Instruction: Generate impression based on findings.

Input: Assess for possible left parieto-occiptal cavernoma: unusual sensory symptoms-water running on right side of head, balance issues. There is a non-enhancing subcentimeter lesion with peripheral susceptibility effect in the right lateral parieto-occipital region and an associated right periatrial developmental venous anomaly. There is no surrounding vasogenic edema. There are unchanged mild scattered punctate foci of nonspecific T2 hyperintensity in the cerebral white matter. 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. There is moderate mucosal thickening in the left sphenoid sinus. The skull and extracranial soft tissues are unremarkable.

Output: Unchanged subcentimeter right parieto-occipital region cavernous malformation and an associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Meningioma. Status post head injury/concussion. The small left parietal convexity dural-based contrast enhancing mass has not changed. It has a maximum thickness of less than 5 mm. No significant significant mass effect.The diffuse T2/FLAIR signal abnormality involving the deep gray nuclei, bilateral pons (with downward extension into the ventral medulla), left greater than right thalami as well as scattered foci of cerebral white matter remain unchanged. There is no diffusion restriction or susceptibility artifact. This likely represents chronic microvascular ischemia. There is no space-occupying or contrast-enhancing brain lesion otherwise. The CSF-containing spaces are mildly expanded, reflecting mild volume loss. Major intracranial vessels are patent.Mild mucosal thickening in the right major sinus without fluid is very nonspecific. The other paranasal sinuses are clear. Remote small right orbital medial wall blowout fracture is unchanged with herniation of the extraconal fat into the ethmoid sinuses but no extraocular muscle entrapment.

Output: 1.The tiny left parietal convexity meningioma has not significantly changed since September 2013.2.The relatively extensive and symmetric T2 signal abnormality primarily involving the deep gray nuclei and pons is not significantly changed since the previous examination. As discussed previously, this may be sequela of prior osmotic demyelination or other toxic-metabolic injury.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58-year-old male with altered mental status and history of chronic osteomyelitis of the right foot. Suboptimal examination secondary to patient motion artifact and patient's inability to tolerate the examination. Again seen is ulceration along the posterior and plantar aspect of the calcaneus with signal abnormality extending to the underlying posterior tuberosity of the calcaneus. There is persistent signal abnormality within the posterior tuberosity of the calcaneus including low signal intensity on T1-weighted images and increased signal intensity on T2-weighted images, compatible with osteomyelitis, which appears less extensive on the current study than on the prior examination. However, there is now a mildly displaced Achilles tendon avulsion fracture off of the superior aspect of the calcaneal tuberosity, which is displaced anteriorly and proximally by 1 cm as seen on the recent radiographs. There is thickening of the distal Achilles tendon likely representing a combination of tendinosis and retraction. Signal intensity of the remaining visualized bones is normal. There is a small amount of fluid within the tibiotalar joint and anterior recess of the subtalar joint which is probably of no current clinical significance. Mild osteoarthritis affects the tibiotalar joint. There is generalized atrophy of the musculature of the foot and ankle. There are multiple foci of signal void extending from the medial aspect of the calcaneal tuberosity to the midfoot and proximal forefoot along the quadratus plantae muscle and flexor digitorum longus tendon which were not present on the prior study and are of uncertain etiology, but we cannot exclude the possibility of gas extending from the ulceration to the midfoot/forefoot. There is diffuse subcutaneous edema.

Output: 1. Osteomyelitis of the posterior tuberosity of the calcaneus as described above with an associated mildly displaced avulsion fracture of the superior aspect of the posterior calcaneal tuberosity.2. Foci of signal void extending from the medial aspect of the posterior tuberosity of the calcaneus into the plantar soft tissues of the midfoot and forefoot along the quadratus plantar muscle and flexor digitorum tendon which may represent soft tissue gas. This could be further evaluated with repeat radiographs.


Instruction: Generate impression based on findings.

Input: 25 year old female. History of Crohn's status post ileocecectomy who developed postop perianal abscess with Seton placement. Patient now presents with new perianal abscess and new perianal skin tags. Need to assess pelvis for new fistulas. Patient is on Remicade. PELVIS:UTERUS, ADNEXA: 9-mm fundal intramural fibroid. Endometrial stripe is unremarkable. No adnexal masses.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Seton is noted in the left posterior perirectal soft tissues. Thin superficial subcutaneous inflammatory tract in the left perineum that is approximately 3.6 cm long, paralleling the skin surface (series 100, image 73). There is overlying skin thickening and enhancement. Post contrast imaging suggest the tract as blind ending prior to termination at the anus, although the diffusion weighted imaging does show restricted diffusion extending to the anus (but this may be phlegmon changes in adjacent skin). No extension of this tract above the levator ani.No perirectal abscess. OTHER: No significant abnormality noted.

Output: Thin, superficial inflammatory tract in the left superficial perineum that appears to be blind-ending with no definite connection to the anus. No perirectal abscess.


Instruction: Generate impression based on findings.

Input: 86 years Female (DOB:8/28/1930)Reason: etiology for memory deficit History: forgetfulPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI IRSK JASON ANDERSON The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are relatively stable compared to the prior exam. Additional T2 and FLAIR hyperintense patchy lesions are present in the brainstem, external capsules and internal capsules. These too appear to be stable.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. The eyeball lenses are thin.There is diffuse calvarial thickening present which was also present on the prior exam this predominantly involves the frontal bones and occipital bones.

Output: 1.No evidence for acute ischemic cerebral infarction.2.Calvarial thickening with findings suggestive of patches disease.3.Periventricular and subcortical white matter lesions as well as lesions in the brainstem, external capsules and internal capsules of a mild degree are nonspecific. At this age they are most likely vascular related. This is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Male, 53 years old. Reason: r/o ganglion vs carpal boss History: dorsal wrist pain LIGAMENTS: Evaluation of the ligaments is limited by lack of intra-articular contrast. However, there is increased signal intensity traversing the membranous portion of the scapholunate ligament and extending into the dorsal fibers of the ligament, suspicious for tear. The lunotriquetral ligament appears intact.TRIANGULAR FIBROCARTILAGE COMPLEX: Although no fluid signal intensity is seen traversing the articular disc of the triangular fibrocartilage complex, a small linear focus of intermediate signal intensity partially traverses the articular disc just medial to its attachment to the radius, which is suspicious for tear, and likely spares the proximal fibers of the disc. There is also mild irregularity of the proximal surface of the triangular fibrocartilage more centrally which likely indicates partial tearing.TENDONS: The tendons appear unremarkable. BONES: There is slight bony prominence along the dorsal aspect of the capitate immediately proximal to the carpometacarpal joint and just medial to the extensor carpi radialis brevis tendon. Immediately distal to this bony prominence is a small ossicle (which may be bipartite) situated dorsal to the carpometacarpal joint, and measuring approximately 3.5 x 3 x 1.5 mm. This ossicle is evident on the lateral wrist radiograph from 02/19/2015. There is also an osteophyte/spur projecting from the ulnar aspect of the dorsal surface of the capitate, extending dorsal to the articulation between the bases of the third and fourth metacarpals.We see no ganglion. Small foci of signal abnormality within the bones of the proximal carpal row are of doubtful clinical significance.

Output: 1.Bony prominences along the dorsal surface of the capitate as well as a tiny ossicle dorsal to the third carpometacarpal joint. We see no ganglion.2.Findings suggestive of scapholunate ligament and triangular fibrocartilage tears as described above, the clinical significance of which is uncertain.


Instruction: Generate impression based on findings.

Input: 32-year-old male post resection of meningioma Post operative changes is post left temporal and frontal craniotomy again noted. Epidural fluid/air collection under the craniotomy flap as well as residual air in the subarachnoid space compatible with expected postoperative changes is stable in appearance. There is no evidence of intraparenchymal or extra-axial hemorrhage. Hypoattenuation in the anterior left temporal lobe adjacent to the surgical bed time, corresponding to area of restricted diffusion seen on prior MRI, is better defined on today's exam. Again noted minimal bulge of the left temporal lobe toward the basal cistern and left perimesencephalic cistern, stable.The appearance of ventricular system and the basal cisterns is unchanged compared to prior exam. There is no midline shift or hydrocephalus. Focus of high density above the left anterior clinoid corresponds to previously identified lytic or sclerotic left supraclinoid internal carotid artery, unchanged.Again noted cystic left cerebellar structure with CSF density, unchanged.The orbits are unremarkable. Left maxillary retention cysts are noted. Otherwise the visualized paranasal sinuses and mastoid air cells are well pneumatized.

