Instruction: Generate impression based on findings.

Input: Reason: portal vein clot reassessment History: portal vein thrombosis The arterial phase is somewhat late which mildly limits evaluation, though this does not significantly impact evaluation of the clinical question.ABDOMEN:LIVER, BILIARY TRACT: The liver has normal morphology. There is a subcentimeter T2 hyperintense lesion within hepatic segment 5/8 which is too small to characterize with reference measurements below.There is a wedge-shaped area of increased T2 signal within hepatic segment 8 with a smaller similar area in the far lateral aspect of segment 2/3. These areas demonstrate corresponding increased enhancement on early phase postcontrast images without associated washout. There is a linear T1 hypointense branching structure in segment 8 which extends to the periphery which is thought to represent a thrombosed subsegmental branch of the right anterior portal vein. There is an additional similar structure extending peripherally into segment 2/3 which is also thought to represent a thrombosed subsegmental branch of the left portal vein.The more proximal branches of the portal vein and superior mesenteric vein appear patent. The hepatic veins appear patent. The hepatic artery appears patent.No biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. The remaining pancreatic parenchyma demonstrates normal parenchymal signal intensity and enhancement. The proximal pancreatic duct is nondilated. No discrete pancreatic lesions are identified, however, this examination was not specifically tailored for evaluation of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes to anterior abdominal wall.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/22/2016 14:00:00)HEPATIC SEGMENT 5/8 LESION: 0.4 x 0.5 cm (Image 23, Series 501).

Output: 1.Thrombosed subsegmental branches of the portal vein in hepatic segments 8 and 2/3 with associated perfusional changes. No evidence of thrombus within the more proximal branches of the main portal vein or superior mesenteric vein.2.Postsurgical changes related to splenectomy and distal pancreatectomy. No discrete pancreatic lesions are identified, however, this study was not specifically tailored for evaluation of the pancreas.3.Subcentimeter hepatic segment 5/8 T2 hyperintense lesion too small to characterize.


Instruction: Generate impression based on findings.

Input: Left orbital mass. There is a smoothly expansile mass involving the left superior lateral orbit extending into the left frontal sinus measuring approximately 2.4 x 2.8 x 2.8 cm in the AP, transverse, and craniocaudal dimensions. Mass exhibits diffuse T1 hyperintensity without fat suppression. No associated enhancement is demonstrated. Smooth expansile osseous changes are better appreciated on recent CT. There is mass effect on the left globe which appears inferiorly displaced and mildly compressed. There is mild left-sided proptosis. Adjacent structures including the lacrimal gland and superior rectus muscle are also displaced. No abnormal signal within the optic nerves.There is dehiscence of the left orbital roof. The inner table of the left frontal calvarium is severely thinned based on recent CT. There is partial opacification of the left anterior ethmoid air cells and minimal elsewhere.No significant mass effect on the adjacent left frontal lobe parenchyma. Brain parenchyma is unremarkable without evidence of edema, infarct, or hemorrhage. No abnormal parenchymal or meningeal enhancement. No hydrocephalus or extra-axial collections. Major flow-voids are preserved. Remainder of the bone marrow signal and extracranial soft tissues are unremarkable.

Output: 1. Smoothly expansile mass involving the left superolateral orbit and left frontal sinus is most consistent with a mucocele. There is mass effect on the left globe which is inferiorly displaced and mildly compressed.2. There is dehiscence of the left orbital roof and significant thinning/questionable dehiscence of the inner table of the left frontal bone.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer. Evaluate for brain metastasis. Confluent frontal and parietal periventricular in addition to patchy deep and subcortical white matter T2 hyperintense abnormalities without contrast enhancement or diffusion restriction probably reflect chronic microvascular ischemia. Similar changes are present in the pons. Focal CSF intensity lesion along the surface of the right cerebellar hemisphere probably representing a tiny chronic infarct. There is no diffusion restriction. There is no space-occupying or contrast-enhancing mass. There is no midline shift. The major intracranial vessels are patent.Orbits are normal. The paranasal sinuses and the mastoid air cells are clear other than very minimal right anterior ethmoidal mucosal thickening, most likely of no significance. There is no destructive skull lesion.

Output: 1.There is no contrast-enhancing or space-occupying brain lesion to indicate metastasis.2.Chronic microvascular ischemia as described above.


Instruction: Generate impression based on findings.

Input: 15 month old male with blunt head trauma The attenuation and morphology of the brain parenchyma is within normal limits for patient's stated age. No evidence of hemorrhage, edema, mass-effect or midline shift is detected. Cortical sulci, ventricular system and all CSF cisterns are within normal limits. A CSF signal density cystic lesion is noted in the pineal region, measuring approximately 21 x 14 mm on image 19. A MRI study is warranted for further evaluation.Calvarium and skull base are negative for displayed fracture. The visualized orbits and mastoid air cells are unremarkable. Small subcutaneous hematoma is seen overlying the forehead.

Output: 1. No evidence of acute intracranial abnormality.2. Pineal region cystic lesion. A MRI study is warranted for further evaluation.3. Small subcutaneous hematoma is seen overlying the forehead.


Instruction: Generate impression based on findings.

