Instruction: Generate impression based on findings.

Input: Patient with adenocarcinoma of the lung and multiple known bony metastases and 3 possible brain metastases shown on outside MRI, but only visible on once axial slice each. Need MRI with thin cuts to evaluate for brain metastases. No focal neurologic deficits. High functioning. There are multiple, at least 15, supratentorial and infratentorial subcentimeter lesions. For example, the largest supratentorial lesion is located in the right precentral gyrus and lateral to the right posterior cingulate gyrus and measure 4 mm in diameter, while the largest infratentorial lesion is located in the left cerebellar hemisphere and measures 6 mm in diameter. There are also multiple enhancing lesions in the skull, including within the clivus, as well as within the mandible. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Multiple, at least 15, supratentorial and infratentorial subcentimeter lesions are compatible with metastases.2. Multiple bone lesions are also compatible with metastases.


Instruction: Generate impression based on findings.

Input: Left-sided hemiplegia, alteration of sensation. There is no evidence of acute ischemic lesion on this scan.However, previously recognized bilateral basal ganglia high signal intensities on FLAIR images have been expanded.Specifically, the right basal ganglia and anterior aspect of the thalamus lesion has been expanded downward to the level of the right side midbrain. In addition, on the right basal ganglia likely at the globus pallidus, there is signal void on SWI images indicating possible hemorrhages.The left side globus pallidus and anterior thalamus lesion does not show significant interval change since prior exam.On Gad enhanced images, there is a bit patchy enhancement on the right basal ganglia lesion which may represent focal inflammation or local Gad leakage due to hemorrhages.Significant interval change of the extent of the right side lesion within relatively short period of time and patchy enhancement pattern suggest possibility of venous congestive encephalopathy with possible hemorrhages or infectious/inflammatory lesion. Possibility of tumorous condition is unlikely. And there is no evidence of arterial ischemic infarction.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Progressed right basal ganglia and thalamus FLAIR high signal intensity lesion which now has expanded toward the right midbrain and upper pons with possible hemorrhages. Diagnostic possibilities include venous congestive encephalopathy or infection/inflammatory lesion. Tumorous condition is unlikely. Clinical correlation is indicated and considering diagnostic angiography is suggested to exclude underlying vascular lesions including dural arteriovenous shunts on venous congestive encephalopathy. This was discussed with Dr.Brorson at the time of this dictation.2. No evidence acute ischemic infarction on this scan.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: assess hypodense lesion History: AMS Bilateral confluent FLAIR high signal intensity lesions bilateral hemispheres especially involving bilateral occipital lobes, bilateral thalami, bilateral frontal, posterior parietal and temporal lobes as well as cerebellar hemispheres. The left basal ganglia and left mesial temporal lobe also show FLAIR high signal intensity lesion. Comparing to prior scan, these lesions are likely to be new interval development or progression of prior scattered FLAIR high signal lesions.Constellation of above findings suggest MR evidence of PRES (posterior reversible encephalopathy syndrome) and differential diagnosis include HIV encephalitis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, 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.The left maxillary and ethmoid sinus show opacification which are related to prior traumatic fractures, grossly unchanged since prior scan.

Output: 1. Confluent bilateral supra and infra tentorial involvement of FLAIR high signal intensity lesions as described above, indicating possible diagnosis of PRES. Differential diagnosis include HIV encephalopathy, other white matter disease or low grade glioma but could be less likely.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.3. No change of left basal ganglia and mesial temporal lobe abnormal FLAIR signal intensity lesions.


Instruction: Generate impression based on findings.

Input: Left shoulder pain. Weakness. ROTATOR CUFF: No evidence is seen of any rotator cuff tears. There is some intermediate signal within the supraspinatus consistent with tendinopathy.No evidence is seen of any fatty atrophy or muscle edema in the rotator cuff. The spinoglenoid and suprascapular notches are within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted.

Output: Supraspinatus tendinopathy. Otherwise negative


Instruction: Generate impression based on findings.

Input: Locking. Loose bodies? MENISCI: The lateral meniscus appears intact. Seen on the short TE weighted images is a poorly defined oblique band of intermediate signal intensity traversing the posterior horn of the medial meniscus on a single image (e.g., image 14 of series 4); I suspect this has a low likelihood of representing a true tear and may be artifactual. The medial meniscus is otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: There are large globular masses of heterogeneous signal intensity within the joint both anteriorly (e.g., adjacent to the anterior horns of both menisci, lateral greater than medial) and posteriorly (including along the popliteus muscle and tendon). The masses are predominantly isointense to skeletal muscle on T1-weighted images and hyperintense to skeletal muscle on T2-weighted images with small foci of low signal intensity internally. These masses correspond to calcification seen on the prior radiographs, and indicate primary synovial chondromatosis. The disease has progressed when compared to the prior MRI study from 2014. Multiple smaller "loose bodies" of cartilage are also noted within the joint.There is a full-thickness defect of the articular cartilage of the weightbearing portion of the medial femoral condyle measuring 6mm in greatest dimension and associated with subchondral cyst formation and edema in the underlying marrow. This is new when compared with the prior MRI study. There is also full-thickness degeneration of the articular cartilage along the medial facet of the patella superiorly with cyst formation and edema in the underlying marrow. This appears similar to that seen on the prior MRI study. I suspect that there is also superficial fraying of the articular cartilage of the femoral trochlea. The articular cartilage of the lateral compartment appears relatively intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Progression of synovial chondromatosis and cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of DCIS status post left mastectomy and reconstruction. History of right mastopexy. Family history of breast cancer in mother. There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.There are postsurgical changes of left mastectomy and reconstruction. There are additional postoperative changes of right mastopexy.No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: first time seizure with hx/o developmental delay - please assess for structural abnormalitiesSigns and Symptoms: seizure, developmental delayComments: Please obtain peds MR Brain wo and seizure 2 protocol | 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 mild mucosal thickening in the paranasal sinuses but mostly in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A punctate focus of signal hypointensity is present in the right thalamus on susceptibility weighted imaging and probably represents an old microhemorrhage.

Output: There is an isolated microhemorrhage in the right thalamus. There is no intracranial mass lesion to explain patient's seizures.


Instruction: Generate impression based on findings.

Input: There is unchanged minimal retrolisthesis of L5 relative to S1. The vertebral body heights are maintained. There is severe loss of intravertebral disc height at L5-S1. The distal spinal cord and conus demonstrate normal morphology and signal. T12-L1: There is no significant spinal canal or neural foraminal stenosis.L1-L2: There is no significant spinal canal or neural foraminal stenosis.L2-L3: There is a minimal disc bulge and facet hypertrophy bilaterally with minimal narrowing of the central canal, but no significant neural foraminal narrowing.L3-L4: There is a mild disc bulge and facet hypertrophy bilaterally with minimal narrowing of the spinal canal, but no significant neural foraminal narrowing.L4-L5: There are postsurgical findings related to left laminotomy and interval removal of synovial cyst. There is marked enhancement of the surgical wound track to the thecal sac predominantly on the left side and a fluid collection in the overlying subcutaneous tissues. There is also high T2 signal and enhancement in the right L4 and L5 pedicles and medial facets, which are hypertrophied. There is also a trace right facet effusion. There is a mild disc bulge and mildly prominent epidural fat result in mild spinal canal narrowing, which has improved from the prior study. There is also mild bilateral neural foraminal narrowing.L5-S1: There is a mild disc bulge and mildly prominent epidural fat without significant spinal canal stenosis or neural foraminal narrowing. However, there is right facet hypertrophy and a small joint effusion.

