative to L5 is seen, probably not significantly changed from prior radiographs. Endplate irregularity and signal alteration, likely degenerative in nature, is seen at L4-5 and to a lesser extent at L5-S1. Otherwise, vertebral body morphology is normal. No worrisome marrow signal abnormality is detected. The visualized spinal cord and conus demonstrate normal signal intensity and morphology. Details of the cauda equina will be discussed below. Near complete loss of intervertebral disc height is seen at L4-5. The remaining discs show relative preservation of height though they have lost their T2 signal. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Moderate bulging disc. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Mild to moderate bilateral foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Disc uncovering and disc bulging. Prominent ventral epidural fat. Severe generalized spinal canal stenosis with crowding and likely impingement of the cauda equina. Severe left and moderate right foraminal narrowing. L5-S1: Moderate facet hypertrophy with effusions and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal stenosis. Severe bilateral foraminal narrowing.

Output: 1.Severe spinal canal stenosis and likely cauda equina impingement at L4-5 due to a combination of disc degeneration, spondylolisthesis and posterior element hypertrophy. Severe left foraminal narrowing is also seen at this level.2.Disc degeneration and posterior element hypertrophy also result in a moderate spinal canal stenosis with crowding of the cauda equina at L3-4.3.Severe bilateral neuroforaminal narrowing is evident at L5-S1.


Instruction: Generate impression based on findings.

Input: 35-year-old female with a history of CVA x 2, now with dysarthria. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. An area of encephalomalacia in the right frontal lesion appears unchanged from the prior study. High density within this region likely represents calcification. No findings to indicate acute ischemia are noted. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. The patient is status post enucleation of the left eye.

Output: No findings to indicate acute ischemia. Areas of encephalomalacia appear unchanged. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with sudden onset dizziness, headache and left ataxia. MRI brain:No restricted diffusion is seen. Scattered foci of T2 hyperintensity are noted in the periventricular regions and the brainstem. No significant edema or mass effect is seen. No evidence to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection is observed. The ventricles are normal in size and morphology.MRA brain:Within the limitations of motion artifact, no high-grade vascular stenosis or occlusion is observed. No definite aneurysm or vascular malformation is seen. A 1 mm posteriorly directed outpouching from the left P1 segment is favored to represent an infundibulum.MRA neck:Common origin of the brachiocephalic and left common carotid arteries is seen. The origins of the great vessels are patent. No significant stenosis is detected in the carotid vessels by NASCET criteria. Likewise, no significant stenosis is detected in the vertebral vessels.

Output: 1.No evidence of acute ischemia. Findings are seen compatible with chronic microvascular ischemic disease.2.No significant vascular stenosis or occlusion is detected in the head or neck.


Instruction: Generate impression based on findings.

Input: 48-year-old female with bilateral complex ovarian masses with pelvic pain, suspect endometriosis PELVIS:UTERUS, ADNEXA: Predominantly cystic left adnexal mass with enhancing septa has increased in size when compared to the prior exam now measuring 9.8 x 8.8 cm. The mass displaces the uterus to the right. A left ovary is not differentiated from this mass.A conglomerate mass in the right adnexa with predominantly solid enhancing tissue and tubular structures which may represent the fallopian tube. This conglomerate has intermediate T1 and T2 bright signal measuring 7.4 x 4.3 cm.A probable fibroid is noted within the posterior wall of the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged bilateral inguinal lymph nodes with the largest measuring 2.1 x 1.9 cm in the left inguinal chain. BOWEL, MESENTERY: There is mild tethered appearance to the anterior portion of the sigmoid colon which may reflect adhesive disease related to the pelvic pathology.BONES, SOFT TISSUES: Probable lipoma in the posterior left iliac wing.OTHER: Susceptibility artifact caused by metallic object in the subcutaneous tissue of the midline abdomen.

Output: 1.Bilateral adnexal masses as described above have increased in size since prior exam. Although findings may represent inflammatory disease with adhesions, malignancy is not excluded. Imaging features are not supportive of endometriosis.


Instruction: Generate impression based on findings.

Input: Right lower extremity wound. Concern for osteomyelitis. Large soft tissue defect along the lateral aspect of the mid to distal fibula. No underlying periosteal reaction or bony erosion. If clinically indicated, MRI could be obtained for further evaluation.

Output: No bony abnormalities associated with the large soft tissue defect seen along the right mid to distal fibula. If high clinical suspicion of osteomyelitis, MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he 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, 20 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 79 seconds

Output: Successful left hip arthrogram as described above.