Input: 46 yo with metastatic breast cancer, evaluate for brain mets. Brain parenchyma appears within normal limits. No intracranial mass or abnormal enhancement to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No evidence of mass effect, midline shift, or herniation. The ventricles are within normal limits in size and configuration. A developmental venous anomaly in the right cerebellar hemisphere is incidentally noted. Major flow-voids are preserved.Partially empty sella is incidentally noted. There is a small left maxillary sinus mucus retention cyst. Mastoid air cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: 41-year-old male with altered mental status. Evaluate for worsening edema. The patient is status post right frontal craniotomy for known anaplastic oligodendroglioma. There is a CSF filled cavity in the right frontal lobe communicating with the right lateral ventricle. This resection site appears stable.As seen on the brain MRI exam from 11/6/2016, there is heterogeneous T1 and T2 hyperintense lesion crossing from the posterior aspect of the tumor bed across the corpus callosum and into the left frontal lobe. There is associated vasogenic pattern of edema which is appears grossly stable to the prior exam allowing for motion degradation on the current and prior studies. On T1-weighted imaging it has heterogeneous signal with some mixed increased and decreased foci of signal. On susceptibility weighted imaging there are multiple punctate foci of signal loss within the lesion. Areas of mineralization were better appreciated on recent CT. There is extensive associated restricted diffusion. There is no midline shift or herniation. No hydrocephalus.

Output: Note examination was performed without contrast. Post-treatment changes in the right frontal lobe with a large heterogeneous lesion along the posterior aspect of the tumor bed which crosses the corpus callosum into the left frontal lobe is not significantly changed since 11/6/2016 but remains suspicious for tumor. No significant interval change in extent of surrounding edema as questioned.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: No abnormal mass 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.

Output: Unremarkable noncontrast MRI of the orbits.


Instruction: Generate impression based on findings.

Input: 51-year-old female with right knee pain. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is within normal limits. No abnormal bone marrow signal is seen.LIGAMENTS: The anterior and posterior cruciate ligaments are intact, as are the medial and lateral ligament complexes. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Large joint effusion and edema of the subcutaneous fat along the iliotibial band.2.No evidence of osseous, ligamentous, tendinous or meniscal injury.


Instruction: Generate impression based on findings.

Input: 20 year-old male. Evaluate for lateral meniscal tear. MENISCI: The medial and lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is unremarkable. The articular cartilage is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: Normal MRI of the knee with no evidence of lateral meniscal tear or other findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Unspecified ptosis of left eyelid [H02.402] / Ocular pain, left eye [H57.12], Reason for Study: ^Reason: mass? History: HA, L eye ptosis, L eye pain Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Orbit MRIThe globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 5.5mm x 2.9mm sized left posterior communicating artery aneurysm. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. 5.5mm x 2.9mm sized left Pcom artery aneurysm.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement. No abnormal signal intensity.3. No evidence of intracranial arterial luminal stenosis.4. No evidence of extracranial arterial luminal narrowing. Neurosurgery and neurology teams were informed at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Ms. Jonikaite is a 40 year old female with recent history of left breast lumpectomy for malignant phyllodes tumor in 12/2015 with multiple positive margins. She presents today for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Expected postsurgical changes are identified in the left superior breast, at site of recent lumpectomy bed. There is architectural distortion and a nonenhancing seroma measuring 2.4 x 1.1 x 2.0 cm (AP times ML times SI). There is no gross abnormal enhancement seen surrounding the seroma cavity. However, extending inferomedially from this lumpectomy bed are three separate enhancing masses with suspicious MR appearance. The largest of these masses measures approximately 1.4 x 1.3 cm. The total span of these masses measures approximately 2.6 x 1.2 x 3.3 cm (AP x ML x SI). The AP oblique extent of these three masses combined measures approximately 3.9 cm. The closest of these masses is located approximately 0.5 cm medial to the lumpectomy site.In addition, there is an abnormal morphology left axillary lymph node measuring 1.8 cm.There are numerous T2 hyperintense lesions identified in both breasts, some of which enhance. These likely represent simple and complicated cysts in both breasts.There is no abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in in the right axillary region.

Output: (1) Expected postsurgical changes from recent left breast lumpectomy with three suspicious enhancing masses extending inferomedial from the lumpectomy bed. Total AP extent of these masses measures approximately 3.9 cm in the AP dimension. (2) Abnormal morphology left axillary lymph node. (3) No MR evidence of malignancy in the right breast.Of note, patient presented for an MR directed ultrasound shortly after the MRI. The findings and final recommendations from this MR directed ultrasound will be detailed in a separate report.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 54 year old male patient with heart/kidney transplant and abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. There is paradoxical shift of signal on in and out of phase imaging of the liver suggesting iron deposition. No intra- or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of cholecystitis. There are no foci of signal void within the common bile duct to suggest choledocholithiasis or other obstructing lesion identified. The hepatic vasculature is patent.SPLEEN: There is paradoxical shift of signal on in and out of phase imaging of the spleen suggesting iron deposition.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic and contain multiple cystic lesions which are likely related to chronic renal disease. Two lesions within the right upper pole which do not meet criteria for simple cysts, do not have appreciable enhancement, and demonstrate intrinsic T1 signal. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact related to a median sternotomy.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis without evidence of cholecystitis or other acute hepatic abnormality.2.Atrophic kidney with multiple cystic lesions, which are likely related to chronic kidney disease. 3.Two right upper pole renal lesions with intrinsic T1 signal likely representing blood products and no appreciable enhancement; while these may represent hemorrhagic cysts, continued close attention is suggested on routine imaging.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Brain: There are a few unchanged T2 hyperintense lesions in the bilateral periventricular and subcortical white matter and right middle cerebellar peduncle. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid within the right mastoid air cells.Cervical Spine: Patchy T2 hyperintense lesions in the spinal cord at the C3 and C6-7 levels are redemonstrated. There is no associated abnormal enhancement. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is a small posterior disc-osteophyte at C5-6 with mild left neural foraminal narrowing, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There is a punctate right thyroid cyst.