Output: 1.Expected postoperative changes status post left frontal and temporal craniotomy as described above.2.Evolutionary change of left temporal lobe hypoattenuation corresponding to previously seen restricted diffusion compatible with infarct in left middle cerebral artery distribution.3.Unchanged posterior cranial fossa cyst.


Instruction: Generate impression based on findings.

Input: 64-year-old male with a history of malignant pleural mesothelioma status post pleurectomy/decortication surgery LUNGS AND PLEURA: Note is made of multiple foci of restricted diffusion consistent with active disease. There is a focus of restricted diffusion corresponding to the pleural thickening along the left anterior upper lobe (series 608; image 432). There is associated enhancement on postcontrast sequences. Note is made of 2 additional foci of restricted diffusion corresponding to pleural thickening along the posterior aspect of the left lower lobe also consistent with active disease (image 96 and image 80 of series 608). There is associated enhancement on postcontrast sequences. Multiple additional foci of increased T2 signal abnormality and peripheral enhancement are identified along the paramediastinal pleura on the left corresponding to pleural thickening seen on prior CT examination, however, there is no restricted diffusion to suggest active disease. These findings likely represent postinflammatory change.Trace bilateral pleural effusions.MEDIASTINUM AND HILA: There is an additional focus of restricted diffusion corresponding to the left intercostal nodes seen adjacent to the body of the sternum on prior CT examination (image 304; series 608). There is associated pathologic enhancement on postcontrast sequences.CHEST WALL: Note is made of postsurgical changes consistent with the stated history of prior cytoreductive surgery. Right chest port tip terminates at the cavoatrial junction.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Small hiatal hernia.

Output: 1. Multiple foci of restricted diffusion with associated enhancement consistent with active disease/mesothelioma corresponding to pleural thickening along the anterior aspect of the left upper lobe and posterior aspect of the left lower lobe. There is also restricted diffusion corresponding to the previously described left intercostal nodes seen on prior CT examination suspicious for metastatic disease.2. Foci of abnormal enhancement and pleural thickening along the paramediastinal and posterior aspect of the left lower lobe do not demonstrate restricted diffusion and likely represent postinflammatory change rather than active disease.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is an intrasubstance linear signal within the supraspinatus tendon representing interstitial tearing. There is no evidence of full-thickness tear within the supraspinatus or remaining rotator cuff tendons. The musculature of the rotator cuff is normal in signal and caliber.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is normal. Mild osteoarthritis affects the glenohumeral joint. The labrum appears intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Mild intrasubstance tearing of the supraspinatus tendon. The remaining rotator cuff tendons are intact.2. Moderate osteoarthritis of the acromioclavicular joint.3. Prominent left axillary lymph nodes. Correlation recommended.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, postoperative imaging following effect or a groove meningioma resection. There are expected postoperative changes status post bilateral bifrontal craniotomy and resection of a large olfactory groove meningioma. A small amount of postoperative blood products are present in the anterior cranial fossa, more so on the left. Small extra-axial fluid collections and postoperative enhancement of the dura are present. There may be a small amount of residual enhancing tumor along the posterior planum sphenoidale, just anterior to the sella (see image 87 series 12), though this area is difficult to assess with accuracy given postoperative blood.There is improved mass effect on both frontal lobes from removal of the mass. Extensive edema in the bilateral frontal lobes, more so on the left does not appear to be significantly changed. No new enhancing intracranial mass is identified. There is no hydrocephalus. The major intracranial flow-voids are preserved. The visualized portions of the paranasal sinuses and mastoid air cells are clear abnormal fluid signal.

Output: Expected postoperative changes related to bifrontal craniotomy and large olfactory groove meningioma resection. Complete or near complete resection of the tumor is seen. There may be a small amount of residual tumor along the posterior aspect of the planum sphenoidale, though this area may be better assessed on subsequent exams after acute postoperative findings have resolved.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma of the left submandibular gland s/p resection (2001) and radiation therapy c/b multiple cranial neuropathies and suspected bone metastases. There are post-treatment findings in the neck, including left submandibular gland resection, without evidence of gross tumor in this particular location. There are denervation changes in the left hemitongue and vocal cord. There appears to be a tumor in the central skull base region with extension to the left jugular foramen. There are also enhancing lesions within the anterior mandible, dens, and C5 through C7 vertebrae. Otherwise, there is a background of fatty marrow in the upper cervical spine likely related to radiation effects. There is no loss of vertebral body heights. There is degenerative spondylosis at multiple levels, most pronounced at C5-6 and C6-7, where there is mild indentation upon the spinal cord. The spinal cord signal is otherwise unremarkable. There does not appear to be significant lymphadenopathy in the neck. There is left tympanomastoid fluid. There are bilateral lens implants.

Output: 1. Multiple bone lesions likely represent metastatic disease. In particular, the skull base lesion may be responsible for denervation effects in the lower cranial nerves. Otherwise, abnormality in the anterior mandible may be related to metastatic disease, infection, or osteonecrosis, for example.2. Findings suggestive of left Eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: 73-year-old male patient with history of cirrhosis and two subcentimeter nodules seen on outside imaging. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Note that evaluation of the left hepatic lobe is limited due to adjacent metal artifact. Nodular liver contour compatible with cirrhosis. Liver is hypointense on in phase imaging compared to out of phase imaging, which can be seen in the setting of iron deposition. No intra or extrahepatic biliary duct dilatation.There is an arterial enhancing lesion in the inferior tip of segment five that measures 1.5 x 1.8 cm (series 901 image 162) and demonstrates restricted diffusion. This lesion does not demonstrate washout on delayed imaging.There is an ill-defined focus of arterial enhancement in segment 8 (series 901 image 277) that is not well seen on delayed imaging.There is recanalization of the umbilical vein.SPLEEN: Mild splenomegaly, measuring up to 13.8 cm in craniocaudal dimension. T1 and T2 serpiginous low signal abnormality may represent sequelae of prior splenic infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple cysts bilaterally. There is a subcentimeter proteinaceous cyst in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two arterially lesions within the liver parenchyma, one of which demonstrates restricted diffusion and is suspicious. However, neither lesion meets specific criteria for diagnosis of HCC. Continue follow up as clinically indicated. 2.Cirrhotic liver morphology and mild splenomegaly.


Instruction: Generate impression based on findings.

Input: 72 year-old female with right hemipelvis retroperitoneal mass extending to the right hip There is a large fatty mass extending through the obturator foramen inferiorly and medial to the hip with several septations, but no enhancement. The mass measures 12.2 x 4.5 cm in largest AP and transverse dimensions and displaces the surrounding musculature. The underlying osseous structures appear unremarkable. A fibroid uterus is also noted.

Output: Fatty mass involving the right hip and pelvis most likely representing a lipoma, as described above.


Instruction: Generate impression based on findings.

Input: Reason: Hx of peritoneal mesothelioma, eval disease progresion History: abdominal pain CHEST:LUNGS AND PLEURA: No gross abnormalities.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Tumor extending anteriorly within the cardiophrenic space is decreased since the prior exam.CHEST WALL: Subcentimeter axillary and internal mammary nodes are unchanged.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Multiple perihepatic subserosal and peritoneal nodular implants extending along the right paracolic gutter are not significantly changed.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 1.4 x 1.2 cm, minimally increased since the prior exam.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged lymph nodes at the porta hepatis which have increased since the prior exam with increased necrosis.BOWEL, MESENTERY: Numerous soft tissue implants throughout the peritoneum and mesentery. Reference measurements are unchanged.BONES, SOFT TISSUES: Complex cystic lesion along the ventral incision site has increased in size.OTHER: Moderate ascites is unchanged.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Soft tissue implants throughout the pelvis with an unchanged reference lesion. Rectosigmoid anastomosis.BONES, SOFT TISSUES: Cystic lesion within the right gluteus minimus measures 1.5 x 1.7 cm. Right-sided paralabral cystOTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 6/13/2016 08:23:50)PERITONEAL NODULAR ADJACENT TO LIVER: 3.7 x 1.9 cm (Image 274, Series 2204); 4.1 x 2.2 cm on prior (4/6/2016) (Image 33, Series 209).PERIPANCREATIC NODULE: 2.5 x 2.6 cm (Image 189, Series 2204); 2.1 x 1.9 cm on prior (4/6/2016) (Image 38, Series 209).VENTRAL BODY WALL COMPLEX CYSTIC LESION: 12.2 x 5.4 cm (Image 1, Series 1701); 7.9 x 3.6 cm on prior (4/6/2016) (Image 57, Series 209).POSTERIOR PELVIC SOFT TISSUE IMPLANT: 3.0 x 2.8 cm (Image 84, Series 3001); 2.9 x 2.9 cm on prior (4/6/2016) (Image 80, Series 209).