Output: 1. Postsurgical findings related to left L4-5 laminotomy and cyst removal, with a nonspecific posterior subcutaneous tissue fluid collection. The presence of enhancement tracking to the thecal sac may represent granulation tissue, although infection is a consideration based on imaging alone.2. Enhancement and edema in the medial right facets and pedicles of L4 and L5 may represent microfractures, degenerative effects, or perhaps an infectious process.3. Mild lower lumbar spine degenerative spondylosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 15-year-old male with chronic abdominal pain. On colonoscopy, the terminal ileum was nodular. Mild inflammation of colon and TI on pathology.EXAMINATION: MR enterography without and with IV contrast 11/19/2015, 1005. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric enhancement without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:Focally dilated loop of small bowel in the right lower quadrant involving a length of 12 cm immediately proximal to the ileocecal valve. The bowel measures 2.5 to 3 cm in diameter. There is mild diffuse enhancement and diffusion restriction of this segment of bowel with decreased peristalsis compared to adjacent small bowel. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: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: Focally dilated loop of small bowel with mild enhancement and mildly decreased peristalsis involving a length of 12 cm immediately proximal to the ileocecal valve. In the correct clinical setting, these findings can represent inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with Chiari and syrinx, yearly follow-up. The cerebral tonsils descend approximately 5 mm below the level of the foramen magnum, unchanged from prior. Moderate crowding of foramen magnum is again observed. Attenuated but detectable biphasic CSF flow is seen anteriorly through the foramen magnum. No obvious flow is detected, however, posterior to the cerebellar tonsils.A syrinx cavity is redemonstrated within the central aspect of the spinal cord. The most prominent component begins at the mid C6 level and continues inferiorly to the upper T1 level. At its point of maximum caliber, the syrinx measures up to 4 x 3 mm which is slightly increased from prior exams. As visualized on sagittal imaging only, trace syrinx or prominence of the central canal of the spinal cord continues inferiorly into the thoracic region.Straightening of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is detected. No significant abnormalities of the intervertebral discs are seen. The spinal canal and neural foramina remain patent.

Output: 1.Demonstration of findings compatible with Chiari I malformation without significant interval change.2.Mild interval increase in the caliber of the syrinx spanning from C6 to T1.


Instruction: Generate impression based on findings.

Input: Male 54 years old with left wrist and hand pain and swelling. LIGAMENTS: The scapholunate and lunotriquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC is grossly intact.TENDONS: There is a small amount of fluid within the dorsal extensor tendon sheaths of uncertain clinical significance. BONES: High T2 and low T1 signal is seen within the hamate, triquetrum, and lunate bones but there is no linear signal to suggest fracture. There is edema in the soft tissues adjacent to the scaphoid but the scaphoid bone itself appears normal. A focus of sclerosis along the lunate bone at the articulation with the catheter tip and hamate may relate to prior injury.ADDITIONAL

Output: Edema signal within the hamate, triquetrum and lunate bones is nonspecific but may reflect contusion. There is no evidence of fracture.


Instruction: Generate impression based on findings.

Input: Redemonstrated are postoperative findings related to right suboccipital and translabyrinthine craniectomy with fat graft for debulking of a right cerebellopontine angle tumor. Residual tumor within the cerebellopontine angle has decreased in size now measuring up to 3.5 cm in maximal dimension (previously 4 cm.) Enhancement within the skeletonized right internal auditory canal has become more defined and also extends along the operative tract (best visualized fat-saturated axial T1 series 19, image 9-10). As before, there are scattered areas of susceptibility effect within the residual tumor, which likely correspond to blood products, particularly along the surgical margins. Mass effect upon the adjacent brainstem and right cerebellar hemisphere, with leftward displacement of the vertebrobasilar system as well as partial effacement of the fourth ventricle, has slightly decreased over the interval. There has also been interval decrease of the vasogenic edema within the affected parenchyma. There remains no dilatation of the third and lateral ventricles. A previously demonstrated small area of restricted diffuse and high T2 signal in the lateral right cerebellar hemisphere has resolved. There are no current findings of restricted diffusion to suggest the presence of acute ischemia. The supratentorial brain is unremarkable. Previously demonstrated subgaleal fluid has resolved.

Output: 1.Residual tumor within the right cerebellopontine angle has decreased in size now measuring up to 3.5 cm in maximal dimension (previously 4 cm.)2.Enhancement within the skeletonized right internal auditory canal has become more defined and also extends along the operative tract.3.Mass effect upon the adjacent brainstem and right cerebellar hemisphere, with leftward displacement of the vertebrobasilar system as well as partial effacement of the fourth ventricle, has slightly decreased over the interval.


Instruction: Generate impression based on findings.

Input: There is no abnormal enhancement, acute infarct, mass effect or midline shift. There is an unchanged right frontal calvarial burr hole with persistent cystic encephalomalacia in the right superior frontal gyrus and nonspecific confluent surrounding T2 hyperintensity extending toward the right periventricular white matter, similar to prior examinations. There is unchanged minimal dural thickening and enhancement subjacent to the burr hole. There is also nonspecific periventricular and subcortical white matter T2 hyperintense signal abnormality elsewhere which is also similar in appearance representing combination of small vessel ischemic changes and posttreatment changes. There is a tiny unchanged chronic left cerebellar hemisphere infarct.

Output: Stable posttreatment findings with no evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: 41-year-old female with popping, locking sensation, repeat traumatic injury. Bone ligaments? MENISCI: There is an abnormally small posterior horn of the medial meniscus which is expelled medially with a flipped fragment underneath the PCL compatible with a bucket handle tear. The lateral meniscus is normal.ARTICULAR CARTILAGE AND BONE: The hyaline cartilage of the patella is uniformly thinned with perhaps some fraying at the junction of the medial and lateral facets. Bone marrow signal is unremarkable. There is mild lateral osteophyte formation noted. LIGAMENTS: The anterior collateral ligament is torn. The posterior collateral ligament, medial and lateral collateral ligaments are normal in appearance.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Bucket-handle tear of the posterior horn of the medial meniscus and anterior collateral ligament tear as described above.


Instruction: Generate impression based on findings.

Input: Ms. Greer is a 39 year old female with known left breast cancer currently on neoadjuvant chemotherapy. She presents today for imaging evaluation as part of the I-SPY2 protocol. Personal history of benign left breast biopsy in the 6:00 location in 9/2016 for stromal fibrosis. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left retroareolar region, the known malignancy now measures approximately 4.6 x 4.4 x 5.2 cm (AP x ML x SI), previously measuring 4.1 x 4.5 x 4.5 cm. The malignancy continues to extend towards and involve the anterior skin and nipple. The biopsy marker clip is seen peripherally at the anterior aspect of the malignancy.No abnormal enhancement is seen in the right breast. Specifically, no heterogeneous enhancement is seen in the right breast, which was seen on prior MRI.Two enlarged left axillary lymph nodes continue to be seen, the larger one of which measures 3.0 x 1.7 cm, previously measuring 3.0 x 1.8 cm. A biopsy marker clip is seen within this lymph node, with benign pathology. No abnormal lymph nodes are identified in the right axillary or internal mammary region.

Output: (1) Slight interval increase in size of known malignancy of the left breast. Stable left axillary lymph node with benign pathology results.(2) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluate presumed meningioma reported on an MRI from another institution, please compare to uploaded outside MRI: vision and hearing loss. There is no evidence of mass lesions within the left middle cranial fossa. There are bilateral lens implants. The bilateral orbital contents are otherwise unremarkable, without evidence of tumor or abnormal enhancement. The imaged portions of the skull appears unremarkable as well.

Output: No evidence of middle cranial fossa or orbital mass.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, history of ganglioglioma. Surveillance imaging. A small surgical cavity within the inferior left parietal lobe is stable in size and morphology. Mild T2 hyperintensity within the surrounding parenchyma is also unchanged. Likewise, a small curvilinear region of enhancement along the lateral and superior edge of the cavity is unchanged.No new intracranial lesions are detected. Findings compatible with a Chiari I malformation are redemonstrated similar to prior. Brain parenchymal morphology is otherwise unremarkable. A few very small scattered foci of T2 hyperintensity are seen in the periventricular white matter, a nonspecific finding.No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: A small resection cavity within the left inferior parietal lobe is unchanged in size and morphology. This includes mild enhancement along the cavity margin which may simply represent postoperative granulation.


Instruction: Generate impression based on findings.

Input: Frequent headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered punctate foci of T2 hyperintensity in the cerebral white matter, particularly in the bilateral frontal subcortical regions. There is mild 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. There is asymmetric fatty marrow of the right petrous apex.