Instruction: Generate impression based on findings.

Input: 15-year-old male with right knee pain for 3 months MENISCI: Menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. No bone marrow edema or fracture.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments are intact. The medial collateral ligament is intact. The lateral collateral complex is intact and normal in appearance. EXTENSOR MECHANISM: The extensor mechanism is intact. There is edema at the quadriceps tendon insertion on the patella without discrete tear. Edema of the lateral retinaculum without discrete tear. ADDITIONAL

Output: Edema of the quadriceps tendon insertion on the patella and of the lateral retinaculum. Subcutaneous soft tissue edema.


Instruction: Generate impression based on findings.

Input: History of Whipple procedure for ampullary benign papillary neoplasm. Specifically pancreatic-type IPMN. ABDOMEN:LIVER, BILIARY TRACT: There are post surgical changes of a Whipple procedure including a hepaticojejunostomy. There is intrahepatic and extrahepatic biliary ductal dilatation to the level of the anastomosis which is unchanged from the prior study. Otherwise the liver is normal in morphology size and signal intensity. No focal suspicious lesion.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes of a Whipple procedure including a pancreaticoenterostomy . There is stable dilatation of the pancreatic duct to the level of the anastomosis compatible with focal stricturing. As seen on the recent prior study there is an additional focal stricture of the pancreatic duct at the level of the pancreatic body. Following secretin administration there is no significant increase in fluid secretion or change in pancreatic ductal caliber. The stricture persists during administration of secretin.No evidence of pancreatitis.The previously seen fluid collection along the inferior margin of the liver anterior to the pancreaticoenterostomy contains a gastrocystostomy drainage catheter without a measurable fluid collection at this time.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are mild inflammatory changes of the anterior abdominal wall without an associated fluid collection. A small bowel loop is noted immediately deep to the anterior abdominal wall incision site without evidence of bowel dilatation.OTHER: No significant abnormality noted.

Output: 1.Interval near complete resolution of the subhepatic fluid collection with gastrocystostomy catheter in place.2.Stable dilatation of the pancreatic duct likely reflecting an anastomotic stricture. Stable stricture at the level of the body of the pancreas. No normal response to secretin administration.3.Mild anterior abdominal wall inflammation without abscess.


Instruction: Generate impression based on findings.

Input: Male 49 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 5.3 x 4.8 x 6.5 cmPeripheral Zone: There is a 0.6 x 0.4 cm T2 hypointense lesion within the left posterolateral prostate gland at the mid gland/apex which demonstrates arterial enhancement and is dark on the ADC map. This suspicious for a focus of prostatic carcinoma. There is a large area of hazy T2 hypointense signal within the anterior prostate gland at the apex. This area is difficult to evaluate as the transition zone extends beneath verumontanum in this patient. We suspect that this represents inferior transition zone however it is not possible to completely exclude anterior tumor.Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular 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.Subcentimeter focus of signal abnormality within the left peripheral zone which is suspicious for a focus of prostatic carcinoma. There is no extracapsular extension.2.Signal abnormality within the anterior prostate at the apex is difficult to evaluate due to inferior extension of the transition zone. We suspect that this represents a combination of transition zone and anterior fibromuscular stroma however it is not possible to completely exclude anterior tumor.


Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer. Fecal incontinence, back pain radiating to knee Thoracic:Again seen is evidence of metastatic disease at multiple levels in the thoracic spine. Relatively largest of the lesions are at the T7, T11, and T12 vertebral levels. No prior thoracic spine MRI is available for comparison, but the larger of the osseous lesions appear unchanged since 11/19/2014 CT chest study. There is no associated epidural tumor. No cord compression or signal abnormality. There is minimal loss of height involving the T7, T11, and T12 vertebral bodies similar to CT chest dating back to 11/19/2014.Right adrenal nodule again seen.Lumbar:Five lumbar type vertebral bodies are present. Multiple enhancing lesions are again seen throughout the lumbar spine as well as the visualized T11 and T12 vertebral bodies, sacrum, and iliac bones. Relatively largest of the lumbar lesions seen at the L3 level measuring 2.0 x 1.7 x 2.1 cm and unchanged. There is a larger right sacral lesion at S1 and S2 measuring 3.1 x 3.8 x 3.8 cm in the AP, transverse, and craniocaudal dimensions and also unchanged. There is some neural foramina narrowing with possible impingement of the exiting right S1 nerve root but unchanged. There is S2 lesion measuring 2.7 x 4.0 x 3.9 cm. There is mild epidural tumor extent greater on the left than the right.No lumbar compression fractures are seen. The conus medullaris is normal in position. No evidence of epidural tumor in the lumbar spine or leptomeningeal disease.Mild multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild disk bulge, ligamentum flavum thickening, and facet arthropathy result in mild spinal canal narrowing. Mild to moderate bilateral neural foramina stenosis.L5-S1: Mild disk bulge and facet arthropathy without significant spinal canal stenosis. There is mild right neural foramina stenosis. No significant left neural foramina narrowing.