Output: 1. No appreciable progression of the intracranial and cervical spine demyelinating lesions.2. Small posterior disc-osteophyte at C5-6 with mild left neural foraminal narrowing, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with weak hip flexors. Assess for lumbar stenosis. Straightening of the lumbar lordosis is seen. Alignment is otherwise unremarkable. Vertebral body morphology is within normal limits. No worrisome marrow signal abnormality is seen.The visualized spinal cord, conus and cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. No significant generalized spinal canal stenosis. Mild foraminal narrowing. L5-S1: Mild facet hypertrophy. Mild bulging disc. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. Incidental note is made of bilateral cystic renal lesions.

Output: Mild degenerative findings are seen without significant spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Left hip pain, assess for labral tear or stress fracture. ACETABULAR LABRUM: There is an increased signal in the anterior superior labrum, suspicious for anterior superior labral tear. No other labral abnormalities.ARTICULAR CARTILAGE AND BONE: There is marked decrease in the bone marrow edema in the medial aspect of the left distal femoral neck/proximal diaphysis adjacent to the lesser trochanter as compared to the prior study, consistent with resolving stress reaction. No discrete fractures.SOFT TISSUES: No significant abnormalities present in the soft tissues.ADDITIONAL

Output: 1.Anterior superior labral tear.2. Marked interval decrease in the stress reaction in the proximal diaphysis of the femur.


Instruction: Generate impression based on findings.

Input: Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified [R93.0], Reason for Study: ^Reason: further eval findings on CT concerning for stroke History: CT findings concerning for stroke, s/p VA ECMO \T\ myocardial dysfunction Brain MRI:There are multifocal restricted diffusion lesions involving left basal ganglia, bilateral frontal lobe parietal lobe and occipital lobe with peripheral enhancement on gadolinium infusion indicating subacute/acute ischemic infarct. On gradient echo images, there are scattered susceptibility lesions on bilateral hemispheres indicating chronic petechial hemorrhage or parenchymal calcification. In particular, right parietal lobe susceptibility lesions which are associated with acute ischemic infarct represent possible hemorrhagic conversion.The lesions show gyriform high signal intensities on T1 weighted images indicating possible laminar necrosis. Ventricular system is slightly dilated otherwise unremarkable.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells show opacifications.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate extremely attenuated left cervical ICA upto the level of the left cavernous sinus segment. The left MCA and ACA appear to be reconstituted through the left Pcom and Acom arteries.Right ICA, MCAs and ACAs appear to be normal. Vertebrobasilar system appears to be normal.Pituitary MRIThe pituitary gland is normal in size, morphology, signal intensity and enhancement. There is no hypo-enhancement or signal abnormality suggestive of neoplasm. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable.

Output: 1. Subacute/acute ischemic infarctions on bilateral hemispheres as described above with hemorrhagic conversion on the right parietal lobe lesion.2. Near complete occlusion of the cervical segment of the left ICA with reconstitution of the distal left ICA at the level of cavernous sinus segment.3. Normal pituitary gland MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Chiari malformation, decompression, syrinx, yearly follow-up, evaluate for change. Signs and symptoms: Neck pain and spasm post surgery. Nonenhanced cervical MRI:Examination demonstrates stable expected postoperative changes of Chiari decompression without change since prior exam.A minimally expansile syrinx of cervical cord extending from C2 to C7 demonstrate no convincing evidence of change in its size or extent. Signal intensity and the alignment of the vertebral column is unremarkable. There is no spinal stenosis or neural foraminal compromise at any level.

Output: 1.No evidence of an acute or new findings since prior study.2.Stable postoperative changes of Chiari decompression with expansion of subarachnoid space.3.Stable minimally expansile single cervical cord from C2 to C7 since prior study.


Instruction: Generate impression based on findings.

Input: cT1N0 nasopharynx squamous cell carcinoma status post treatment. There are post-treatment findings in the neck and scattered secretions and mucosal thickening in the paranasal sinuses. There is no measurable right nasopharyngeal tumor. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids appear to be intact. The osseous structures are unchanged. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck without measurable residual nasopharyngeal tumor.


Instruction: Generate impression based on findings.

Input: Headaches. Postoperative changes of a left temporal craniotomy for clipping of the aneurysm again is identified and remains is stable. Small area of lucency in the subcortical white matter of left parietal is noted. This finding was not present on the prior study. Also new since prior exam is an additional foci of low density in the subcortical white matter of the operculum of the left frontal lobe. These areas are concerning for small vessel strokes. Further evaluation with an MRI is recommended. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus is present.

Output: Suspected areas of loss of cortical lucency concerning for small vessel disease which was not noted on the prior study. Further evaluation with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 62 year old male patient with history of head and neck cancer, tracheostomy, found to have an exophytic lesion in the liver. Evaluate liver lesion. ABDOMEN:LIVER, BILIARY TRACT: There are multiple T2 hyperintense lesions within the liver which demonstrate nodular peripheral discontinuous enhancement with progressive filling in of contrast on delayed imaging; these are compatible with hemangiomas. The largest is within segment two of the liver measuring approximately 3.7 x 3.3 cm (image 348, series 703).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube is noted within the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple hepatic lesions with imaging characteristics compatible with hemangiomas.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dysphagia, unspecified WeaknessClinical question: met ovarian cancer with swallowing difficulty, eval for leptomeningeal diseaseSigns and Symptoms: met ovarian cancer with swallowing difficulty, eval for leptomeningeal disease MRI brain:There is a small hemorrhagic focus present along the medial aspect of the left temporal lobe which is hypointense on susceptibility weighted imaging and measures 3 mm on T2-weighted imaging. It is associated with contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small left lateral recess disc protrusion present at this level.At C3-4 there is no significant compromise to the spinal canal. There is a small left lateral recess disc protrusion present at this level which mildly encroaches on the nerve roots at the left lateral recess.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a small hemorrhagic lesion present along the medial aspect of the left temporal lobe which is too small to characterize further the possibility this represents metastatic disease cannot be excluded2.There are some degenerative changes present in the cervical spine associated with some small disc protrusions in the upper cervical spine and some mild encroachment of the left-sided exiting nerve roots at C3-4.