Output: 1.Soft tissue implants along the anterior mediastinum have slightly decreased since the prior exam.2.Extensive peritoneal and mesenteric soft tissue implants are not significantly changed accounting for differences in technique.3.Peripancreatic lymph nodes are slightly increased in size with increased central necrosis.4.Large cystic lesion along the anterior abdominal wall is increased in size.5.Small cystic foci in the right gluteus minimus is of uncertain etiology.


Instruction: Generate impression based on findings.

Input: Meningioma versus dural breast cancer metastasis. There is a 6 mm wide dural-based, homogeneously enhancing mass along the left middle frontal gyrus convexity. There is no evidence of intracranial hemorrhage or acute infarct. There are minimal scattered punctate foci of high T2 signal in the cerebral white matter. There is a nonspecific punctate focus of susceptibility effect in the left parietal lobe deep white matter without associated enhancement. There is a small left cerebellar hemisphere developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A 6 mm wide dural-based, homogeneously enhancing mass along the left middle frontal gyrus convexity likely represents a meningioma and less likely a metastasis given the lack of aggressive features, but there can be overlap in the imaging findings of the conditions. 2. A nonspecific punctate focus of susceptibility effect in the left parietal lobe deep white matter without associated enhancement may represent a chronic microhemorrhage rather than an atypical metastasis. Otherwise, no evidence of brain metastases.


Instruction: Generate impression based on findings.

Input: 36-year-old male with Ewing's sarcoma to right shoulder status post radiation. The patient has been called back for repeat imaging, free of charge, as the most recent study dated 4/12/2016 did not include the entire extent of the lesion. Please refer to recent report for MRI of the right shoulder dated 4/12/2016 accession #16025634. Again seen on this repeat study is a lobular mass within the right axilla. It measures approximately 3.8 cm (anteroposteriorly) x 3.1 cm (medial to lateral) x 4.9 cm (craniocaudal) suggesting a slight increase in the craniocaudal dimension of the mass, although subjectively the mass appears similar to that seen on the prior study and slight differences in dimension may simply reflect differences in patient positioning. The mass is isointense to muscle on T1-weighted images, heterogeneously hyperintense to muscle on T2-weighted images and enhances diffusely following contrast administration. The mass lies just beneath the neurovascular bundle without frank invasion of the neurovascular bundle, muscle, or bone. Several smaller lymph nodes are noted within the right axilla appearing similar to prior study. Linear enhancing foci extend from the mass towards the pectoralis muscle and breast tissue appear slightly more prominent on the current study when compared to the prior study and may represent extension of tumor.Please refer to recent MRI study dated 4/12/2016 (accession #16025634) for additional findings specific to the shoulder.

Output: Right axillary mass and other findings as described above reflecting the patient's Ewing's sarcoma, perhaps slightly increased in size from the prior study. We do not see findings to suggest a treatment response.


Instruction: Generate impression based on findings.

Input: Left-sided hemiparalysis on or finding difficulties, sickle cell disease Right parietal temporal encephalomalacia indicating chronic ischemic infarct.There is no evidence of new ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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: No evidence of new ischemic or hemorrhagic lesion.Chronic ischemic infarction, right parietotemporal lobe.


Instruction: Generate impression based on findings.

Input: The study was prematurely terminated at patient's request. Limited study as only diffusion sequences and sagittal T1 sequence were obtained. The study demonstrates right lateral intraventricular hemorrhage and hemorrhage in the right thalamus, as seen in the previous CT.

Output: Study was terminated prematurely at patient's request. There is right lateral intraventricular hemorrhage and hemorrhage in the right thalamus, as seen on the previous CT.


Instruction: Generate impression based on findings.

Input: Knee pain, stem cell transplant and chronic steroid use The exam is slightly limited by motion artifactMENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Multiple foci serpentine signal abnormality are evident within the distal femur as well as the fibular head and patella.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Osteonecrosis of the distal femur, patella, and proximal fibula.


Instruction: Generate impression based on findings.

Input: 37-year-old male with a salivary cancer. Status post 4 cycles of treatment. Compare and provide measurement. CT of soft tissues of the neck with infusion:Large destructive mass involving the left ethmoid air cells and with extension into the left orbit is again noted. In comparison with the prior exam there may be slight increase in the size of tumor in the retro-orbital space. Extensive tumor across the midline into the right ethmoid air cells with extensive bony erosion is also noted. This section of tumor demonstrates no definitive interval change. Erosion of the anterior wall of the sphenoid sinus with extension of tumor remains a stable. Increased soft tissue density on the lateral aspect of right orbit and right infratemporal fossa also remains a stable. Extensive posttherapy/surgical changes remains stable. No evidence of pathologic adenopathy in the neck. Limited images of the apices of the lungs are negative. Limited images of the mediastinum are negative on this study. Please review the dictated report of CT of chest that visualizes both these sections with more accuracy.CT of brain with infusion.No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. No evidence of abnormal enhancement of brain parenchyma or leptomeninges. To better evaluate patient's known tumor at the skull base in particular for epidural spread into the intracranial space an MRI is recommended.

Output: 1. With the exception of possible minimal increase in the left the retro-orbital tumor this is study remains a stable.2.Unremarkable CT of brain. Three see above comments.


Instruction: Generate impression based on findings.

Input: Posterior left knee pain MENISCI: There is fraying of the inner free edge of the medial and lateral menisci without discrete tear.ARTICULAR CARTILAGE AND BONE: There is mild tricompartmental cartilaginous thinning although no fluid-filled full-thickness defect is identified.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Mild diffuse thinning of the articular cartilage of the left knee.2. Degenerative fraying of the menisci without discrete tear.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, status post lumbar spine surgery with lower back pain and left leg radiculopathy. Postoperative findings are seen compatible with posterior instrumented fusion from L4 to L5 and laminectomy from L3 to L5. The surgical instruments were better assessed on prior CT.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is observed.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Loss of disc height with disc bulging. Prominence of the dorsal epidural fat. Mild to moderate spinal canal narrowing. Severe right foraminal narrowing with probable nerve root impingement. Moderate left foraminal narrowing. L3-4: Postoperative findings. Loss of disc height. No significant spinal canal stenosis. At most, mild left foraminal narrowing. L4-5: Postoperative findings. Loss of disc height and minimal disc bulging. No spinal canal stenosis. No significant foraminal narrowing. L5-S1: Advanced facet arthropathy, particularly on the left. Disc bulging. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing.

Output: 1.Postoperative findings compatible with posterior instrumented fusion from L4 to L5 and laminectomy from L3 to L5.2.At L2-3, there is severe right and moderate left foraminal narrowing with a mild to moderate generalized spinal canal stenosis.3.At L5-S1, there is advanced facet arthropathy, particularly on the left, with moderate to severe bilateral foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 67-year-old female presents with left knee pain, evaluate for lateral meniscus tear. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the patellar cartilage, however, no focal defects are identified. Ill-defined T1 hypointense, T2 hyperintense lesion within the proximal tibia just inferior to the articular surface is most consistent with an endochondroma.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Small joint effusion with otherwise normal-appearing menisci, cartilage, and ligaments.


Instruction: Generate impression based on findings.

Input: 71-year-old female with headache, dizziness and vertigo. Evaluate for structural causes. MRI Brain:No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No significant parenchymal signal abnormality. There is mild supra and infratentorial parenchymal volume loss which is appropriate for age. Brain parenchyma is otherwise unremarkable.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is a partially empty sella which is usually a normal variant in this age group. There is T1 and T2 hyperintensity involving the mastoid air cells presumably related to under pneumatization. Bone marrow signal and extracranial soft tissues are otherwise unremarkable.MRI Orbits:No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.MRI IACs:The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable.

Output: Brain parenchyma appears within normal limits for age. Specifically, no evidence of infarct, hemorrhage, or intracranial mass. Unremarkable examination of the orbits and IACs.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache; likely migraine, but rule out other structural reason. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, cerebellum, brainstem, and pituitary gland appear unremarkable. There is an incidental left occipital lobe developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No evidence of intracranial structural abnormalities other than an incidental left occipital lobe developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, eval for progressionSigns and Symptoms: paresthesiasComments: 3T DCAM, Dr Javed MS protocol version 1.1, No DTI | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular white matter lesions and subcortical white matter lesions some which are perpendicularly oriented to the lateral ventricles. Additional lesions are present in the brainstem and cerebellum. Some lesions extend to the corpus callosum. These lesions were also present on the prior exam. There is no associated contrast enhancement with any of these lesions. Compared with the prior exam there is no interval change appreciated.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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: There is redemonstration of multiple periventricular and subcortical white matter lesions in the brain which are stable compared to the previous exam from 4/7/2015.