Output: Scattered punctate foci of T2 hyperintensity in the cerebral white matter, particularly in the bilateral frontal subcortical regions, are nonspecific, but can be associated with migraines, for example. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Left adnexal mass. Extrinsic compression of cecum. Evaluate etiology. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis an mild hepatomegaly are noted.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: Bowel is normal in caliber without evidence of obstruction or ileus. Marked diverticulosis the distal colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There is no evidence of adnexal mass. Uterus is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of compression of the cecum as stated in the clinical history. No suspicious bowel lesion. Bowel is normal in caliber. Marked diverticulosis of the distal colon is also noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of adnexal mass.2.Diverticulosis.3.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: CHEST:LUNGS AND PLEURA: Bilateral numerous punctate centrilobular micronodules. These can be infectious or metastatic in etiology. An index nodule is in the right upper lobe measuring 4 mm on image number 35, series number 5.MEDIASTINUM AND HILA: Multiple small mediastinal lymph nodes, not enlarged by CT criteria. Index node measures 1.4 x 0.7 cm image number 41, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypodense lesions in the liver. Possibility of metastatic disease cannot be excluded. Further evaluation with MRI is recommended. A hypodense lesion in the right lobe of the liver measures 2-cm in diameter image number 90, series number 3. Cholelithiasis.SPLEEN: Enlarged spleen. Multiple small hypodense lesions in the spleen. Index lesion measures 1.6-cm in diameter image number 108, series number 3.PANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 1.6 by 1.2-cm image number 101, series number 3.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple punctate hyperdense foci throughout the spine suspicious for metastatic disease.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: Lytic lesion in the left sacrum on image number 164 posters number 3, suspicious for metastatic disease. Other smaller lytic lesion are present in the left iliac bone and in some of the vertebral bodies, as seen on T12 vertebral body on coronal image 26 on the left side. Correlation of these findings with bone scan is recommended.OTHER: No significant abnormality noted

Output: Bilateral numerous centrilobular micronodules in the lungs which may represent metastatic disease versus less likely infection.Hepatic and splenic lesions suspicious for metastatic disease. Liver MRI may be helpful for better characterization and evaluation of the liver lesions.Left adrenal indeterminate nodule. Cholelithiasis.Lytic bone lesions in the sacrum and iliac bone suspicious for metastatic disease. Smaller lesions are also noted in the vertebral bodies. Correlation with bone scan is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Heterogeneity, including right-sided T2 hyperintensity, is noted involving the limited visualized aspects of the thyroid gland. Otherwise the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: There is a small central disc protrusion which abuts and slightly flattens the anterior cord surface without intrinsic cord signal abnormality and no resulting central stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: 1.Heterogeneity, including right-sided T2 hyperintensity, is noted involving the limited visualized aspects of the thyroid gland. 2.C5/6: There is a small central disc protrusion which abuts and slightly flattens the anterior cord surface without intrinsic cord signal abnormality and no resulting central stenosis.


Instruction: Generate impression based on findings.

Input: History of side branch pancreatic IPMN. Please evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: 8 mm probable hemangioma in the right hepatic lobe is stable. No suspicious liver lesion. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Stable 9 x 4 mm (series 7/27) slightly lobulated cystic lesion (versus two adjacent discrete lesions) in the pancreatic head which appears to communicate with the main pancreatic duct compatible with a sidebranch IPMN without suspicious imaging features.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes measuring less than 1 cm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable cystic lesion in the head of the pancreas likely represents a sidebranch IPMN without suspicious imaging features, see discussion above.


Instruction: Generate impression based on findings.

Input: Left ankle pain. Right knee pain. Questionable fall. Left ankle: There is mild soft tissue swelling about the ankle, particularly medially, but I see no fracture. Note is made of small plantar and posterior calcaneal spurs, not necessarily of any current clinical significance.Right knee: There is swelling of the soft tissues of the knee anteriorly. No fracture. There is a questionable small joint effusion. Anterior soft tissue swelling limits evaluation of the quadriceps tendon, and if there is clinical concern for quadriceps tendon rupture, MRI may be considered.

Output: Soft tissue swelling of the left ankle and right knee without fracture evident.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: eval for cervical spine pathologySigns and Symptoms: pain in lateral neck with movement The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. There is mild narrowing of the left neural foramen at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc extrusion present at this level which is associated with small uncovertebral osteophytes and some encroachment of the neural foramina bilaterally and encroachment of exiting nerve roots. The encroachment is slightly worse on the left when compared to the right side. Disc material extrudes behind the superior aspect of the C4 vertebral body.At C5-6 there is no significant compromise to the spinal canal or neural foramina.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.The right thyroid lobe is larger than the left thyroid lobe. This was also true on the prior CT exam.

Output: 1.There are some degenerative changes present in the cervical spine which are worse at C4-5 where there is a central disc extrusion present associated with small uncovertebral osteophytes and encroachment of exiting nerve roots within the neural foramina.


Instruction: Generate impression based on findings.

Input: There are disk osteophyte complexes with ligamenta flava thickening causing mild/moderate spinal canal stenoses at C3-4 through C5-6. However, there is no evidence of acute cord compression or cord signal abnormality.The most inferior well formed disk space is referred to as L5-S1. Dedicated imaging through the lumbar spine shows normal vertebral body and disk heights except at L4-5 where there is disk desiccation and moderate loss of disk height. There is normal lumbar alignment. The conus terminates at L1-2.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis. L2-3: No disk herniation or spinal stenosis. Moderate bilateral facet arthropathy.L3-4: Mild disk bulge and ligament flava thickening with moderate bilateral facet arthropathy causing mild spinal canal and bilateral neural foraminal stenosis.L4-5: Diffuse disk bulge with large central/right paracentral disk protrusion causing severe spinal canal stenosis. Moderate facet arthropathy with no significant neural foraminal stenosis.L5-S1: Disk bulge with tiny central disk protrusion with no spinal stenosis. Disk material abuts the bilateral S1 nerve roots in the subarticular zones without significant displacement or stenosis.

Output: 1.No evidence of cord compression.2.Multilevel lumbar spondylosis as described above, worst at L4-5 where there is severe spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Glioblastoma. On Avastin. The study is at least moderately limited by patient motion. Besides hemosiderin staining along the margin of the surgical cavity in the inferior right temporal lobe, there is no intracranial hemorrhage. There is no acute infarct. Accounting for the significant limitation caused by motion on today's examination, irregular faint contrast enhancement along the surgical margin and adjacent parenchyma in the right temporal lobe has not grossly changed in extent. It still involves the body of the right hippocampus and reaches to the trigone of the lateral ventricle. It is associated with mildly restricted diffusion. There is no definitive new contrast-enhancing brain lesion. The ill-defined periventricular T2-hyperintensity involving the right hemispheric cerebral white-matter has slightly increased in extent. The less extensive periventricular T2 intensity in the left cerebral hemisphere is not changed. There are changes related to the known infarct involving the posterior limb of the right internal capsule on the right. The ventricular system continues to be moderately dilated as well as the sulci and basal cisterns, reflecting parenchymal volume loss.Dynamic susceptibility-weighted contrast-enhanced MR perfusion imaging was performed but the study is degraded by gross motion.

Output: 1.The study is at least moderately limited by patient motion.2.The thick rim of faint contrast enhancement related to the right temporal resection cavity is grossly unchanged since February 2016. 3.Probable treatment related white matter signal abnormality continues to progress slowly on the right.


Instruction: Generate impression based on findings.

Input: 68 years, Male, Reason: Please assess prostate cancer History: Gleason 7, PSA 10, palpable disease. PELVIS:PROSTATE:Prostate Size: 6.1 x 4.1 x 4.6 cmPeripheral Zone:Intrinsic T1 signal is compatible with hemorrhage, likely from prior biopsy.There is a lesion in right peripheral zone measuring 2.4 x 1.0 cm (601/14) which extends from the right mid prostate to base and has low signal on T2/ADC and early enhancement, suspicious for prosthetic adenocarcinoma. There is a small focus of extracapsular extension posteriorly. There is no involvement of the seminal vesicle.There is a separate focus in the left apex with low signal on ADC/T2 without enhancement, also suspicious for adenocarcinomaCentral Gland: Heterogeneity likely reflects benign prosthetic hypertrophy.Seminal Vesicles: No involvement identified.Extracapsular Extension: Small focus of extracapsular extension along the right posterior capsule adjacent to the tumor.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter left common iliac node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right peripheral zone lesion in the mid prostate and base with signal characteristics suspicious for adenocarcinoma and a small focus of extracapsular extension.2.Additional smaller lesion in the left apex is also suspicious for prostatic adenocarcinoma.


Instruction: Generate impression based on findings.