Instruction: Generate impression based on findings.

Input: 66 year old female with a history of hypertrophic cardiomyopathy who underwent heart transplant in 12/2015 who developed CMV viremia and chest pain. She is referred for cardiac MRI for further evaluation of possible pericarditis. Due to chronic kidney disease, contrast was not administered for this study. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 51 ml/m2 (normal range: 65+/-11), the LVEDV is 92 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 33 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 76 g (normal range 114+/-24). There is mild, concentric left ventricular hypertrophy (~12 mm at the mid septal and lateral walls). There are no regional wall motion abnormalities present. The pre-contrast native myocardial T1 relaxation time is normal (1080 ms). Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 26 ml (normal range 110+/-24), the RV end systolic volume index is 47 ml/m2 (normal range 22+/-8), and the RVESV is ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is mild hyperintensity of the pericardium in T2 STIR and T2 GRASE imaging. There is no evidence of pericardial constriction. No definite pericardial adhesions.Extracardiac FindingsSternal wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 64%). 2. The right ventricle is mildly dilated with normal systolic function (RVEF 58%). 3. There is mild hyperintensity of the pericardium in T2 STIR and T2 GRASE imaging. This finding may suggestive pericarditis. There is no evidence of pericardial constriction. Of note, gadolinium not administered due to renal function, so complete pericardial evaluation not possible.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for herniated disc. Signs and symptoms: Right lumbar pain. Nonenhanced lumbar MRI:Unremarkable lower most visualized thoracic spine and cord from T11 inferiorly.T12-L1, L1-L2, L2-L3 levels are unremarkable.L3-L4 demonstrate mild ligamentum flavum hypertrophy and minimal facet disease without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc desiccation with loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a central and rightward broad base disc protrusion with resultant mass effect and posterior displacement of the thecal sac causing mild central spinal stenosis. There is also significant right and mild left lateral recess compromise without neural foraminal compromise.5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral ligamentum flavum and mild facet hypertrophic changes. There is a right lateral disc extrusion resulting in significant right lateral recess compromise and mass effect on the right S1 nerve root (axial T2 series 7 image 44). No spinal stenosis or neural foraminal compromise.The alignment of vertebral column remains within normal and no detectable perispinal soft tissue abnormalities.

Output: 1.L5-S1 demonstrate degenerative changes as well as a right lateral disc extrusion with resultant mass effect on the right lateral recess without spinal stenosis or neural foraminal compromise.2.L4-L5 demonstrates degenerative changes and a broad-based central and rightward disc protrusion resulting in mild central spinal stenosis and bilateral recess compromise (right greater than left) and without neural foraminal compromise.3.Unremarkable images at other levels.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to resection of a left choroid plexus papilloma with unchanged enlargement of the left occipital and temporal horns and gliosis surrounding the surgical margins. There is also an unchanged 1 cm thick left cerebral convexity subdural CSF signal intensity fluid collection that is contiguous with the left lateral ventricle via the surgical tract and results in 4 mm rightward midline shift. There are multiple unchanged foci of susceptibility effect in the region of the surgery compatible with chronic blood products. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.Unchanged postoperative findings related to resection of a left choroid plexus papilloma without evidence of recurrence.2.Stable left cerebral convexity subdural fluid collection is contiguous with the left lateral ventricle via the surgical tract and results in unchanged 4 mm rightward midline shift.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of dense breasts. Family history of breast cancer in two paternal aunts and one paternal cousin. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Bilateral intramammary lymph nodes are present, unchanged. Scattered small cysts are present bilaterally.A biopsy clip is noted within the inferior right breast.No suspicious enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of T4 corpectomy and T3-T5 fusion. Two views of the thoracic spine demonstrate posterior stabilization rods with screws entering T3 and T5. Thoracic spine alignment is within normal limits. There is moderate loss of height of the T4 and T9 vertebral bodies appearing similar to recent MRI. Intervertebral disc spaces are grossly maintained. Surgical skin staples are present along the midline back.

Output: Posterior spinal fusion at T3-T5 and loss of height of T4 and T9 appearing similar to recent MRI.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: CSF leak or abnormality that could cause debilitating headache History: chronic daily headache that started after car accident in 2014 Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: Normal brain MRI and MRA


Instruction: Generate impression based on findings.

Input: Transient left facial droop and dysarthria. There is an area of restricted diffusion involving the right parietal lobe, right occipital lobe, as well as additional foci involving the right frontal corona radiata and right anterior temporal cortex just inferior to the level of the basal ganglia. Chronic infarct in the right posterior cerebral artery territory is again seen involving the occipital lobe and medial temporal lobe. There are patchy areas as well as scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. Chronic right pontine lacunar infarct. Chronic infarct in the right inferior cerebellum is also noted. There is susceptibility effect indicative of hemosiderin staining along the right PCA territory and right inferior cerebellar infarcts. Additional punctate foci of susceptibility effect compatible chronic microhemorrhages in the cerebellum are also noted.Volume loss with surrounding T2 FLAIR signal/gliosis in the anterior and medial temporal lobes is noted with ex vacuo dilatation of the temporal horns. No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. There is mild opacification of the paranasal sinuses. There are several scattered foci of signal abnormality involving the calvarium such as in the left parietal and right frontal regions with low T1 signal, with corresponding sclerotic densities seen on CT. Recent CT demonstrated additional scattered sclerotic foci such as at the left greater sphenoid wing.