Instruction: Generate impression based on findings.

Input: 27-year-old male with history of squamous cell carcinoma of the right buccal mucosa with new right apical lung mass LUNGS AND PLEURA: Demonstration of a right apical pleural based heterogeneously enhancing mass (image 17 series 3) measuring 37 mm x 23 mm. Adjacent satellite irregularly marginated nodule (image 23, series 5) measures 9 mm x 8 mm.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy can be identified. Port-A-Cath with its tip in the SVCCHEST WALL: Soft tissue subcutaneous edema is identified within the visualized portions of the lower neck on the right.Right chest port.UPPER ABDOMEN: Hepatomegaly. Hypodense 24 mm x 23 mm mass in left kidney with CT numbers higher than expected for a simple cyst. Dedicated MRI or CT imaging of the kidneys is recommended.

Output: 1.Right apical pleural based mass with adjacent satellite nodule probably represents metastatic disease. However, location, is somewhat unusual for metastatic disease and raises the question of a second primary.2.Well-defined, hypodense lesion in the left kidney, with CT numbers higher than expected for simple cyst. Dedicated imaging of the kidney is recommended. 3.Hepatomegaly without evidence of an intrahepatic lesion.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There is redemonstration of the intraparenchymal hematoma involving the right thalamus and the medial aspect of the basal ganglia. The hematoma measures approximately 24 x 14 x 14 mm (AP x T x CC), slightly increased in size since the previous study. There is a small focus of restricted diffusion in the anterosuperior aspect of the hematoma. The hematoma is abutting and mildly compressing the lateral aspect of the posterior right lateral ventricle. There is mild edema surrounding the hematoma.Multiple foci of susceptibility signal are dispersed throughout the brain parenchyma, representing old blood products from a previous microhemorrhages. These may be related to chronic hypertension versus amyloid angiopathy.There are T2/FLAIR nonspecific foci and confluence of hyperintensities in the periventricular and the subcortical white matter and in the centrum semiovale. These are more likely vascular related.MRA BRAIN:The internal carotid arteries are normal bilaterally. The anterior, middle, and posterior cerebral arteries are patent with no evidence of significant stenosis or aneurysm. The anterior communicating artery is patent. The posterior communicating arteries are not well visualized and most likely diminutive.The basilar is patent. Vertebral arteries are patent with dominant right vertebral artery.

Output: 1. Evolving intraparenchymal hemorrhage of the right thalamus and the right basal ganglia with a small focus of restricted diffusion in the anterosuperior aspect of the margins of the hematoma which may represent small focus of ischemia. The edema surrounding the hematoma is more prominent in the current study than in the previous head CT.2. Confluence of T2/FLAIR hyperintensities in the corona radiata and in the central semiovale, representing chronic small vessel ischemic changes. 3. There are multiple foci of susceptibility signal dispersed throughout the brain parenchyma, representing old microhemorrhages. These microhemorrhages are more likely due to hypertensive disease. Amyloid angiopathy cannot be excluded.4. The MRA demonstrates normal anterior and posterior brain circulation. There is no significant stenosis or aneurysm.


Instruction: Generate impression based on findings.

Input: The sequences performed include axial and sagittal T1 weighted, axial and coronal T2 weighted with fat suppression, and coronal STIR sequences. Only the inferior portions of the patient's known cystic lymphangioma can be visualized due to the extensive susceptibility artifact, and the study is non-diagnostic for characterization of this lesion due to this limitation. Intravenous contrast was not administered.

Output: Nondiagnostic examination of the patient's known cystic lymphangioma due to extensive susceptibility artifact from the patient's braces. Following discussion with the referring physician Dr. Baroody and neuroradiologist Dr. Lee, the decision was made to terminate the examination without administering contrast. An ultrasound is recommended for further lesion characterization.


Instruction: Generate impression based on findings.

Input: 44-year-old female with new right-sided lumbar pain Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. The conus medullaris is normal in position and appearance.Individual levels as below:T11-T12: Slight kyphotic deformity with degenerative disk disease and disc bulge causing slight flattening of the anterior cord surface however without abnormal cord signal. Bilateral ligamentum flavum hypertrophy.T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild disc bulge and mild facet hypertrophy without stenosis.L5-S1: Grade 1 retrolisthesis of L5 and S1. Degenerative disc disease. Mild facet hypertrophy. Disc bulge causing mild right greater than left neuroforaminal narrowing.Redemonstrated is a right renal simple cyst. Otherwise the visualized paraspinal soft tissues are within normal limits.

Output: 1. Grade 1 retrolisthesis of L5 on S1 and spondylosis causing mild bilateral neuroforaminal narrowing.2. Degenerative changes as described above, most pronounced at T11-T12 and L5-S1.


Instruction: Generate impression based on findings.

Input: Thyroid cancer, enlargement of left submandibular gland. Benign salivary gland tissue (ductal and acinar cell groups) in a background ofblood- possible chronic sialadenitis There is a well-defined enhancing mass along the posterior aspect of the left submandibular gland that measures up to 11 mm. The right submandibular gland is unremarkable. There is fatty replacement of the right parotid gland. The left parotid gland is unremarkable. There are postoperative findings related to thyroidectomy. There appears to be an enhancing nodular lesion in the right tracheoesophageal groove that measures up to 12 mm. There is also a mildly prominent left level 4 lymph node that measures up to 10 mm. The rest of the cervical lymph nodes appear unremarkable. The osseous structures are grossly intact. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. A well-defined enhancing mass along the posterior aspect of the left submandibular gland that measures up to 11 mm may represent a salivary gland neoplasm or focal chronic sialoadenitis, such as a Kuttner tumor, as suggested by the prior FNA.2. A nodular lesion in the right thyroidectomy bed region that measures up to 12 mm is nonspecific, but may represent tumor. 3. A mildly prominent left level 4 lymph node that measures up to 10 mm is also nonspecific.


Instruction: Generate impression based on findings.

Input: Reason: lymphoma of scalp in past.new epidural and vertebral tumor on lumbar MRI and PET scan. History: none;findings as noted Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Following needle removal images obtained that demonstrate no complications.

Output: 1.L3vertebral bone biopsy under CT guidance. A total of five bone biopsy samples were delivered to pathology for analysis.2.L3 paraspinous soft tissue biopsy under CT guidance. A total of 3 samples were delivered to pathology for analysis.3.Touch preps from each specimen were obtained and analyzed by cytopathologist who was present throughout the procedure. Only the paraspinous tissues demonstrated lymphoid tissue.


Instruction: Generate impression based on findings.

Input: Active calciphylaxis with right-sided weakness, right-sided vision changes and right-sided hearing loss evolving over last 6 hours. History of end stage renal disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is also a small area of encephalomalacia in the right cerebellar hemisphere. There is an enlarged partially-empty sella. 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. There is diffuse low T1 and T2 signal throughout the imaged bone marrow.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease versus early posterior reversible encephalopathy syndrome.3. Chronic right cerebellar hemisphere lacunar infarct. 4. An enlarged partially-empty sella is nonspecific, but can be a manifestation of pseudotumor cerebri. 5. Diffuse low T1 and T2 signal throughout the imaged bone marrow may be related to renal osteodystrophy.


Instruction: Generate impression based on findings.

Input: 73-year-old male with rotator cuff impingement. Evaluation is limited due to inability to optimally position the patient. The patient was severely claustrophobic and was unable to lie with his palm up, limiting external rotation.ROTATOR CUFF: There is increased signal intensity and thickening of the supraspinatus tendon indicating moderate tendinosis. There is a small (<1cm) focus of fluid signal intensity separating the anterior-most fibers of the supraspinatus from its insertion on the greater tuberosity indicating a tear, although it is difficult to determine whether this is a partial or full-thickness tear on this examination; we suspect that there is at least involvement of the bursal surface fibers. There is mild fatty infiltration of the supraspinatus along the myotendinous junction. There is also increased signal intensity and thickening indicating moderate tendinosis of the infraspinatus tendon. There are small linear foci of fluid signal intensity along the myotendinous junction likely representing interstitial tearing. There is mild fatty infiltration along the myotendinous junction. There is cyst formation within the greater tuberosity, likely reflecting overlying rotator cuff abnormalities. The teres minor muscle and tendon appear intact. There is thickening of the subscapularis which may reflect tendinosis coupled with redundancy due to internal rotation of the humerus. There is increased signal intensity along the undersurface fibers of the tendon suggesting a small partial-thickness tear.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subdeltoid bursa anteriorly. Moderate osteoarthritis affects the acromioclavicular joint with osteophytes and capsular hypertrophy resulting in mild impression on the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small glenohumeral joint effusion. Mild osteoarthritis affects the glenohumeral joint. There is mild deformity of the superior labrum which may reflect a chronic tear with blunting of the anterior labrum that likely represents age-related degeneration.BICEPS TENDON: Evaluation of the biceps tendon is limited due to patient positioning, but we see no discrete tear. Fluid within the tendon sheath of the long head of the biceps may represent extension of fluid from the glenohumeral joint.