Input: 81-year-old female with pain in right thigh Hardware components of a total right hip arthroplasty and bilateral knee arthroplasties are identified. There are no associated fluid collections or other evidence of complication. A conglomerate focus of low signal intensity within the soft tissues along the medial distal femur is consistent with heterotopic bone formation seen on prior radiographs. A trace right knee joint effusion is noted. There is mild diffuse muscle atrophy.

Output: Right THA and TKA without evidence of associated complication or other specific findings to account for the patient's thigh pain.


Instruction: Generate impression based on findings.

Input: 30-year-old female with persistent right knee pain/locking. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The ACL, PCL and LCL complex appears intact. The superficial band of the MCL appears intact, although there is edema along the ligament suggestive of a mild sprain. This edema spreads anteriorly along the medial retinaculum/medial patellofemoral ligament likely representing additional sprain.EXTENSOR MECHANISM: Extensor mechanism appears intact without significant abnormality.ADDITIONAL

Output: Sprain of the MCL and medial retinaculum, however we see no meniscal tear.


Instruction: Generate impression based on findings.

Input: Male 66 years old with small cell neuroendocrine tumor metastatic to transplanted liver s/p partial hepatectomy July 2016. PET suggested possible new lesion. Evaluate on MRI. History: PET positive lesion ABDOMEN:LIVER, BILIARY TRACT: Status post resection of the right lobe of the transplant liver. At the posterior resection margin there is a 2.3 x 1.4 cm lesion which is T1 hypointense, mildly T2 hyperintense with restricted diffusion and enhancement. This corresponds to the FDG avid lesion seen on recent PET/CT. This lesion abuts the right adrenal gland which demonstrates nodular thickening. Although we don't see evidence of such, direct invasion into the right adrenal gland is not excluded.There is no biliary ductal dilatation. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: A 2.8 x 2.2 cm T1 hypointense, T2 hypointense lesion in the body of the pancreas unchanged since 2014 and may represent a small mucinous neoplasm. No pancreatic ductal dilatation.ADRENAL GLANDS: Nodular thickening of the right adrenal gland. The hepatic lesion abuts the right adrenal gland as described above. The left adrenal gland is unremarkable.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average fecal burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate right pleural effusion with associated compressive atelectasis. Trace left pleural fluid.

Output: 1.2.3 x 1.4 cm liver lesion at the posterior resection margin is highly suspicious for residual tumor2.A cystic lesion pancreatic body is stable since 2014, it may represent a mucinous neoplasm.


Instruction: Generate impression based on findings.

Input: There is a relatively well-circumscribed enhancing lesion within the right posterior superior aspect of the L2 vertebral body with extension into the right pedicle, measuring up to 15 mm in height, previously 12 mm. There is no associated retropulsion or extension into the spinal canal. Aside from a small Schmorl's node within the posterior inferior endplate of L3, the vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The tip of the conus is at L1. There is multilevel degenerative spondylosis that is most pronounced at L4-L5, where there is severe right and mild left neural foraminal stenosis and associated endplate signal alterations, including patchy enhancement. However, there is no significant central canal stenosis. The paraspinal soft tissues are unremarkable.

Output: 1.The lesion within the L2 vertebra, which has slightly increased in size and demonstrates hypermetabolism on PET, likely represents a metastasis without associated extension into the spinal canal or fracture.2.Multilevel degenerative spondylosis that is most pronounced at L4-L5, where there is severe right and mild left foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma on Temodar. The intrinsically T1 hyperintense lesions in the bilateral cerebral hemisphere are stable to slightly decreased in size. For example, a lesion in the left occipital lobe measures 4 mm in diameter, previously also 4 mm, while a lesion in the right anterior cingulate gyrus measures 3 mm in diameter, previously 5 mm. There is no appreciable vasogenic edema associated with the lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stable to slight interval decrease in size of the brain metastases.


Instruction: Generate impression based on findings.

Input: 59-year-old male with right foot drop and a history of metastatic NSCLC/SCC. There is no acute cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. Degenerative changes are noted on sagittal imaging of severe from C4 through C6 with mild loss of disc height.

Output: 1.No acute cord compression.2.Dedicated segment-specific MRI is recommended if symptomology localizes and/or if chronic pathology is identified requiring subsequent therapies which has not been imaged previously.


Instruction: Generate impression based on findings.

Input: 57-year-old male with right foot ulcer. Evaluate for osteomyelitis. Fascial edema is noted within the plantar musculature and dorsal soft tissues of the foot. However, there is no evidence of osteomyelitis in the underlying bones. No soft tissue ulceration is identified. The visualized flexor and extensor tendons are within normal limits. Moderate to severe osteoarthritis affects the first MTP joint, and additional scattered degenerative changes are also noted throughout the forefoot.

Output: Fascial edema involving the plantar musculature and dorsal soft tissues without evidence of ulceration or osteomyelitis.


Instruction: Generate impression based on findings.

Input: History of small cell lung carcinoma with metastasis to the brain. There has been interval increase in size and number of numerous supratentorial and infratentorial metastatic lesions and associated vasogenic edema. For example, previously demonstrated lesion in the anterior left temporal lobe now measures 14 mm, previously 6 mm and a lesion in the superior vermis measures 13 mm, previously 4 mm. In addition, there are several new lesions in the cerebral and cerebellar hemispheres. For example, a new lesion in the left inferior temporal lobule measures 11 mm and a lesion in the right mid cerebellum measures 9 mm. Several of these lesions demonstrates leptomeningeal involvement. There is diffuse subcortical and periventricular white matter T2 hyperintensity. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are unchanged 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. Interval increase in size and number of supratentorial and infratentorial metastatic lesions with associated vasogenic edema.2. Diffuse cerebral white matter T2 hyperintensity is nonspecific, but may in part be related to treatment effects and/or small vessel chronic ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari decompression on 4/8/16: post-operative surveillance. There are postoperative findings related to Chiari decompression surgery with a small amount of fluid overlying the posterior fossa dura and C1 laminectomy bed. There cerebellar tonsils display rounded morphologies and there is intact cerebrospinal fluid flow across the neo-foramen magnum. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. At C3-4, there is facet hypertrophy, uncovertebral hypertrophy, and a small central disc protrusion, which results in narrowing of the left neural foramen. There is otherwise no significant spinal canal stenosis at this or the other cervical spine levels. The spinal cord displays normal signal and morphology.

Output: Postoperative findings related to Chiari decompression surgery with a small amount of fluid overlying the posterior fossa dura and C1 laminectomy bed and intact cerebrospinal fluid flow across the neo-foramen magnum.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass, or mass effect. There is mild diffuse global parenchymal volume loss including mild volume loss involving the cerebellum. There are moderate periventricular and subcortical white matter T2 hyperintensities which are nonspecific, but likely representing moderate chronic microvascular ischemic changes. There is no hydrocephalus. Brain parenchyma is otherwise unremarkable. Sella and orbits are grossly unremarkable. Paranasal sinuses and mastoid air cells are clear. Major flow-voids are preserved. Calvarium is intact.

Output: Mild age-related volume loss and moderate chronic small vessel ischemic disease. No evidence of acute infarct. No focal lesions in the cerebellum or disproportionate cerebellar atrophy as questioned.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Fibromyalgia with burning pain in neck and arms. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of degenerative spondylosis or spinal cord lesions in the cervical spine.


Instruction: Generate impression based on findings.