Output: 1. Multiple areas of restricted diffusion consistent with acute infarcts involving the right cerebral hemisphere as described above. 2. Encephalomalacia consistent with prior infarcts in the right posterior cerebral artery territory as well as in the right inferior cerebellum are again seen. Chronic blood products are noted within these regions. There are additional foci of chronic microhemorrhage in the bilateral cerebellar hemispheres which are nonspecific but may be related to chronic hypertension. There is advanced volume loss and gliosis involving the bilateral anterior and medial temporal lobes. There is also evidence of moderate chronic small vessel ischemic disease.3. Multiple small area of signal abnormality involving the calvarial bone marrow with recent CT demonstrating multiple sclerotic foci. Findings are suspicious for sclerotic metastases.Dr. Ali discussed findings with Dr. Cejas at 1625 hrs on 5/24/2015.


Instruction: Generate impression based on findings.

Input: 56-year-old female with back pain, a history of lytic bone lesions seen on CT and metastatic ovarian cancer. MRI C-Spine:There is a small T2 hyperintense lesion, with a somewhat ring appearance, within the right posterolateral medulla.A focal marrow abnormality which is hypointense on both T1 and T2 are present within the C7 vertebral body and correlates with a sclerotic focus on previous chest CT. A hemangioma is noted within the C4 vertebral body.The craniovertebral junction appears within normal limits. There is straightening of the cervical spine. The cervical vertebral bodies are appropriate in height. There are multilevel degenerative changes including multilevel disc height loss most conspicuous at the C5-6 level with multilevel. However there is no significant spinal canal stenosis in the cervical spine. There is at most mild to moderate left sided neural foraminal narrowing at the C5-6 level The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.MRI T-Spine:Focal marrow abnormalities which are hypointense on both T1 and T2 are present within the thoracic spine, correlating with primarily sclerotic foci on previous chest/abdomen CT. Specifically, these can be found within the inferior endplate of T2, the vertebral body of T3, the vertebral body of T4, and separately the posterolateral leftward aspect of T4 vertebral body extending into the adjacent pedicle,The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Note is again made of bilateral pleural effusions, lymphadenopathy, as well as T2 hyperintense liver lesions.

Output: 1.There is a small T2 hyperintense lesion, with a somewhat ring appearance, within the right posterolateral medulla. This is highly suspicious for metastasis and could be better characterized by brain MRI with contrast.2.There are several T1 and T2 hypointense lesions within the cervical and thoracic osseous spine, correlating with primarily sclerotic foci identified on prior chest/abdomen CT, consistent with metastasis. There is no epidural tumor or cord involvement.3.The extent of osseous metastatic disease could be further characterized by bone scan.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: Multiple sclerosis; follow-up progression. Signs and symptoms: Anesthesia. Pre and post enhanced brain MRI:Examination is performed utilizing multiple sclerosis protocol. Precise comparison is hindered secondary to difference in technique between the 2 exams (multiple sclerosis protocol on current study and routine brain MRI on prior exam) and lack of sagittal FLAIR on prior study. Images through posterior fossa are also limited due to extensive pulsation artifact.There is a suspected lesion in the right aspect of pons and axial FLAIR series (series 601 image 16) which cannot be confirmed with certainty on sagittal FLAIR sequence and could be artifactual.Few tiny demyelinating plaques in supratentorial subcortical and periventricular white matter are present. There is subtle interval increase in the number of lesions since prior study however note should be made that this observation can be at least partially secondary to difference in technique.No detectable abnormal enhancement on post infused images. Cortical sulci and ventricular system as well as the CSF spaces remain within normal for patient of stated age of 24.

Output: Minimal findings of chronic demyelinating disease in the supratentorial space with suggestion of subtle interval progression since prior exam from 2013 as detailed. Please see above comments.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic lung cancer, prostate cancer, rule out brain metastases. Signs and symptoms: Cough. Pre- and post enhanced brain MRI:Unremarkable diffusion-weighted images.Examination demonstrates no detectable abnormal parenchymal, meningeal or calvarium enhancement to suggest metastatic disease.There are scattered punctate foci of FLAIR/T2 hyperintensity in bilateral subcortical and periventricular white matter and minimally in the bilateral basal ganglia and pons highly suggestive of mild chronic small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.Examination demonstrates a focus of T2 hyperintense and T1 hypointense enhancing lesion in the left pterygoid muscle measuring at 12 x 17 mm in transaxial dimensions (axial enhanced series 1/4/2001 image 8 and sagittal post enhanced series 1/5/2001 image 9. Considering patient's history of malignancy finding is highly suspicious for focus of metastatic lesion.

Output: 1.No acute intracranial process.2.No detectable calvarium, leptomeningeal or parenchymal enhancement.3.Focus of signal abnormality and enhancement in the left pterygoid muscle measuring at 12-17 mm in transaxial dimensions with evidence of increased muscle size/edema which is suspected of a metastatic lesion. No prior exams for comparison.4.Negative diffusion weighted image and findings suggestive of mild chronic small vessel ischemic strokes as detailed.


Instruction: Generate impression based on findings.

Input: 40-year-old male with history of NF1 evaluate left flank mass. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesion. No intra or extrahepatic biliary distention.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter T2 hyperintense lesions compatible with cysts.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.Bilateral subcentimeter renal cysts.2.Dural ectasia in the sacral canal with remodeling of the canal in the sacrum is not significantly changed.3.Scattered subcutaneous neurofibromas.