Output: 1. Osteoarthritis of the acromioclavicular and glenohumeral joints.2. Rotator cuff tendinosis with focal insertional tearing of the anterior fibers of the supraspinatus and focal undersurface tearing of the subscapularis tendon as described above.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with dysarthria and worsening bilateral leg and left proximal arm pains. Mild patchy periventricular T2 hyperintensity is seen, a nonspecific finding. No evidence of restricted diffusion is detected. No parenchymal edema or mass effect is seen. There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.

Output: No acute intracranial abnormality, and no specific findings to account for patient's symptoms..


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stenosis. Signs and symptoms: Neck pain. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 is unremarkable with the exception of mild degenerative changes.C3-C4 demonstrate mild degenerative changes with mild right-sided asymmetric uncovertebral hypertrophy resulting in moderate right neural foraminal compromise and unremarkable otherwise.C4-C5 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C5-C6 demonstrate advanced disc disease with loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a disc-osteophyte complex on the left with resultant mass effect, flattening and posterior displacement or on the left. There is moderate central spinal stenosis, moderate left neural foraminal compromise and patent right neural foramen. There is interval resolution of a right para median disc protrusion since prior exam and resultant slight interval improvement of central spinal stenosis.C6-C7 demonstrate advanced disc disease and loss of disc height, mild facet and ligamentum flavum hypertrophy with resultant mild central spinal stenosis. There is however interval decreased disc bulge or disc protrusion at this level since prior exam with resultant mild improvement of spinal stenosis(axial T2 series 901 images 16 through 18). Severe right and moderate left neural foraminal compromise demonstrate no significant interval change.C7-T1 demonstrate mild degenerative changes however without spinal stenosis or neural foraminal compromise.There is a tiny central anterior cord linear T2 hyperintensity (axials T2 series 901 images 16 through 20 concerning for myelopathy.

Output: 1.Extensive degenerative changes at C5-C6 and C6-C7 levels with resultant central spinal stenosis as detailed. There is mild interval improvement of central spinal stenosis however secondary to decreased right paracentral disc protrusion since prior exam and decreased bulging disc at C6-C7. Neural foraminal compromise at both these levels demonstrate no significant change2.No central spinal stenosis at any other level.3.Neural foraminal compromise as detailed per level above.4.Tiny linear T2 hyperintensity of cord concerning for myelopathy at C6 and C7 levels.


Instruction: Generate impression based on findings.

Input: Laser ablation of seizure focus. There are postoperative findings related to right temporal depth electrode removal and laser ablation of the right hippocampus, with enhancement and susceptibility effect along the margins of the ablation zone. There is no evidence of acute intracranial hemorrhage or infarction. There is no midline shift. There skull and extracranial structures are unchanged.

Output: Expected postoperative findings related to laser ablation of the right hippocampus.


Instruction: Generate impression based on findings.

Input: 52-year-old female presents with left knee pain. MENISCI: Intermediate signal intensity within the posterior horn of the lateral meniscus with extension to the articular surface and an accompanying parameniscal cyst is compatible with a lateral meniscus tear. The anterior horn of the lateral meniscus demonstrates intermediate signal intensity which does not fully extend to the articular surface and likely reflects myxoid degeneration. The medial meniscus is unremarkable in appearance.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Tear of the posterior horn of the lateral meniscus with an adjacent parameniscal cyst


Instruction: Generate impression based on findings.

Input: Female 49 years old Reason: Right achilles tendinopathy vs tear - evaluate achilles tendon and calcaneous. History: Right achilles pain, chronic TENDONS: No significant abnormality noted. In particular, the Achilles tendon appears normal.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Punctate focus of T2 hyperintense signal within the subchondral tibia which likely represents a small subchondral cyst. T1 hypointense/T2 hyperintense signal focus within the posterior talus likely represents a synovial herniation. There is no edema within the surrounding bone.ADDITIONAL

Output: Unremarkable study. No specific findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Chronic osteomyelitis. Assess changes in osteomyelitis, elevated CRP and history of osteomyelitis and psoas abscess infection. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits aside from slight collapse of the left lateral aspect of the endplates at the L2-L3 level. There is dextroscoliosis at the L2-L3 level which was present previously. There has been improvement in previously seen findings of discitis-osteomyelitis at the L2-L3 level with marked decrease in edema and enhancement involving the L2 and L3 vertebral bodies as well as the intervening intervertebral disc space. Paravertebral enhancement at the L2-L3 level is also improved. Mild residual signal abnormalities at this level are nonspecific. Paravertebral enhancement at L3-L4 has improved. There is mild edema involving the L3-L4, L4-L5, and L5-S1 disc spaces and adjacent endplates, which compared to 4/15/2016 demonstrates mild increase involving the left aspect of the superior L4 endplate, as well as the right aspect of the L4-L5 and L5-S1 endplates. Mild enhancement involving the right paravertebral soft tissues at the right L5-S1 level is again seen with interval increase in enhancement extending posteriorly to the L4-L5 and L5-S1 facet joints. There are also two enhancing lesion involving the right aspect of the sacrum at the S1 and S2-S3 levels measuring approximately 1 centimeter.No residual or new fluid collections in the paraspinous soft tissues to suggest abscess. There is also no evidence of epidural abscess.Distal spinal cord and cauda equina nerve roots are unremarkable. Multilevel degenerative changes are again seen without significant central spinal canal stenosis at any level. There is mild left L1-L2, mild to moderate left L2-L3, mild to moderate left L3-L4, and mild to moderate right L5-S1 neural foraminal stenosis.

Output: 1. Compared to 4/15/2016 and 2/17/2016, signal abnormalities related to discitis-osteomyelitis at L2-L3 continue to improve. Paravertebral enhancement at L3-L4 is also improved.2. Edema and enhancement involving the L3-L4, L4-L5, and L5-S1 discs and adjacent endplates are again seen and are nonspecific. There are however areas of interval increase in signal abnormalities involving the right lateral L4-L5 and right L5-S1 levels extending into the posterior elements as well as new enhancing lesions involving the right aspect of the sacrum. These are concerning for worsening osteomyelitis, especially the new enhancing foci in the sacrum3. No residual or new fluid collections in the paraspinous soft tissues to suggest abscess. No epidural abscess.


Instruction: Generate impression based on findings.

Input: 15-year-old male with history of tuberous sclerosis. Evaluate for renal abnormality. ABDOMEN:LIVER, BILIARY TRACT: No biliary dilatation or perihepatic fluid collections.SPLEEN: The spleen is within normal limits.PANCREAS: No peripancreatic fluid collections or findings of inflammation.ADRENAL GLANDS: The adrenal glands are within normal limits.KIDNEYS, URETERS: Punctate T1 hypointense, T2 hyperintense foci in the left renal cortex is again seen, unchanged. No masses or new significant abnormalities.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy or other retroperitoneal abnormality.BOWEL, MESENTERY: No small bowel obstruction, bowel wall thickening or other significant abnormality.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits.OTHER: No significant abnormality noted.

Output: Punctate cortical angiomyolipomas in the left kidney, without interval change.


Instruction: Generate impression based on findings.

Input: 64-year-old male presenting with confusion and altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:12/17/1965)Reason: rule out structural abnormality History: seizuresPROVIDER/ATTENDING NAME: JAMES X. TAO JAMES X. TAO The CSF spaces are appropriate for the patient's stated age with no midline shift. Exam is degraded due to patient motion.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 demonstrate a minor opacity in the left sphenoid sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No intracranial mass lesions are appreciated to account for the patient's seizures.2.Examination is degraded due to patient motion artifact which may obscure more subtle abnormalities


Instruction: Generate impression based on findings.