Input: Sudden onset of numbness on the left side finger and pelvis. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is about 15 mm x 10 mm sized relatively well marginated but irregularly-shaped signal void lesion based on the left frontal lobe meninges indicating meningeal calcification or calcified meningioma. There is no evidence of associated adjacent brain edema or mass effect. This lesion was seen on prior scan obtained in 2013, no change in terms of signal characteristics, size and configuration since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. Minimal several scattered nonspecific high signal intensities on bilateral white matter especially frontal lobeThere is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. 15mm x 10mm sized left frontal area meningeal calcifications without evidence of mass effects, no change since prior exam.2. Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: History of right hepatic lobe lesion incidentally seen on breast MRI which has gradually increased in size since 2009. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity. Within segment 5, there is a lobulated sharply marginated structure (series 4, image 10) measuring 16 x 22 mm. The structure demonstrates high T2 signal, does not enhance, and is compatible with a benign cyst. This cyst has increased in size from 2009 when it measured up to approximately 13 mm in greatest dimension. There are a few scattered additional subcentimeter cysts. No suspicious focal hepatic lesions are identified.No biliary ductal dilatation. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal signal intensity and enhancement without focal lesions. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A few subcentimeter simple cysts are present within the left kidney. No suspicious renal lesions are identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Benign simple cyst in the right lobe of the liver.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, history of breast cancer with left hand tremors and prior brain metastases. Assess metastases. Several small metastatic lesions are redemonstrated as follows:1. A lesion along the hand motor area of the left precentral gyrus is smaller and less conspicuous measuring no more than 6 x 4 mm, previously 8 x 5 mm.2. Two very small lesions in the right inferior parietal lobule are stable to perhaps 1 mm smaller each.3. A 3-mm left temporal lobe lesion is not changed4. A right cerebellar lesion no longer demonstrates enhancement on the present study, but shows relatively stable mild FLAIR hyperintensity.No new lesions are detected. Scattered small foci of T2 hyperintensity are demonstrated in the cerebral hemispheres. These are stable and not necessarily related to metastatic disease. No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. There is no evidence of significant intracranial hemorrhage. Ventricles are stable and normal in size.

Output: 1.Several small metastatic lesions in the brain are demonstrated, some of which are smaller and some unchanged.2.No new intracranial lesions are detected.


Instruction: Generate impression based on findings.

Input: convulsionsClinical question: seizures from right temporal lobeSigns and Symptoms: seizures from right temporal lobe he calvarium appears dolichocephalic with anterior convex to the towards the left. There is mild flattening of the skull base with retroflexion and superior migration of the odontoid process abutting the lower medulla/upper cervical cord.The hippocampi appear symmetric.The body of the corpus callosum is relatively thin.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.

Output: 1.The calvarium and skull base are dysmorphic.2.No convincing evidence for mesial temporal sclerosis is appreciated


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: eval for pancreatic and/or biliary pathology History: abdominal pain, weight loss ABDOMEN:LIVER, BILIARY TRACT: 2.8 x 1.5 cm mass in the right lobe of the liver enhancing at the arterial phase and does not washout on the portal venous and delayed phase. This lesion is unchanged compared to outside CT dated 2/11/2016. This lesion is slightly hyperintense on diffusion-weighted images. MR characteristics of this lesion is suggestive of focal nodular hyperplasia or adenoma. MRI of the liver within 6 months would FNH protocol may be helpful for differentiation between these 2 lesions if clinically indicated. No evidence of intra or extrahepatic biliary dilatation. Pancreas is unremarkable.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: There is a 1.2 x 2 cm T2 hyperintense lesion L3 vertebral body which is hypointense on T1-weighted images. Metastatic lesion cannot be excluded. Further evaluation of this lesion with lumbar spine MRI is recommended. This lesion is not well seen on CT images.OTHER: No significant abnormality noted.

Output: 1. Enhancing lesion in the right lobe of the liver with MR characteristics suggestive of focal nodular hyperplasia or adenoma. If differentiation between these 2 lesions is clinically indicated, MRI would FNH protocol may be helpful.2.Lumbar spine MRI is recommended for evaluation of the L3 vertebral body lesion.


Instruction: Generate impression based on findings.

Input: Reason: 57 y.o. with autoimmune enterocolitis on cyclosporine, with persistently elevated bilirubin. h/o gallstones. Please eval for obstruction/choleystatis. History: persistently trending up bilirubin, jaundice. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Low insertion of the cystic duct is noted. There is no intra or extrahepatic biliary ductal dilatation. The common duct is well seen to the level of ampulla. No evidence of choledocholithiasis.There is biliary sludge within the gallbladder with layering stones.SPLEEN: No significant abnormality noted.PANCREAS: Age-related pancreatic atrophy. Pancreatic duct is normal in caliber.ADRENAL GLANDS: Right adrenal gland nodule measures 1.7 cm. It loses signal on out of phase imaging and is compatible with an adenoma.KIDNEYS, URETERS: Kidneys are mildly atrophic bilaterally. No suspicious focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of choledocholithiasis. There is layering biliary sludge and stones within the gallbladder. No intra or extrahepatic ductal dilatation.1.7 cm right adrenal adenomaI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with altered mental status, difficulty weaning from vent. A single 5 mm focus of restricted diffusion is seen within the white matter of the right centrum semiovale. No other areas of restricted diffusion are evident.Extensive patchy FLAIR hyperintensity is seen within the periventricular white matter, the basal ganglia and the pons. There is no associated edema or mass effect. No specific abnormalities are seen within the inferior right frontal lobe as suspected on prior CT.No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are normal. The sulci are prominent compatible with parenchymal volume loss. No pathologic parenchymal or extra-axial enhancement is seen.Fluid and mucosal inflammation in the paranasal sinuses is compatible with intubation. An oval enhancing focus is seen within the right parietal bone corresponding to an area of lucency noted on prior CT. No other significant bone marrow abnormalities are detected.

Output: 1.A single 5 mm focus of acute ischemia is seen within the right centrum semiovale.2.The background brain demonstrates moderately advanced chronic small vessel ischemic disease.3.No evidence of parenchymal edema, mass effect or pathologic intracranial enhancement is seen.4.A nonspecific enhancing right parietal bone lesion is seen.


Instruction: Generate impression based on findings.

Input: Meningiomas, surveillance. Again seen are postoperative changes of prior left parietal craniotomy related to meningioma resection. There is redemonstration of a relatively large area of encephalomalacia in the left superior parietal lobule similar to prior study. There is dural based thickening and enhancement along the posterior falx and along the left posterior parietal convexity which was present previously. The thickening along the posterior falx measures 4 mm, previous 3 mm. The thickening along the left parietal convexity measures 5 to 6 mm in the sagittal plane, previously 4 mm. These are suspicious for en plaque meningiomas and suggest continued close attention on follow-up.Again seen is a meningioma along the high right frontal convexity abutting the superior right frontal sulcus and measures approximately 8 x 8 which is similar to recent study from 11/12/2015 although clearly larger when compared to prior study from 5/8/2010. Slightly more inferiorly along the right frontal convexity is a meningioma measuring approximately 6 x 8 mm previously 5 x 8 mm in the axial plane, measured similarly. There is no evidence of acute intracranial hemorrhage or acute infarction. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Again noted is prominent enhancement at the left jugular foramen suspicious for meningioma, but not significant changed in the interval. There appears to be extension of tumor proximally into the straight sinus. No significant change in prior.

Output: 1. Stable to minimal interval increase in size of two small meningiomas along the right frontal convexity. There is also slight increase in dural thickening along the posterior falx and left parietal convexity suggesting possibility of small en plaque meningiomas in these regions. Suggest continued attention on follow-up. No significant associated mass effect. 2. No significant change in previously described enhancement at the left jugular foramen which is suspicious for meningioma. There is suggestion of tumor extension into the left straight sinus. Consider high resolution CT of the skull base with CTV protocol for confirmation.


Instruction: Generate impression based on findings.

Input: MRA BRAIN:Postsurgical changes related to transsphenoidal surgery with residual sellar and suprasellar mass with associated blood products as well as opacification of the paranasal sinuses as more fully characterized on 8/5/2016 MRI. There is minimally asymmetrically decreased caliber of the right internal carotid artery, developmental in etiology. No flow limiting stenoses are identified in the internal carotid arteries. A patent anterior communicating artery is visualized. The left A1 segment is asymmetrically decreased in caliber, a normal variant. The middle cerebral arteries are unremarkable. A right posterior communicating artery is visualized. A left posterior communicating artery is not definitively visualized. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: 1.Major intracranial arteries are patent without evidence of flow-limiting stenosis or aneurysm.2.Major cervical vessels are patent without evidence of flow-limiting stenosis.3.Postsurgical changes related to transsphenoidal surgery and residual sellar/suprasellar mass more fully characterized on 8/5/2016 MRI.


Instruction: Generate impression based on findings.