Instruction: Generate impression based on findings.

Input: Left optic glioma. Orbits: There is fusiform enlargement up to 6 mm in diameter and tortuosity of the orbital segment of the left optic nerve with associated T2 hyperintensity, but no enhancement, with extension into the canalicular and cisternal segments of the left optic nerve. The optic chiasm does not appear to be involved and the right orbit is intact. Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: The left optic nerve glioma appears to be unchanged.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, history of CNS lymphoma, restaging examination. No evidence of pathologic enhancement, restricted diffusion or other new parenchymal signal abnormal is seen. Patchy T2 hyperintensity is again demonstrated in the bilateral basal ganglia, periventricular white matter, and the left lateral cerebellum, most which probably corresponds to sites of prior lymphomatous disease. No evidence of any new parenchymal edema or mass effect is seen. The ventricular system is stable in size and morphology including asymmetry with the left lateral ventricle larger than the right. No pathologic intracranial fluid collections are seen. No evidence of acute intracranial hemorrhage is noted.

Output: 1. No findings are seen to suggest new or recurrent intracranial lymphomatous disease.2. Scattered patchy areas of parenchymal signal abnormality are redemonstrated, perhaps representing a combination of sites of prior lymphomatous disease and some superimposed chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: Evaluate for signs of pseudotumor cerebri and rule out other possible causes of elevated ICP: papilledema. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered areas of cerebral white matter T2 hyperintensity, primarily in an periventricular distribution. The brain, brainstem, and cerebellum otherwise appear unremarkable. There is mild flattening of the pituitary gland, which measures 5 mm in craniocaudal dimension. 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: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild flattening of the pituitary gland, which measures 5 mm in craniocaudal dimension, is nonspecific. LIkewise, a few scattered areas of cerebral white matter T2 hyperintensity, primarily in an periventricular distribution, are nonspecific.


Instruction: Generate impression based on findings.

Input: 63-year-old female patient with left medial knee pain. Evaluate for left medial meniscus tear. MENISCI: There is abnormal increased T2 intrasubstance signal within the medial meniscus that is compatible with degeneration. There is blunting of the free edge of the body of the medial meniscus, best seen on coronal images, likely due to a degenerative tear. The anterior horn of the lateral meniscus is diminutive and there is abnormal increased T2 intrasubstance signal within the lateral meniscus that is compatible with degeneration.ARTICULAR CARTILAGE AND BONE: There is tricompartmental osteophyte formation. There is marked chondral thinning of the medial and lateral facets of the patella with a full thickness chondral fissure in the lateral facet with underlying edema-like signal in the subchondral marrow. There is partial thickness chondral thinning of the weightbearing portions of the medial and lateral compartments. There is a full-thickness chondral defect in the lateral femoral trochlea, measuring 1.2 cm on sagittal images, with underlying reactive edema-like marrow signal abnormality.LIGAMENTS: There is fluid signal about the iliotibial band of the lateral collateral ligament complex that may represent inflammatory changes. Increased T2 signal within the anterior cruciate ligament is compatible with mucoid degeneration. The posterior collateral ligament, medial collateral ligament, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis with chondromalacia as described above. 2.Degeneration of the medial and lateral menisci with blunting of the free edge of the body of the medial meniscus, which may represent a degenerative tear.3.Fluid signal about the iliotibial band is suggestive of inflammatory changes.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for acute or subacute subdural hematoma. Signs and symptoms: Altered mental status with unclear history. Nonenhanced head CT:Examination demonstrates very extensive subcortical and periventricular low-attenuation white matter which considering patient's age likely are presenting advanced small vessel ischemic strokes of indeterminate age.There is also a focus of low attenuation involving the cortex and subcortical white matter of the left posterior temporal -- and which has the appearance of a cortical stroke or with indeterminate age. Similar larger finding in the right posterior temporal -- occipital region is also present and is suspected of an acute to early subacute ischemic stroke.No evidence of acute intracranial hemorrhage, midline shift or hydrocephalus.Recommend follow-up with an MRI examination.

Output: 1.Advanced small vessel ischemic strokes of indeterminate age.2.Regions of cortical stroke in the bilateral posterior temporal -- occipital regions which are also indeterminate as of their age. Recommend follow up with MRI exam.3.No detectable acute intracranial hemorrhage, midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: Reason: R Small Finger Chronic Dislocation History: Boutonierre Deformity The extensor digiti minimi tendon can be followed to the level of the PIP joint of the fifth digit of the right hand at which point it becomes indistinct and is likely completely disrupted. There is a flexion deformity about the PIP joint. There is a moderate amount of fluid within the PIP joint of the fifth digit which may represent a synovitis. The DIP joint is held in extension. There is circumferential fluid within the common flexor tendon which may reflect a mild tenosynovitis. There is bowstringing of the common flexor tendon at the level of the PIP joint suggesting disruption of the A3 pulley. There is slight increased bone marrow signal abnormality within the base of the middle phalanx of the fifth digit which may represent a contusion. There is soft tissue inflammatory changes/swelling in the surrounding area.

Output: 1. Disruption of the extensor digiti minimi tendon at the level of the PIP joint as described above. There is an associated boutonniere deformity of the fifth digit. The small avulsion fracture fragment seen on prior radiographs is not well visualized on this examination.2. Bowstringing of the common flexor tendon may reflect disruption of the A3 probably of the fifth digit as described above.


Instruction: Generate impression based on findings.