Input: Clinical question: Progressive glioblastoma, compared to last MRI. Signs and symptoms: Post 2 cycles of PD L1 therapy. Pre- and post enhanced brain MRI:Examination demonstrates postsurgical and therapy changes of right anterior temporal and inferior frontal lobes without significant change since prior exam. A well demarcated surgical cavity with hemosiderin laden surgical wall and adjacent right temporal lobe as well as extensive surrounding FLAIR hyperintensity remains nearly identical to prior study.There is resultant ex vacuo dilatation of right lateral ventricle with slight rightward deviation of midline also similar to prior exam.On post enhanced images there is a tiny linear focus of enhancement along the medial aspect of surgical cavity and abutting the right frontal horn of lateral ventricle. There is no convincing evidence of any appreciable interval change in the size or extent of this focus of enhancement. It measures approximately 10 x 6 mm in transaxial dimensions similar to prior exam. Additionally mild enhancement of the ependymal lining of the right frontal horn and a small focus of parenchymal enhancement in the corpus callosum is noted. These findings also appears to be fairly similar to prior exam and without convincing evidence of change. Finding is more suggestive of posttreatment change however less likely possibility of tumor cannot be entirely excluded.

Output: 1.Post operative/treatment changes of right anterior temporal and right inferior frontal tumor without evidence of change since prior exam.2.Persistent stable right frontal periventricular and corpus callosum enhancement in size, morphology and extent since prior study and more suggestive of posttreatment related finding however less likely possibility of residual tumor cannot be entirely excluded..


Instruction: Generate impression based on findings.

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

Output: Negative MRI examination of the right knee


Instruction: Generate impression based on findings.

Input: MRI: There is mild prominence of the ventricles and sulci compatible with generalized parenchymal volume loss. There is no midline shift or mass effect. There are scattered areas of high T2 signal in the periventricular and subcortical white matter, as well as what appears to be a punctate focus of encephalomalacia in the left postcentral gyrus. There is no evidence of acute infarction. MRV: The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. The left transverse sinus is dominant and right transverse sinus is hypoplastic. There is no evidence of venous thrombosis.

Output: 1. Probable chronic small vessel ischemic disease and what may represent a tiny chronic infarct in the left postcentral gyrus, but no acute infarct, intracranial hemorrhage, or mass.2. Hypoplastic left transverse sinus is dominant and right transverse sinus, but no evidence of dural venous sinus thrombosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cirrhosis. HCC screening. Abdominal aortic aneurysm. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with numerous T1 hyperintense nodules. The hepatic dome ablation zone is stable at 2.3 x 1.7 cm (series 9, image 101) without evidence of enhancement. The peripheral segment 8 ablation zone is stable at 2.8 x 1.5 cm (series 9, image 116) without evidence of enhancement. The segment 3 ablation zone is stable at 1.7 x 1.4 cm (series 9, image 135) without evidence of enhancement. A new arterially enhancing 1.3 x 1.0 cm lesion in inferior segment 5 (series 9, image 139) demonstrates washout compatible with hepatocellular carcinoma.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: The infrarenal abdominal aortic aneurysm is incompletely evaluated on this study, though is unchanged at 4.7 cm in largest transverse diameter as seen on coronal images.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.New arterially enhancing 1.3 x 1.0 cm lesion in inferior segment 5 with washout compatible with hepatocellular carcinoma.2.Stable appearance of the 3 prior liver ablation zones, without evidence of enhancement.


Instruction: Generate impression based on findings.

Input: Partially imaged is a mild disc bulge at T11-T12 without significant spinal canal or neural foramen stenosis. There is multilevel lumbar disc desiccation. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. Partially imaged on the sagittal STIR sequence is 1 mm thick high signal intensity of spinal cord extending from above the plane of the image to the T11 level. The conus terminates at L1-L2. There is no evidence of intraspinal mass or abnormal enhancement. There is a subcentimeter presumed right renal cyst. The paravertebral soft tissues are unremarkable.L1-L2: There is no significant disc disease, spinal canal, or neural foramen narrowing.L2-L3: There is a mild disc bulge without significant spinal canal or neural foramen stenosis.L3-L4: There is a mild disc bulge as well as mild facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foramen stenosis. There is a small linear focus of T2 hyperintensity and enhancement within the left lateral disc compatible with an annular fissure.L4-L5: There is a mild disc bulge as well as mild facet arthropathy and ligamentum flavum thickening without significant spinal canal stenosis. There is resultant mild left neural foramen narrowing.L5-S1: There is no significant disc disease, spinal canal, or neural foramen narrowing.

Output: 1.No evidence of intraspinal or paraspinal abscess.2.Mild lumbar spine degenerative changes without significant spinal canal stenosis, including an annular fissure of the L3-L4 disc.3.Small partially imaged thoracic spinal cord central high signal intensity of uncertain etiology or significance. Cervical and thoracic spine MRI is suggested for further evaluation if there is concern for pathology.


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: Reason for left hip pain History: Left hip pain with weight bearing ACETABULAR LABRUM: There is some blunting of the anterosuperior labrum with diffuse labral thinning, consistent with degeneration. If there is concern for labral tear further evaluation with MR arthrogram is recommended.ARTICULAR CARTILAGE AND BONE: Osteoarthritis affects the left hip.SOFT TISSUES: There is abnormal fluid signal intensity within the common tendon of the semitendinosus and rectus femoris as well as the tendon of the semimembranosus. There is associated edema within the hamstring muscles. The appearance is suggestive of partial tear of the hamstrings tendon at the myotendinous junction without retraction. Intermediate signal within the tendon suggests background tendinosis. Additionally there is edema within the left gluteus maximus muscle.ADDITIONAL

Output: 1. Partial thickness tear of the hamstrings tendons without retraction. There is associated edema within the hamstrings musculature.2. Left gluteus maximus muscle edema.3. Degeneration of the acetabular labrum. If there is concern for labral tear further evaluation with MR arthrogram is recommended.


Instruction: Generate impression based on findings.

Input: Pain over cervical, lumbar spine, bowel incontinence unsteady gait. The vertebral bodies are appropriate in the overall alignment and height. No areas of concerning marrow signal abnormality are seen.There are multilevel degenerative changes in the cervical spine with areas of canal narrowing. Motion at the cervical level precludes evaluation for cord edema. There is degenerative change in the lower lumbar spine, with some narrowing of the spinal canal likely at L4-L5.

Output: No acute cord compression is identified. Areas of chronic spinal canal narrowing in the cervical region related to degenerative disc disease.This is a limited exam specific for the exclusion of cord compression only and does not evaluate for more subtle lesions.


Instruction: Generate impression based on findings.

Input: 2 month old female with concern for nonaccidental trauma. BRAIN: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Scattered fluid within the paranasal sinuses and fluid visualized within the mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits. CERVICAL SPINE:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.The vertebral artery flow voids appear to be intact. CSF flow voids are visualized in the adjacent to the inferior cervical spine.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. No evidence of abnormal signal within the spinal cord.


Instruction: Generate impression based on findings.

Input: Newly diagnosed right lateral tongue cancer, evaluate for extent of tumor spread/involvement. There is a mass along the posterolateral right oral tongue, mandibular gingiva, and floor of mouth that measures up to 32 mm. The tumor abuts and mildly indents the left medial pterygoid muscle. There is no gross evidence of mandibular invasion or perineural tumor. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is deformity of the left lamina papyracea, which may be post-traumatic.

Output: 1. A mass along the posterolateral right oral tongue, mandibular gingiva, and floor of mouth that measures up to 32 mm is compatible with squamous cell carcinoma.2. No evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Reason: sah. eval for aneursym History: sah . Diabetes, Chronic renal insufficiency, hypertension, peripheral vascular disease. patient states he has had issues with the LUE in terms of weakness. MRI of the brainSeveral foci of punctate sized diffusion restriction are present one is located in the right centrum semiovale in the frontal lobe and one is located in the left occipital lobe cortex at the level of the cuneus. There are couple of small foci of diffusion restriction present in the left cerebellar hemisphere.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No 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. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 1.5mm right cavernous cave aneurysm present which originates below the level of the ophthalmic artery and is directed into the cavernous sinus.A small 1.5 mm infundibulum is present at the anterior communicating artery on the right side associated with the origin of a perforator.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The right vertebral artery is larger than the left vertebral artery. The origin of the left vertebral artery is partially obscured by artifact.