Input: 60 yo M hx of metastatic colon cancer s/p duodenal stent for duodenal obstruction presents w/ jaundice and leukocytosis. MRI/MRCP to further evaluate biliary obstruction Examination is limited by motion.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The hepatic vasculature appears patent.There is significant intrahepatic and extrahepatic biliary ductal dilatation. The common hepatic duct at its confluence measures up to 2.1 cm. As best seen on series 601, image 19, there is an abrupt segment of narrowing of the common bile duct with near complete occlusion measuring approximately 1.5 cm in length with associated surrounding infiltrative soft tissue. It is difficult to evaluate this area on other sequences due to motion artifact. The common bile duct reconstitutes more distally. SPLEEN: There is mild splenomegaly measuring up to 13 cm.PANCREAS: Parenchymal signal intensity appears within normal limits. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A duodenal stent is present in the transverse portion of the duodenum extending to the region of the ligament of Treitz.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild ascites is present.

Output: 1.Examination somewhat limited by motion.2.Significant intrahepatic and extrahepatic biliary dilatation likely related to 1.5 cm segment of abrupt narrowing of the common bile duct with associated surrounding infiltrative soft tissue. This area is difficult to evaluate on other sequences due to motion. ERCP may be helpful for additional evaluation.


Instruction: Generate impression based on findings.

Input: Secondary amenorrhea and low FSH - assess for pituitary lesion. Pituitary: The pituitary gland demonstrates homogeneous enhancement and is not enlarged. The posterior pituitary bright spot and infundibulum are intact. There is no evidence of sellar or suprasellar lesions. The optic apparatus and cavernous sinuses are intact. Brain: There are subcentimeter nodular foci along the margins of the lateral ventricle with signal characteristics that parallel grey matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The There is no abnormal intracranial enhancement. The ventricles are normal in size. 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. No evidence of pituitary lesions.2. Subcentimeter nodular foci along the margins of the lateral ventricles may represent subependymal heterotopia.


Instruction: Generate impression based on findings.

Input: Head and neck cancer, right frontal meningioma. IMPRESSION:Report Electronically Signed: 2/21/2008 2:23 PM Vivek Sehgal, MD

Output: No significant change. No evidence of tumor. Follow-up is suggested. TECHNIQUE:


Instruction: Generate impression based on findings.

Input: Clinical question: Recent seizure activity. Signs and symptoms: Left head/neck colonic/thymic movement. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse periventricular and to a lesser degree subcortical foci of FLAIR and T2 hyperintensity in bilateral cerebral hemispheres. Similar signal changes are also noted in bilateral basal ganglia and thalami. Although nonspecific considering patient's stated age of 77 findings also are present microvascular ischemic changes. There is no evidence of hemorrhagic changes with the findings. Small foci of chronic left cerebellar ischemic stroke in the distribution of left superior cerebellar artery is also noted.There is mild prominence of cortical sulci and the ventricular system which likely represent mild underlying parenchymal volume loss considering patient's stated age.No convincing evidence of cortical signal abnormality. No evidence of mass effect, midline shift or hydrocephalus.The signal void of major intracranial arterial branches are identified.Post contrast images demonstrate no detectable abnormal enhancement of brain parenchyma or the leptomeninges and no enhancement of the calvarium or the retro-orbital spaces.There is exuberant pneumatization of paranasal sinuses and including extensive pneumatization of frontal bones/frontal sinuses with multiple patchy foci of mucosal thickening and retention cysts.

Output: 1.No acute intracranial process.2.Findings suggestive of chronic nonhemorrhagic small vessel ischemic strokes of moderate degree and a small chronic left cerebellar ischemic stroke as detailed.3.No detectable abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.4.Exuberant pneumatization of paranasal sinuses with extensive pneumatization of frontal bones with multiple foci of mucosal thickening and retention cysts.


Instruction: Generate impression based on findings.

Input: Reason: eval pancreatic mass for malignancy History: 25lb weight loss ABDOMEN:LUNG BASES: Multiple bilateral basilar lung nodules noted, better seen on recent CT chest abdomen and pelvis study.LIVER, BILIARY TRACT: There is a peripheral wedge-shaped T1 and T2 hypodensity in the right lobe of the liver with persistent contrast enhancement. This region remains indeterminant, attention on follow-up imaging. Mildly dilated common bile duct. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: The pancreatic parenchyma is atrophic. There is cystic lesions in the pancreas correlating with changes of chronic pancreatitis seen on prior CT scan. Pancreatic duct of the head and uncinate process appears within normal limits. Pancreatic duct at the body and tail is not well visualized.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse thickening of the distal esophagus is again partially imaged, please correlate with endoscopy findings.BONES, SOFT TISSUES: The bone marrow are heterogeneous, consider PET scan.OTHER: No significant abnormality noted

Output: 1. Morphologic changes of the pancreas consistent with chronic pancreatitis. At least three adjacent fluid collections do not contain suspicious features, and are likely related to the chronic pancreatitis.2. There is a peripheral wedge-shaped T1 and T2 hypodensity in the right lobe of the liver with persistent contrast enhancement. This region remains indeterminant, attention on follow-up imaging. CT liver protocol may be useful as there will be less motion artifact.3. Diffuse thickening of the distal esophagus and pulmonary nodules are again partially imaged, and suspicious for neoplasm with metastatic disease.


Instruction: Generate impression based on findings.

Input: 76-year-old female with abdominal pain. Assess the pancreas or inflammation and please also do pelvis. Prior imaging showing focal pancreatitis versus diverticulitis. CHEST:LUNG BASES: Again seen is the previously described right lower lobe pulmonary nodule, unchanged in appearance. Follow-up dedicated imaging is still recommended.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: PANCREAS:Inflammatory changes primarily surrounding the tail of the pancreas are again seen. Additional periappendiceal inflammatory changes are seen posterior to the body of the pancreas. The splenic vein is thrombosed with numerous enlarged portosystemic collateral vessels noted. These findings make focal pancreatitis the favored diagnosis. The pancreatic duct is not dilated. There is no evidence of abscess or pseudocyst formation. Additionally, retroperitoneal lymph nodes with indistinct soft tissue haziness surrounding the celiac artery is seen. These may represent further additional inflammatory changes, versus lymph nodes. Follow-up imaging with MRI following resolution of this acute episode is recommended to exclude an occult pancreatic neoplasm.. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes are noted.BOWEL, MESENTERY: Hiatal hernia is again seen. Focal thickening of the colonic wall near the splenic flexure is again visualized. This is likely secondary to adjacent peripancreatic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Hiatal hernia is again seen. Focal thickening of the colonic wall near the splenic flexure is again visualized. This is likely secondary to adjacent peripancreatic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. inflammatory changes surrounding the tail of the pancreas with thrombosis of the splenic vein is suggestive of focal pancreatitis. Additionally, ill-defined perivascular soft tissue thickening around the celiac artery may represent additional inflammation versus adenopathy. Follow up MRI is recommended following resolution of the patient's acute episode of pancreatitis to exclude an underlying occult pancreatic neoplasm..2. Right pulmonary nodule unchanged from 10/26/2010. Recommend follow up dedicated imaging for further evaluation. 3. Hiatal hernia


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: Again seen is partial-thickness undersurface tearing of the distal fibers of the supraspinatus tendon, the extent of which appears similar to the prior exam. This is superimposed upon tendinopathy of the supraspinatus tendon which does appear more prominent than the prior exam. There is otherwise no evidence of rotator cuff tear. The rotator cuff musculature is normal in caliber and signal. Degenerative cystic changes are seen along the greater tuberosity near the rotator cuff insertion.SUPRASPINATUS OUTLET: Severe osteoarthritis affects the acromioclavicular joint, similar to the prior exam. There is no significant subacromial subdeltoid fluid.GLENOHUMERAL JOINT AND GLENOID LABRUM: Within the limits of a non-arthrographic study, there is degenerative tearing of the labrum without gross labral detachment. Mild osteoarthritis and degenerative cystic changes are noted in the glenoid. BICEPS TENDON: A small amount of fluid is seen within the biceps tendon sheath. The biceps tendon is otherwise intact. ADDITIONAL

Output: 1. Partial thickness undersurface tearing of the distal fibers of the supraspinatus tendon appearing similar to the prior exam although there is worsening tendinopathy. There is otherwise no evidence of full-thickness rotator cuff tear.2. Severe osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Cervical, thoracic, and lumbar radiculopathy on EMG as well as fasciculations, possible ALS. There is a small area of nonexpansile T2 hyperintensity in the dorsal columns and left grey matter of the spinal cord at the C2 level. There is no associated abnormal enhancement. The rest of the spinal cord appears to be unremarkable. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable, aside from a small hemangioma in a mid thoracic vertebral body. There is a disc extrusion at L3-4 that results in moderate to severe spinal canal stenosis. There is also facet hypertrophy and ligamentum flavum thickening at this level, which results in mild to moderate bilateral neural foraminal narrowing. There is a disc protrusion at L4-5 that results in mild spinal canal narrowing. There is also facet hypertrophy and ligamentum flavum thickening at this level, which results in mild bilateral neural foraminal narrowing. There is no significant spinal canal or neural foraminal narrowing at the other lumbar levels or in the cervical and thoracic spine. The paravertebral soft tissues are unremarkable, aside from dependent edema in the posterior lumbar subcutaneous tissues. There is a small left renal cyst. There may be cholelithiasis.