Input: word finding difficulty, confusion Multiple restricted diffusion lesions on bilateral frontal lobes and left parietal lobe indicating multiple acute ischemic infarctions.There is no evidence of hemorrhagic lesion on this scan.Underlying brain shows patchy high signal intensities on bilateral periventricular white matter on FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Patent Acom artery and right Pcom artery are seen but the left Pcom artery is not shown.There is no evidence of intracranial arterial aneurysm, stenosis or occlusion.

Output: 1. Multifocal ischemic foci on bilateral frontal lobes and left parietal lobe without evidence hemorrhagic conversion.2. Normal brain MRARec: Neck MRA or CT angiography of head and neck is recommended for further investigation of extracranial craniocervical arterial system.


Instruction: Generate impression based on findings.

Input: Ms. Dupree is a 73 year old with recent right pleural biopsy positive for metastatic adenocarcinoma suggestive of breast primary. She presents for MRI evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. In addition, no abnormal internal mammary lymph nodes are identified.Extensive inflammatory changes are identified in the right hemithorax, including right pleural fluid, pleural thickening and enhancement.Multiple T2 hyperintense, non-enhancing hepatic lesions are seen.

Output: (1) No MRI evidence for malignancy. Specifically, no primary identified to correspond to recent right pleural biopsy results.(2) Extensive right hemithorax findings. Please correlate with recent PET exam and CT scans for detailed information.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 30 years Male (DOB:5/23/1986)Reason: epilepsy History: surveillancePROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is a cystic mural nodule mass present centered in the upper fourth ventricle and aqueduct which currently measures 46 x 41 mm sagittal dimensions and previously measured 41 x 37 mm sagittal dimensions. On axial imaging the mass measures 40 x 38 mm and previously measured 38 x 34. There are some punctate foci of susceptibility effect within the lesion as well as scattered within the lateral ventricles. These were also present on the prior exam. This enhancing component of the lesion measures approximately 22 x 22 mm axial dimensions and previously measured 22 x 22 mm axial dimensions. There is a catheter which courses through the right frontal bone into the right frontal lobe, into the right lateral ventricle and from there into the cystic portion of the lesion with its tip abutting the solid component. Another catheter courses to the right frontal lobe into the right lateral ventricle with tip in the body of the right lateral ventricle. Biventricular diameter on coronal imaging measures 61 mm on the current exam and previously measured 61 mm. A small focus of encephalomalacia is present in the right occipital lobe probably representing a ventriculostomy tube tract.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 minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a fourth ventricular and the aqueductal mass present associated with ventriculomegaly. The mass is a cyst and mural nodule appearing mass which is mildly enlarged compared to the previous exam. The enhancing component of the mass is stable. This is known to represent a pleomorphic xanthoastrocytoma2.There is redemonstration of catheters within the right lateral ventricle and another one within the cystic component of the mass. Since the prior exam the lateral ventricles are stable.3.


Instruction: Generate impression based on findings.

Input: 14 year-old female with headaches. Reevaluate known inflammatory brain lesions following immunosuppressive treatment. Multiple patchy ill-defined areas of parenchymal and brain surface T2/FLAIR hyperintensity and enhancement are again seen involving the bilateral cerebral hemispheres and the cerebellum. Overall, these lesions appear improved especially within the right cerebellum. There is residual persistent enhancement of a subset of these lesions, although this also has improved compared to the prior exam. There are no new lesions. There is evidence of a small biopsy tract in the left frontal lobe lesion without complication. The area of subcortical T2 hyperintensity and mild gyral volume loss without enhancement involving the left parietal lobe is again seen and remains similar to the prior exam. Redemonstrated is sinus inflammation which appears similar to the previous exam.

Output: Persistent multiple cerebral and cerebellar lesions which are overall decreased in their T2/FLAIR conspicuity and enhancement, especially within the right cerebellum.


Instruction: Generate impression based on findings.