Output: 1. Diffuse metastatic disease in the thoracic and lumbar spine which is not significantly changed since MRI of the lumbar spine from 1/7/2015 and CT of the chest from 11/19/2014.2. Mild pathologic compression fractures in the thoracic spine remain unchanged.3. No evidence of epidural tumor or cord compression in the thoracic or lumbar spine. 4. Again seen is a large sacral lesion with epidural tumor extension at the S2 level without high grade spinal canal stenosis and unchanged. There is narrowing of the right S1-S2 neural foramen related to tumor, which may be impinging on the exiting right S1 nerve root. There may also be impingement of the left S2 nerve root related to S2 metastatic lesion. These findings appear not significantly changed since 1/7/2015.5. Unchanged degenerative changes including mild disk bulges in the lower lumbar spine and facet arthropathy. Mild right sided neural foraminal narrowing at L4-L5 and L5-S1 related to degenerative disease.


Instruction: Generate impression based on findings.

Input: 38-year-old male with recurrent retroperitoneal sarcoma and abdominal pain. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Previously seen fluid density medial to the left adrenal gland demonstrates heterogeneous enhancement and is compatible with tumor.KIDNEYS, URETERS: Distortion of the left kidney with hydronephrosis due to extensive left retroperitoneal tumor, similar to prior exam (see below).RETROPERITONEUM, LYMPH NODES: Extensive left retroperitoneal heterogeneous tumor has increased in size since prior study. The largest, central solid component of the mass measures up to 18.5 x 14.6 cm in greatest axial dimension at the level of the aortic bifurcation (series 2101/39), previously 13 x 9.7 cm. Central hypoenhancement of the solid component is most likely due to tumor necrosis. Tumor crosses the midline in the abdomen.Surrounding rim-enhancing, cystic lesions have increased in number and size significantly, with the largest centered in the mid abdomen and measuring up to 10.9 x 12.9 cm (series 2101/98), most compatible with increased tumor. Enhancing tumor is seen medial to the left adrenal gland, where there is mild invasion into the left medial diaphragmatic crus. Tumor extends posterior to the left kidney and inferiorly to the level of the mid left external iliac artery. Tumor distorts and invades into the mid to inferior pole of the left kidney, which is inseparable from the largest solid component. Tumor invades into the pancreatic tail and lesser sac. There is compression of the underlying iliopsoas muscle, which is inseparable from the tumor over a large extent. The aorta, IVC, and SMA are deviated to the right by the tumor. Tumor encases the left renal artery near the hilum, abuts the left common iliac artery, and encases the left external iliac artery.BOWEL, MESENTERY: Extrinsic displacement and compression of bowel by the retroperitoneal mass, including the second portion of the duodenum. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Extensive left retroperitoneal tumor has significantly increased in size, as detailed above.


Instruction: Generate impression based on findings.

Input: Liver cirrhosis, chronic hepatitis C, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour and fissural prominence, compatible with cirrhosis. Bandlike areas of increased T2 signal indicative of superimposed fibrosis. Stable subcentimeter right hepatic cyst. No suspicious liver lesion delineated. Stable to mildly increased dilatation of biliary duct dilatation, common bile duct measures 11 mm, previously measured 9 mm. Recanalized umbilical vein and venous collaterals, including in subcutaneous tissues of ventral abdomen.SPLEEN: Splenomegaly, spleen measures 19.8 cm in longitudinal dimension, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing subcentimeter renal lesions, most likely cysts.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal and periportal lymph nodes, likely reactive in etiology.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New ascites.

Output: Hepatic cirrhosis and additional stigmata of portal hypertension including splenomegaly. No suspicious liver lesion.New ascites, no significant change otherwise.


Instruction: Generate impression based on findings.