Output: 1.There is a small right cavernous cave aneurysm present which originates below the level of the ophthalmic artery and is directed into the cavernous sinus.2.There are several punctate foci of cerebral infarction scattered in multiple territories as detailed above which includes left cerebellar hemisphere, left occipital lobe and right frontal lobe.3.There is subarachnoid blood present along the high convexities of the right hemisphere without an obvious cause identified on this exam.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.6.Findings were discussed with Dr Awad at the time of the exam.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Pathology dated 6/29/2015 showed left lateral mid gland Gleason 3+3 disease. PELVIS:PROSTATE:Prostate Size: 3.5 x 5.2 x 4.6 cmPeripheral Zone: In the left mid gland there is a small focus measuring 7 x 5 mm (series 704/344) with corresponding subtle T2-weighted hyperintensity.Central Gland: No focal suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.7 x 5 mm left mid gland focus is suspicious for the patient's known prostate cancer.2. No additional suspicious foci.


Instruction: Generate impression based on findings.

Input: 47 year old who is status post right lumpectomy at outside hospital. The reason for the surgery or the results were not provided. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, there is a seroma cavity at posterior lower outer quadrant with maximum diameter of 65 mm. A drainage tube is identified near the seroma. Diffuse edema with mild enhancement, and some smaller seromas are seen in the lower outer quadrant in the right breast. In addition, there is an oval shaped seroma in the right axilla, with maximum diameter of 33 mm. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: Probable post surgical changes in the right breast. Mild enhancement in the right breast is likely due to surgical changes. As the details of the right lumpectomy are unknown, precise interpretation cannot be made. No MR evidence for malignancy in the left breast.BIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 52 year old with multicentric ILC at 2 sites, OSH MRI was inadequate. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Right breast:Spiculated heterogenously enhancing mass with clip artifact is noted within the superior and posterior breast (lower axillary region) corresponding to biopsy proven cancer. It measures 20 x 16 x 13 mm (AP X ML X CC) with post biopsy changes tracking towards the skin surface. Clip artifact noted within the second biopsy proven cancer in the right breast 11 to 12:00 position that measures 32 x 33 x 30 mm (AP X ML X CC). It is irregular in shape with heterogenous enhancement difficult to locate the margins accurately. Located immediately lateral and posterior to this lesion is another irregular mass which measures 28 x 22 x 18 mm (AP X ML X CC) located in right breast 11:00 position. Extensive non mass enhancement is noted anterior to the anteriormost biopsy proven mass reaching within 9 mm from the nipple. Total extent of the masses and non mass enhancement (excluding the spiculated mass in the lower axillary region) within the right breast measures 110 x 62 x 60 mm (AP X ML X CC).No abnormal axillary lymph nodes are identified in right axillary region.Left Breast:Irregular heterogenously enhancing masses are seen in the central posterior left breast measuring 25 x 12 x 13 mm (AP X ML X CC) and at 11:00 position mid depth measuring 9 x 8 x 10 mm (AP X ML X CC). Extensive non mass enhancement adjacent to these masses is seen predominantly from 10 to 2:00 position in mid to anterior depth reaching 12 mm from the nipple. Total extent of masses with non mass enhancement is 63 x 50 x 46 mm (AP X ML X CC).No abnormal axillary lymph nodes are identified in left axillary region.

Output: 1. Two biopsy proven ILC sites in right breast with additional masses and extensive non mass enhancement measuring more than mammogram.2. Two suspicious masses in the left breast central posterior and 11:00 mid depth with adjacent non mass enhancement. MR directed ultrasound and spot compression views of focal asymmetries in the upper inner and central breast are recommended. If no correlate is found, MRI guided biopsy is recommended. 3. No abnormal axillary lymph nodes are seen bilaterally. BIRADS: 6 - Known cancer.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Reason: osteo History: purulent foot ulcer There are multiple ulcerations along the dorsal and plantar surfaces of the mid and forefoot extending deep to the ossific margins with overlying extensive soft tissue swelling, skin thickening, and multiple punctate foci of gas. The osteotomy margins appear grossly intact yet along the inferior aspect of the base if 1st metatarsal remnant there is an enhancing focus demonstrating T1 hypointense and T2 hyperintense signal; correlating with a questionable area on the plan film of cortical indistinctness. The other remaining digits laterally demonstrate post-surgical changes from the transmetatarsal amputation of the 2nd through 5th digits. There is an additional area of abnormal T1 hypointense, T2 hyperintense signal and enhancement concerning for additional infection underlying more pronounced soft tissue changes and a deep fluid containing cleft overlying the mid-foot to the base of the 3rd metatarsal. A third and more prominent area of enhancement is proximal in the midfoot and observed along the bases of the 3rd and 4th metatarsals and extending to the cuneonavicular articulation, with extension of abnormal and suspicious signal into the body of the navicular. The calcaneus and talus appear spared.

Output: Abnormal MR signal and enhancement throughout the mid and forefoot with overlying ulcerations, indicating extensive osteomyelitis. See locations and areas described.


Instruction: Generate impression based on findings.

Input: 51-year-old female with Crohn's disease of the small bowel. Please evaluate for obstruction and active disease. History of stricturing and fistula formation. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis, without focal lesions or biliary dilation. SPLEEN: No significant abnormality noted.PANCREAS: Note is made of pancreas divisum. Otherwise, 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: Again seen is tethering of bowel loops to the anterior abdominal wall in the region of the ileocecal valve in the right lower abdominal quadrant, similar to 2013. No definite fistula is evident. The terminal ileum is mildly distended, however, no stricturing is noted in the right lower quadrant or elsewhere. There is fibrofatty proliferation of the right lower quadrant mesentery. No abnormal bowel wall enhancement is noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is tethering of bowel loops to the anterior abdominal wall in the region of the ileocecal valve in the right lower abdominal quadrant, similar to 2013. No definite fistula is evident. The terminal ileum is mildly distended, however, no stricturing is noted in the right lower quadrant or elsewhere. There is fibrofatty proliferation of the right lower quadrant mesentery. No abnormal bowel wall enhancement is noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Chronic tethering of bowel loops to the anterior abdominal wall in the right lower abdominal quadrant, similar to 2013. No abnormal bowel wall enhancement, fistulization, or stricturing is identified.


Instruction: Generate impression based on findings.

Input: 43 years Male (DOB:9/10/1972)Reason: 43 yo R-handed man w/ recurrent GBM, WHO grade IV, IDH1 R132H mut, ATRX wt; s/p resection 7/7/2014 and 3/7/16; s/p RT/TMZ followed by cyclic TMZ x 12-13 cycles (completed 10/2015) plus rindopepimut; compare to prior uploaded scans History: 43 yo R-handed man w/ recurrent GBM, WHO grade IV, IDH1 R132H mut, ATRX wt; s/p resection 7/7/2014 and 3/7/16; s/p RT/TMZ followed by cyclic TMZ x 12-1PROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS The patient is status post a right sided craniotomy for removal of a a right inferior parietal lobule and adjacent temporal lobe mass. There is a CSF collection present at the tumor removal site. There is a heterogeneously enhancing lesion present along the posterior and inferior aspect of the tumor resection site which is suggestive of some residual tumor. It measures approximately 22 x 11 mm in sagittal dimensions and is associated with high cerebral blood volume. There is a small enhancing linear nodule along the superior aspect of the tumor resection site which could represent a vascular structure or residual tumor. A couple punctate nodules of enhancement along the margins of the tumor resection site medially. These punctate nodules are best seen on sagittal sequence #1301 image 22 and 23.Since the prior exam the patient has developed bilateral subdural effusions.Since the prior exam an arachnoid cyst in the left middle cranial fossa has changed signal characteristics. Subarachnoid cyst measures 58 x 41 mm axial dimensions on the current exam and previously measured similar dimensions. On susceptibility weighted imaging appears to be some siderosis along the surface of the left temporal lobe.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.Since the prior exams the patient has developed bilateral subdural effusions which have a somewhat heterogeneous signal. It is possible that there is proteinaceous debris within these subdural collections which in part may represent blood.2.Since the prior exam an arachnoid cyst in the left middle cranial fossa although has not changed dramatically in size has changed in signal characteristics raising the question of hemorrhage within the cyst.3.Since the prior exam a right inferior parietal lobule and temporal lobe mass has been removed. There are enhancing components present along the margins of the tumor resection site as detailed above which are suspicious for either residual tumor or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90] / Disseminated malignant neoplasm, unspecified [C80.0] / Encounter for antineoplastic chemotherapy [Z51.11] / Encounter for examination for normal comparison and control. There are multiple variable sized the abnormal enhancing nodules including left precentral sulcus suspicious posterior aspect of pars opercularis, left frontal lobe inferior frontal gyrus pars orbitalis, right mesial thalamus, right anterior aspect of superior temporal gyrus and posterior aspect of middle temporal gyrus, medial aspect of left middle cerebellar peduncle and inferior aspect of the left cerebellar hemisphere. Considering the patient clinical history, these enhancing nodules represent multiple metastatic lesions.There is also localized not clearly circumscribed area of replacement of normal fatty marrow of skull on the midline occipital bone which shows inhomogeneous enhancement. This finding could also represent focal bony metastasis. Thus, if indicated, either head CT scan with thin section around occipital bone or bone scan can be considered for further imaging evaluation if clinically indicated.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal bihemispheric, supra and infratentorial variable sized enhancing nodules as described above, compatible with multifocal intracranial metastasis.2. Possible occipital bone lesion as described above.