Output: 1. Nonspecific lesion involving the dorsal columns and left grey matter of the spinal cord at the C2 level. Differential considerations include prior ischemia, trauma, or infection, for example.2. A disc extrusion at L3-4 that results in moderate to severe spinal canal stenosis.3. A disc protrusion at L4-5 that results in mild spinal canal narrowing. 4. Possible cholelithiasis.


Instruction: Generate impression based on findings.

Input: Left hip pain ACETABULAR LABRUM: Small partial thickness tear of the superior lateral labrum.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Normal bone marrow signal throughout.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small partial thickness tear of the superior lateral labrum.


Instruction: Generate impression based on findings.

Input: 59-year-old female with status post left lumpectomy for invasive ductal carcinoma at outside institution. Preoperative mammograms showed an indeterminate focal asymmetry posterior to the known cancer. Breast parenchyma is almost entirely fat in both breasts.Mild parenchymal enhancement is noted bilaterally.Postoperative seroma cavity is seen at anterior upper outer quadrant in the left breast, measuring 47 x 40 x 29 mm (AP x LR x CC). There are small areas of enhancement at anteromedial and posterolateral borders of the seroma, likely postsurgical changes. No suspicious enhancement is seen around the seroma.There is a nonenhancing mass, measuring 14 mm in AP direction, located posterior to the seroma, likely corresponding to the focal asymmetry in question on the prior mammogram. As there is no enhancement in this mass, this is considered a benign lesion.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy in either breast. Status post lumpectomy in the left breast for invasive ductal carcinoma. A small focal asymmetry posterior to the known cancer seen on the outside mammogram corresponded to a benign non-enhancing mass on the current MRI.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 19 year-old female with history of hydrocephalus status post VP shunt placement presenting with headache and vomiting. Evaluate for worsening hydrocephalus. Ventricular shunt catheter enters the right parietal burr hole with catheter tip in the left lateral ventricle, unchanged in position. Stable morphology and increased volume of both lateral ventricles is evident. Previously evident contrast within the left lateral ventricle is no longer seen. There is no evidence of intracranial hemorrhage, abnormal extra-axial fluid collections, or edema. The remainder of the cerebral and cerebellar hemispheres are stable in appearance. The pituitary gland appears mildly prominent, which correlates with convex morphology seen on recent MRI.Postoperative changes status post right parietal burr hole and are unchanged, with the remainder of the calvarium visualized osseous structures intact. Visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable hydrocephalus with no additional acute findings to explain headache and vomiting.


Instruction: Generate impression based on findings.

Input: Pain medial joint line after twisting motion suspect MCL injury. MENISCI: Complex multidirectional tear of the medial meniscus including a horizontal component through the body and anterior horn and multidirectional component through the posterior horn extending to the femoral and tibial articular surfaces.The lateral meniscus is intact with no discrete tear.ARTICULAR CARTILAGE AND BONE: Mild thinning of the medial compartment articular cartilage. The lateral compartment and patellofemoral compartment articular cartilage appears intact.No acute fracture. Alignment is anatomic.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complex multidirectional tear of the medial meniscus as described above.


Instruction: Generate impression based on findings.

Input: 62 year old with history of diabetes presenting for evaluation of abnormal echocardiogram. Left VentricleThe left ventricle is normal in size with normal systolic function. There is severe left ventricular hypertrophy which is global). The overall LV ejection fraction is 67%, the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVEDV is 136 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 45 ml (normal range 47+/-19). No regional wall motion abnormalities. There is no focal delayed enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Flow acceleration is noted along the LVOT. The native T1 times averaged 1000 msec and there was no heterogeneity in native T1 mapping.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 56%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 106 ml (normal range 142+/-31), the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9), and the RVESV is 47 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. The anterior mitral valve leaflet appears thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function with severe global LVH without focal hypertrophy2. No delayed enhancement3. Normal RV systolic function


Instruction: Generate impression based on findings.

Input: Pulmonary nodules and brain tumor with left numbness not correlated with left side brain tumor, also hyperreflexic LUE and BLE. There is a peripherally enhancing masa that measures up to approximately 5 cm in the anterior left temporal lobe with surrounding T2 hyperintensity, which may represent vasogenic edema. There is mild left uncal herniation and effacement of the left temporal horn. There is mild midline shift to the left. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a nasopharyngeal retention cyst that measures up to 19 mm in length.Spine: There is degenerative spondylosis at C3 through C6, with mild to moderate spinal canal narrowing. There is also extensive posterior thoracic epidural lipomatosis that markedly narrows the thecal sac and mildly compresses the spinal cord at T6-7. However, the spinal cord signal is within normal limits. There is also degenerative spondylosis at L3 through L5, but no significant spinal canal stenosis. There is scattered fatty infiltration of the vertebral bone marrow and degenerative endplate signal alterations at L4-5, but no evidence of enhancing lesions within the imaged spinal column. The vertebral body heights are preserved. There are nodules in the partially imaged right lung. There is also a partially imaged left hepatic cyst. There are postoperative findings related to aortoiliac bypass.

Output: 1. Left anterior temporal lobe mass measuring up to approximately 5 cm may represent a metastasis.2. Degenerative spondylosis at C3 through C6, with mild to moderate spinal canal narrowing. 3. Extensive posterior thoracic epidural lipomatosis that markedly narrows the thecal sac and mildly compresses the spinal cord at T6-7.4. Degenerative spondylosis at L3 through L5, but no significant spinal canal stenosis. 5. No evidence of spine metastases.6. Partially imaged right lung metastases. 7. Partially imaged left hepatic cyst.8. Aneurysmal dilatation of the infrarenal aorta, measuring up to approximately 25 mm in width.


Instruction: Generate impression based on findings.

Input: Male 72 years with blindness and history of lymphoma. MRI Brain:Exam is severely limited by motion. There is prominent restricted diffusion, masslike FLAIR signal abnormality and intense enhancement extending across the splenium with extension into the parietal, occipital and posterior temporal lobes bilaterally. There is evidence of recent biopsy via right parieto-occipital approach. There is question of increased vascularity and/or leptomeningeal enhancement in the medial parieto-occipital region as well as along the left temporal horn, not adequately assessed given the severe motion degradation.No gross evidence of acute infarct or hemorrhage. There is mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease.There is no significant midline shift or herniation. No hydrocephalus.MRI Orbits:Severely limited exam. Postcontrast sequences could not be obtained. No obvious mass within the orbits is appreciated. No gross signal abnormality involving the optic nerves. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen.

Output: 1. Infiltrative mass extending across the splenium of the corpus callosum and involving the bilateral parietal, occipital, and posterior temporal lobes is consistent with lymphoma. 2. There is suggestion of abnormal leptomeningeal enhancement in the medial parietal-occipital regions as well as along the left temporal horn surface which is not adequately evaluated due to motion degradation but raises possibility of leptomeningeal disease. Follow-up imaging with sedation or correlation with CSF sampling is suggested.3. No obvious orbital lesion is appreciated. Please see comment in technique section.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for ischemic infarcts or small brain metastases: syncope, memory loss, and breast cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged mild scattered foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is minimal residual left frontal scalp hematoma.

Output: 1. Mild probable chronic small vessel ischemic disease, but no evidence of acute cerebral infarction.2. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 6.3 cm LR x 4.4 cm AP x 5.0 cm CC.Peripheral Zone: There is a 1.5 x 1.3 cm T2 hypointense lesion demonstrating diffusion restriction in the left mid gland, compatible with carcinoma. An additional 1.0 x 0.4 cm focus of T2 hypointensity and diffusion restriction in the right mid gland towards the apex at the periphery is also suspicious for carcinoma.Central Gland: Heterogeneous with nodules, compatible with BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The aforementioned lesions abut the capsule, without evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: A prominent right iliac lymph node (series 1701, image 93) is nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Two prostatic lesions suspicious for carcinoma, as described above.2. Prominent right iliac lymph node. This is nonspecific and metastatic disease cannot be excluded.