Input: 46-year-old female patient with 3.1 cm FNH. ABDOMEN:LIVER, BILIARY TRACT: Well-circumscribed, mildly T2 hyperintense, homogenously enhancing lesion that demonstrates isointensity to liver on delayed imaging in segment 7 measures 3.1 x 2.6 cm (series 1002 image 212), stable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unchanged lesion in segment seven compatible with focal nodular hyperplasia.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are multiple scattered punctate foci of abnormal T2/FLAIR hyperintensity within the subcortical white matter, which are nonspecific. There are 2 foci of susceptibility corresponding to coarse calcification on recent CT of the face. These are located in the right posterior frontal lobe and the peripheral right posterior temporal lobe. No other foci of susceptibility are visualized. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Images are slightly limited by patient motion. The cervical spine is in normal alignment, with slight straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated although marrow signal overall is decreased diffusely respect to adjacent disks on T1-weighted images, which is nonspecific. The spinal cord is of normal caliber and signal.At C3-C4, there is a trace disc bulge with mild right uncovertebral hypertrophy and possible bilateral facet arthropathy. There is mild to moderate right and minimal left foraminal narrowing.At C4-C5, there is a trace disc bulge which flattens the ventral thecal sac without stenosis.At C6-C7, there is a mild diffuse posterior osteophyte disk complex with slight right-sided prominence. There is bilateral uncovertebral hypertrophy and left facet arthropathy.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine.

Output: 1. No acute intracranial abnormality.2. Foci of susceptibility corresponding to 2 foci of coarse calcification in the right cerebral hemisphere. These are nonspecific, and could relate to dystrophic calcification from previous infection including nodular calcified neurocysticercosis, or relating to tiny cavernomas.3. Nonenhancing nonspecific punctate foci of T2 hyperintensity within the white matter. These may relate to an infectious/inflammatory process, demyelinating disease, chronic small vessel ischemic changes, or possibly migraine headaches. Please correlate clinically.4. Very minimal cervical spinal spondylosis with only up to mild-moderate right foraminal narrowing at C3-C4.5. Diffuse abnormal marrow signal within the cervical spine which is nonspecific, and can be due to reactive hyperplastic marrow although other infiltrative processes can have a similar appearance. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Incidental note is made of a small right choroidal fissure cyst of no clinical significance. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There are sporadic foci of mucosal thickening in the paranasal sinuses. The mastoid air cells are clear. There is no abnormal enhancement within the brain. Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no degenerative changes or stenoses.

Output: Negative MRI of the brain and cervical spine including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's right arm numbness.


Instruction: Generate impression based on findings.

Input: Clinical question: Is there change in cerebellum or ?olivary lesionSigns and Symptoms: ataxia MRI brain:There is redemonstration of cystic lesions in the medulla bilaterally at the expected location of the all of which is larger on the left compared to the right side. There is no associated diffusion restriction. There is no associated susceptibility effect. There is no associated contrast enhancement on the prior exam. The one on the left measures 4 x 5 mm axial dimensions and 4 x 9 mm coronal dimensions whereas the one on the right measures 3 x 3 mm axial dimensions and 3 x 3 mm coronal dimensions. These cystic lesions are slightly more prominent on the current prior exam though this appearance of a larger on the current versus the prior exam may be due to difference in slice thickness and gap on the prior MR acquisition and therefore may not be valid. This there is no convincing evidence for interval change in size of these lesions.There is associated cerebellar atrophy present. This is also present on the prior exam. The degree of cerebellar atrophy appears similar compared to the prior exam.There are no associated lesions appreciated in the dentate nuclei nor in the right nuclei.The supratentorial 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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present 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.

Output: 1.There are cystic lesions centered in olivary nuclei bilaterally (left larger than right) - suspected to represent cystic degeneration - associated with relatively symmetric cerebellar atrophy.2.No intrinsic spinal cord lesions are appreciated3.There are mild degenerative changes present in the cervical spine mainly in the form of disk degeneration without significant compromise to the spinal canal or neural foramina. At age 22 this is more disk dessication than usually expected.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with metastatic lung cancer to the brain, planning exam for stereotactic radiosurgery. A nonenhancing lesion within the left inferior frontal lobe has not significantly changed in size. On T2-weighted images, this lesion measures 10 x 6 mm.A 6 mm mildly enhancing lesion along the right occipital lobe cortex is unchanged. A 5 mm mildly enhancing lesion along the right superior parietal lobule cortex is unchanged.A lobular lesion within the left cerebral hemisphere showing questionable minimal internal enhancement is redemonstrated. On T2-weighted images, this lesion measures 10 x 10 mm showing no significant interval change.No evidence of any new intracranial lesions is seen. The above lesions cause no significant edema or mass effect. Morphology of the brain parenchyma is otherwise unremarkable. The ventricles are stable and normal in size.