Instruction: Generate impression based on findings.

Input: 74-year-old female with history of memory loss and left sided signs. There is marked periventricular and subcortical white matter increased T2/FLAIR signal abnormality extending into the pons, which is nonspecific. There are no definite areas of restricted diffusion to suggest acute ischemic infarction. Increased T2 signal is present within the pons and medulla, with correlating T2 shine through on the DWI images. There is no evidence of acute intracranial hemorrhage. There is moderate volume loss which may be age related. 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. There is a small amount of debris/mucocele within the left frontal sinus. Otherwise, the visualized portions of the paranasal sinuses, mastoid air cells and orbits are unremarkable.

Output: Marked periventricular and subcortical white matter increased T2/FLAIR signal abnormality extending into the brainstem which is nonspecific, but may be the sequela of chronic small vascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: know hx of liver mass, HCC? History: cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Diffuse infiltrative slightly T2 hyperintense, T1hyperintense lesions within both lobes of the liver with restricted diffusion. Some areas demonstrate early arterial enhancement and some areas demonstrate no enhancement possibly due to necrosis. The proximal left and right anterior portal veins and distal main portal vein are not visualized likely due to tumor thrombus. Findings suspicious for diffuse hepatocellular carcinoma.SPLEEN: Splenomegaly with the spleen measuring 19.5 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged portal hepatitis lymph nodes. BOWEL, MESENTERY: Esophageal varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of ascites.

Output: Cirrhotic morphology with portal hypertension. Findings suspicious for diffuse bilobar hepatocellular carcinoma with distal main portal vein and proximal left and right anterior portal vein tumor thrombosis.


Instruction: Generate impression based on findings.

Input: Questionable hemorrhage on CT status post fall. History of extra-axial mass likely meningioma. No evidence of acute traumatic intracranial hemorrhage. Focus of increased density in the left pons on CT therefore represents mineralization. Punctate focus of restricted diffusion in the right cerebellar vermis compatible with a small acute infarct. New focus of mild diffusion restriction in the right anterior frontal lobe white matter with mild increased T2 signal compatible with an acute to subacute infarct. There is a third focus of new T2 signal abnormality in the left frontal corona radiata with associated susceptibility which does not currently demonstrate diffusion restriction and is compatible with a subacute to chronic infarct with associated chronic microhemorrhage.There are additional foci of periventricular and subcortical white matter T2 signal abnormality that are similar to prior compatible with small vessel ischemic changes. Stable chronic lacunar infarct in the right caudate head.Redemonstration of an extra-axial mass centered along the right aspect of the prepontine cistern and extending down to the level the pontomedullary junction. Stable extension into an expanded right Meckel's cave and foramen ovale. The mass abuts the cavernous sinus anteriorly. There is significant mass effect on the right cerebral peduncle, pons, and the right middle cerebellar peduncle. Overall the mass is not significantly changed in size measuring 2.6 x 2.0 cm in maximum axial dimension, previously 2.9 x 1.8 cm. There is increased T2 signal in the adjacent pons which may reflect edema and/or gliosis and similar to prior.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Punctate focus of acute infarct involving the right cerebellar vermis as well as an acute to subacute punctate infarct in the right frontal lobe. There is also a focus of microhemorrhage with associated gliosis in the left frontal corona radiata which appears chronic but is new since prior study from 8/18/2015.2. Stable appearance of extra-axial mass centered in the right prepontine cistern with extensive mass effect on the adjacent pons and extension into Meckel's most compatible with a schwannoma or meningioma.3. Minimal chronic small vessel ischemic changes in the cerebral white matter and a chronic right basal ganglia infarct.4. Punctate focus of hyperdensity in the left pons as seen on recent CT is consistent with calcification.Findings were discussed with Dr. Gulati in the emergency room at 13:51


Instruction: Generate impression based on findings.

Input: Clinical question: History of buccal mucosal cancer. Status post chemo. Evaluate for response. Signs and symptoms: None Enhanced CT of soft tissues of neck:This examination is severely limited due to patient's cervical fusion (fixating rods and multi-level transpedicular screws), significant kyphosis and extensive metallic dental filling. Extensive areas of the study is completely obscured by streak artifact from the metal and poor quality exam due to inability of patient to lie flat within the scanner.Within the significant restriction no definitive evidence of any new masses or pathologic adenopathy is noted. Very extensive postoperative changes of neck is again noted. Examination again demonstrates very heavy calcification of bilateral carotid bifurcations. Significant artifacts obscures the detail for assessment of vascular stenosis. Grade 1 anterolisthesis of C3 on C4 and and minimal retrolisthesis of C5 on C6 is again identified.Enhanced MRI of brain:There is no evidence of abnormal enhancement of brain parenchymal or leptomeninges. Findings suggestive of advanced small vessel disease of indeterminate age are again identified.Calvarium is intact.Complete opacification of left mastoid air cells and partially of the left middle ear cavity with no detectable bony changes is again identified. Limited view of paranasal sinuses are unremarkable. Right mastoid air cells and middle ear cavity are unremarkable.70 cc of Omnipaque 350 was administered per above studies.

Output: 1.Severely limited CT examination of soft tissues of neck due to above described causes. Examination however grossly remains similar to prior study and with no evidence of tumor or pathologic adenopathy.2.Negative CT of brain and calvarium for metastatic disease. Extensive small muscle disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 47 year old male with history of electrocution 20y ago, chest pain, PVCs/PACs. Referred for cardiac MRI to rule out PVC induced cardiomyopathy. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%. The LVEDV is 179 ml (normal range 142+/-34), the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVESV is 75 ml (normal range 47+/-19) and the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time could not be reliably assessed.There is no myocardial iron overload. There is no LV thrombus. 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 58%. The RVEDV is 204 ml (normal range 142+/-31), RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVESV is 86 ml (normal range 54+/-17), and the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%.3. There are no regional wall motion abnormalities present. 4. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 32M with new onset anisocoria, eval for intracranial processSigns and Symptoms: anisocoria The CSF spaces are appropriate for the patient's stated age with no midline shift. The left lateral ventricle is asymmetrically larger than the right lateral ventricle. The left anterior septal vein appears to drain on the right sideNo 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 right ICV is larger than the left ICV. Left sigmoid sinus is larger than the right sigmoid sinus. The left BVR is larger than the right BVR.The visualized portions of the paranasal sinuses demonstrate some minor mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Asymmetry of the lateral ventricles is present without any obvious underlying cause. This is a frequent finding an can be considered a variant of normal. The fact that there is associated underlying anomalous drainage suggests that this could be congenital.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Evaluate for metastases. CT of brain with infusion:Examination demonstrates no evidence of metastatic disease to the brain. Finding consistent with minimal small vessel disease of indeterminate age are noted. Extensive postoperative changes of left frontal craniotomy is again identified with interval improvement since prior exam. Area of low attenuation in the left frontal lobe inferiorly in the pattern of vasogenic edema is again identified and is believed to represent an area of encephalomalacia on the current exam. This area has decreased in extent since prior study. There is no evidence of mass effect as was noted on the prior exam and no midline shift is noted. Extensive postoperative changes along the floor of the left anterior cranial fossa including bony grafts and extensive sclerotic changes of the floor of the left anterior cranial fossa remains stable. Postoperative changes along the left lamina papyracea with surrounding soft tissue thickening with associated mass effect on the left medial rectus muscle appears similar to prior study. This area should be further evaluated with dedicated CT or MRI of orbit/ maxillofacial region with infusion.There is better pneumatization of the left maxillary sinus and left ethmoid air cells and left maxillary sinus since prior examination.This examination was performed without any added contrast for this study however patient received contrast for CT of abdomen and this exam was performed immediately after CT of abdomen.

Output: 1.No evidence of metastatic disease to the brain or leptomeninges.2.Extensive postoperative changes at the level of the floor of the left anterior cranial fossa, left orbit and left ethmoid air cells with no definitive appendectomy she will interval change. This area can be reevaluated with dedicated the studies.