Instruction: Generate impression based on findings.

Input: Clinical question: Mass? Mesial temporal sclerosis. Signs and symptoms: Syncope and shaking. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate scattered small varying size foci of FLAIR and T2 hyperintensity extensively in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres. None of specific, nonhemorrhagic and nonenhancing. The appearance is highly suggestive of chronic small vessel ischemic strokes as was noted on prior head CT. There is a slight prominence of cortical sulci and the lateral ventricles patient's stated age which could be as a result of small vessel ischemic strokes. There is no detectable abnormal parenchymal or meningeal enhancement.Examination is performed utilizing routine brain MRI protocol and without coronal FLAIR series. Within this limitation however there is suggestion of FLAIR/T2 hyperintensity and T1 hypointensity along the medial aspect of the left anterior temporal lobe without suggestion of parenchymal volume loss. Finding is highly suspected medial temporal sclerosis. Recommend follow-up with coronal FLAIR sequences for better assessment. Unremarkable images through the orbits including axial fat sat post enhanced series.Calvarium and soft tissues of the scalp are unremarkable.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.There are no prior MRI exams for comparison however if such studies are available and provided to the radiology department an addendum to this report will be submitted after comparison.

Output: 1.No acute intracranial process.2.Findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes primarily within the subcortical and periventricular white.3.No abnormal enhancement is detected.4.Increased T2/FLAIR signal intensity of the medial aspect of the left anterior temporal lobe without parenchymal volume loss suspected for mesial temporal sclerosis. Recommend follow-up with coronal FLAIR sequences for further assessment/confirmation.


Instruction: Generate impression based on findings.

Input: Clinical question: 78-year-old female with history of CVA. Now with slurred speech. Signs and symptoms: Slurred speech Nonenhanced head CT:Examination demonstrate mild to moderate findings of small vessel ischemic disease of indeterminate age in the subcortical and periventricular white matter of bilateral cerebral hemispheres. Exclude possibly to overlapping new stroke recommend an MRI exam.There is no evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus.

Output: Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Male 15 years old Reason: r/o meniscal/ligamentous injury History: pain, swelling MENISCI: Medial and lateral menisci are intactARTICULAR CARTILAGE AND BONE: Articular cartilage is intact. There is a small T2 hyperintense bone contusion in the medial femoral condyle.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Small bone contusion in the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: 17 year old female status post head trauma. Evaluate for change. There is no evidence of intracranial mass or edema. A small focus of high density presumably represents an extra-axial fluid collection adjacent to the frontoparietal cortex, (images 12 and 13), unchanged. Focus of soft tissue density overlying the left parietal occiput likely represents a hematoma without underlying fracture.These focal findings suspicious for a small subdural hematoma would be better evaluated with an MRI.Low-density focal widening of the right lateral sylvian fissure may represent an arachnoid cyst (image 7).The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Unchanged, small focus of hyperdensity, as described above, may represent a subdural hematoma which would be better evaluated with MRI.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 53 years, Male, new onset nocturnal episodes of headaches in the setting of prostate cancer. No evidence of metastatic disease. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size with cavum lucidum and cavum vergae incidentally noted. A few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild age-related white matter changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain appears within normal limits for age. No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, with altered mental status. Assess for swelling, radiation effect or tumor. Postoperative findings are seen compatible with right parietal craniotomy and paramedian parietal craniectomy with mesh cranioplasty. A small pocket of extra-axial fluid is seen subjacent to the craniectomy which is unchanged from prior.Since the prior examination, an irregularly enhancing nodule of presumed residual tumor along the left parietal lobe at the upper aspect of the resection cavity has increased in size from approximately 20 mm to 30 mm. This lesion is contiguous with nodular tumor at the inferior aspect of the resection cavity, spanning the midline, which has also substantially increased in size.Edema and T2 signal abnormality within the left parietal lobe have increased from prior. Edema and T2 signal abnormality within the right parietal lobe are relatively unchanged. Areas of cystic degeneration within the right parietal lobe are stable to slightly smaller.Redemonstrated are scattered nonspecific foci of brain parenchymal T2 hyperintensity. No restricted diffusion is seen. No acute intracranial hemorrhage is suspected. Apart from the residual and/or growing tumor, no new enhancing lesions are seen. The lateral and third ventricles are slightly more prominent than on the prior examination but are not frankly dilated.On MR imaging, no high-grade intracranial vascular stenosis or occlusion is suspected. No aneurysm or vascular malformation is observed. The right vertebral artery is congenitally small and primarily supplies the right PICA. Prominent bilateral PCOM arteries are present. The ACOM artery is small and unremarkable.

Output: 1.Findings are seen concerning for progression of tumor at the site of prior tumor resection in the high parietal regions.2.Slight progression of edema in the left parietal lobe. Stable edema and cystic encephalomalacia in the right parietal lobe.3.No acute intracranial abnormality.4.No intracranial vascular compromise.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with brain metastasis status post radiotherapy. Surveillance exam. Evidence of prior surgery is again seen in the right operculum. A small rim-enhancing, hemosiderin stained cavity or cyst within the opercular tissues is unchanged in size and morphology. The degree of surrounding T2 hyperintensity is also unchanged. Mild T2 hyperintensity along the right dentate nucleus is also unchanged. No new enhancing lesions are seen. Ill-defined bilateral periventricular T2 hyperintensity is unchanged. No significant edema or mass effect is detected. Ventricular size and morphology are within normal limits.

Output: Stable postoperative and posttreatment findings with no new or growing lesions.


Instruction: Generate impression based on findings.

Input: 88-year-old female with vaginal bleeding. New vaginal cancer diagnosis. PELVIS:UTERUS, ADNEXA: On the right aspect of the vagina there is a 2.8 x 4.4 cm mass (series 601 image 23) that is T1 hypointense, T2 hyperintense and peripherally enhancing lesion. The lateral aspect of the lesion involves the right obturator internus muscle. This lesion extends anterolaterally, and the tip abuts the posterior border of the right inferior pubic ramus (series 1103 image 131). The lesion extends medially and involves the majority of the right side of the urethra (series 601 image 22). The lesion contacts the anterior wall of the rectum without discrete evidence of invasion (series 601 image 25).Status post hysterectomy.BLADDER: Known vaginal lesion involves the majority of the right side of the midportion urethra. No definite evidence of involvement of the bladder wall.LYMPH NODES: Mildly enlarged left external iliac and left inguinal lymph nodes (axial series 601 images 33, 37), which were not FDG avid on the 12/14/2016 PET/CT exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.On the right aspect of the vagina, there is a 2.8 x 4.4 cm T2 hyperintense and enhancing lesion extending medially with involvement of a majority of the right side of the urethra. The lesion abuts the rectum without discrete evidence of invasion. Other anatomic descriptions listed above.2.Mildly enlarged left external iliac and left inguinal lymph nodes were not FDG avid 12/14/2016 PET/CT exam.


Instruction: Generate impression based on findings.

Input: Chiari malformation: headaches, choking on food, and back pain. The images are generally degraded by patient motion artifact. The cerebellar tonsils extend up to 12 mm inferior to the foramen magnum and have pointed morphologies. There is also impeded flow of cerebrospinal fluid across the foramen magnum. There appears to be a very short segment 1 mm diameter syrinx in the upper cervical spinal cord. The rest of the spinal cord displays normal signal and morphology. The conus medullaris is located at the L1 level and there is no evidence of fibrofatty filum terminale. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Findings compatible with Chiari type 1 malformation, including cerebellar tonsils that extend up to 12 mm inferior to the foramen magnum, with pointed morphologies, and impeded flow of cerebrospinal fluid across the foramen magnum. 2. Apparent very short segment 1 mm diameter syrinx in the upper cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Altered mental status at church. Rule out stroke, acute process. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation. Calcifications are noted within the basal ganglia bilaterally which is probably dystrophic.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there clinical concern for an acute stroke, an MRI may be considered for further evaluation.