Output: Multiple nonenhancing or minimally enhancing lesions are demonstrated both supra and infratentorially. No significant change is seen in any of these lesions, and no new lesions are detected.


Instruction: Generate impression based on findings.

Input: Hb-SS disease with acute chest syndrome [D57.01] / Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: f/u aneurysm. Yearly eval History: none Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is right frontal chronic hemorrhage with encephalomalacia, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate a focal aneurysmal luminal outpouching on the left PCA P1 segment. The lesion is measured about 2.7mm and directed posterior and superiorly. Unchanged since 2015.Otherwise, normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Right frontal chronic hemorrhagic infarction, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. The left PCA P1 segment aneurysm is again seen, unchanged in terms of its configuration and size since 2015.


Instruction: Generate impression based on findings.

Input: 66 year old female with altered mental status. Redemonstrated and no interval change is a prominent lateral ventricles. As compared to prior exam an MRI is recommended to evaluate for possible obstructive lesion. Small area of encephalomalacia and high convexity left parietal remains stableno evidence of hemorrhage, edema, mass effect, midline shift is detected this exam is essentially stable since prior study.

Output: No new finding since prior exam.


Instruction: Generate impression based on findings.

Input: Ms. Hall is a 37-year-old female with strong family history of breast cancer in mother and maternal aunt. She presents for MRI high risk screening evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Numerous non-enhancing subcentimeter cysts are identified bilaterally. Few scattered foci of enhancement are seen bilaterally, none of which are more suspicious than the rest. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Incidental note is made of a thoracic cord syringomyelia.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: Tumor Rt distal phalanx little finger History: pain and swelling. Within the distal phalanx, there is an expansile mass, that is predominantly T2 hyperintense, T1 hypointense in signal intensity with small foci of signal void compatible with calcifications seen on radiograph. This mass is bilobed and predominantly peripherally enhances compatible with low internal vascularity or tumor necrosis. This mass measures approximately 1.1 x 0.9 x 2.3 cm (AP by transverse by CC). Small amount of adjacent soft tissue edema.The remainder of the bone marrow signal is within normal limits. The remainder of the soft tissue structures are within normal limits.

Output: Expansile mass involving the distal phalanx of the right fifth finger. MRI findings in conjunction with radiographic findings are compatible with a cartilaginous lesion and malignancy cannot be excluded.


Instruction: Generate impression based on findings.

Input: C-spine:A small focus of signal abnormality is suspected within the spinal cord at the C6 level. However, this is only identified on the sagittal STIR sequence without confirmation on other sequences. Elsewhere, spinal cord signal intensity and morphology are unremarkable. No pathologic cord enhancement is seen.Spinal alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow signal replacement or enhancement is detected.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild facet hypertrophy. Mild posterior disk osteophyte formation with perhaps some thickening of the PLL. No significant spinal canal or neuroforaminal stenosis. C5-6: Mild posterior disk osteophyte formation along with some thickening of the PLL. Mild spinal canal narrowing. No cord impingement. Moderate left foraminal narrowing. C6-7: Mild posterior disk osteophyte formation along with PLL thickening. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. C7-T1: Left facet hypertrophy. Mild bulging disk. No significant spinal canal or neuroforaminal stenosis. T-spine:Cord morphology and signal characteristics are within normal limits. No definite pathologic cord or leptomeningeal enhancement is seen.A small defect is evident within the left dorsal epidural fat at T5 which does not enhance and which follows fluid signal characteristics. The spinal canal is not significantly narrowed at any point. The neural foramina remain patent. Mild disk bulging is evident at T12-L1 and L1-2.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No pathologic marrow signal intensity or enhancement is observed.

Output: 1.A questionable focus of cord signal abnormality is evident at C6, seen only on one sequence however. This is nonspecific and may be artifactual.2.No discrete spinal cord abnormalities are evident elsewhere in the cervical or thoracic spine.3.Mild degenerative findings are noted in the cervical spine without any high-grade spinal canal stenosis.4.A small incidental cystic lesion is suspected within the left dorsal epidural space at T5 which may represent a developmental cyst or a cyst of the ligamentum flavum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.