Input: History of stroke now with new onset generalized tonic-clonic seizure. Evaluate for new stroke. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with extensive chronic small vessel ischemic changes. Lacunar infarcts are noted involving the bilateral corona radiata, external capsules, along the caudate heads, left pons, and right cerebral hemisphere. Chronic blood products are noted associated with the small right cerebellar infarct. Encephalomalacia is seen involving the right inferior frontal and right anterior and inferior temporal lobes. No abnormal parenchymal or meningeal enhancement.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.No evidence of acute infarct. No intracranial mass or mass effect.2.Multiple chronic lacunar infarcts as well as right frontotemporal cortical encephalomalacia as described above. Extensive chronic small vessel ischemic changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Disorder of trigeminal nerve, unspecified. Neoplasm of uncertain behavior of central nervous system, unspecified. Disorder of facial nerve, unspecified Sixth (abducent) nerve palsy, unspecified eyeDiagnosis Edits: |||Clinical question: Outside Request: known R. Cavernous sinus lesion w/ext. along R. infraorbital nerve; clinically has R. V, VI, VIII CN palsies, please do high resolution imaging of intra-/extracranial course of CNs V, VI, VII MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense patchy lesions are present in the brainstem. These are all stable when compared to the prior examSeveral punctate hypointense foci are present in the periventricular white matter on susceptibility weighted imaging.There is no abnormal enhancement appreciated along the course of the seventh cranial nerve.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRI cavernous sinuses:An infiltrating lesion is present along the lateral aspect of the right cavernous sinus which extends into the right foramen of volume as well as the right foramen rotundum and the right superior orbital fissure. The extent of the lesion is stable and compared to the June exam.There is new enhancement of the right trigeminal nerve along its cisternal segment and Meckel's cave.There is enhancement and thickening of the nerve root within the foramen rotundum and foramen ovale as well as nerve roots coursing the right superior orbital fissure.MRI orbits:An infiltrating lesion is present along the lateral aspect of the right cavernous sinus which extends into the right foramen of volume as well as the right foramen rotundum and the right superior orbital fissure. The lesion does appears to involve the Meckel's cave and the cisternal segment of the trigeminal nerve. There is enhancement and thickening of the nerve root within the foramen rotundum and foramen ovale as well as nerve roots coursing the right superior orbital fissure.The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: 1.Findings suggest interval progression of an infiltrating lesion centered along the lateral aspect of the right cavernous sinus and extending into the right foramen ovale, and partially into the right foramen rotundum and right superior orbital fissure. There is associated enhancement along the right trigeminal nerve including cisternal segment as well as components in the Meckel's cave and cavernous sinus and the branches in the foramen ovale, foramen rotundum and superior orbital fissure. The component involving the cisternal segment of the right trigeminal nerve was not identified on the prior exam indicating interval progression. Differential considerations include infiltrating neoplasm and granulomatous disorder.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Patchy lesions in the brainstem are likely vascular related.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:5/18/1963)Reason: intracerebral abnormality? History: HAPROVIDER/ATTENDING NAME: NAOUM P ISSA NAOUM P ISSA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.On susceptibility imaging there is a punctate focus of signal loss present in the right periventricular white matter adjacent to the trigone of the right lateral ventricle. This could represent a microhemorrhage which in isolation is of little clinical significance.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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: Periventricular and subcortical white matter signal changes of a mild to moderate degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Female, 24 years old, with back pain status post lumbar puncture. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is seen.The visualized distal spinal cord and conus are unremarkable. The nerve roots of the cauda equina disperse evenly through the thecal sac. No epidural abnormalities are suspected.The intervertebral discs are preserved. No significant bulge or herniation is seen. Mild to moderate facet arthropathy is evident at lower lumbar levels. No significant spinal canal or foraminal stenosis is seen.

Output: 1.Facet hypertrophy is evident at lower lumbar levels.2.Otherwise, no significant abnormalities are identified which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There are no meniscal defects.ARTICULAR CARTILAGE AND BONE: There are no fluid-filled cartilaginous defects.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: There has been prior MPFL reconstruction. The graft appears thick but intact, with metal artifact in the distal femoral diaphysis due to the fixation screw. There is mild thickening and irregularity of the lateral retinacular structures, likely representing surgical changes and scarring from prior release.ADDITIONAL

Output: 1. Surgical changes related to prior MPFL reconstruction and presumed lateral retinacular release, as described above.2. Borderline tibial tubercle-trochlear groove distance and mildly elevated Insall-Salvati ratio; subjectively, the femoral trochlea appears slightly shallow.


Instruction: Generate impression based on findings.

Input: Seven months status post microfracture of the patella and cochlea. Check for healing. Specifically observed cartilage and check for meniscal tear. Pain Persistent and recurrent overall quality degradation due to metallic susceptibility artifact from orthopedic hardware and prior tibial osteotomy.MENISCI: The lateral meniscus is intact and unremarkable. The medial meniscus demonstrates a somewhat diminished anterior horn, possibly due to postsurgical reshaping, however I do loss or surgical removal of the body of the medial meniscus extending into the posterior horn is essentially similar to prior exam.ARTICULAR CARTILAGE AND BONE: Interval continued degradation and loss of the cartilage in the medial compartment with increased thinning and focal defects most prominent in the posterior aspects along both the tibial and condylar surfaces. The lateral compartment is otherwise intact with more moderate changes in the patellar surface greater involving the medial facet. Other than minimal edema-like contusions largely involving the medial condyles, no additional gross marrow signal abnormalities again within the limitations describedLIGAMENTS: ACL repair remains intact. The PCL, patellar and extensor complex are otherwise unchanged and intact. Collateral ligaments are also unremarkable EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Postsurgical changes including ACL repair and medial meniscal abnormalities with extensive medial cartilaginous losses; see detail provided


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate intracranial hemorrhage, cerebral edema. Signs and symptoms: Worsening hepatic encephalopathy. Unenhanced CT of brain:Patchy areas of periventricular and subcortical low attenuation although nonspecific could represent small vessel disease of indeterminate age. Considering provided clinical data all hepatic encephalopathy these findings may represent edematous changes from hepatic encephalopathy. There is no evidence of any associated mass-effect with his findings. Prior examination from 6 -- 2 -- 2010 was performed with a helical CT and imaging quality was not as good as the current exam and precise comparison is difficult.There is no evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Follow up would and MRI can significantly improved the assessment.

Output: Diffuse patchy areas of subcortical and periventricular low attenuation with no associated hemorrhage, mass-effect or midline shift as detailed. Please see above comments.


Instruction: Generate impression based on findings.

Input: There is a complex multiseptated, multiloculated cyst measuring overall up to 15 x 26 mm in greatest axial dimensions and approximately 17 mm CC. The lesion is centered in the right basal ganglia and extends to the level of the anterior commissure. It is unchanged in size since the outside CT of 9/24/2015. It is of CSF signal intensity, with no restricted diffusion. There is no surrounding FLAIR abnormality or associated enhancement. There is minimal localized mass effect. There is no midline shift.

Output: Nonenhancing complex CSF signal intensity cystic structure centered in the right basal ganglia with no surrounding abnormal signal and only minimal localized mass effect. The differential diagnosis includes primarily neuroglial cyst or large prominent peri-vascular space, less likely cryptococcal infection or cystic neoplasm. However, recommend obtaining the remote outside CT that was performed reportedly 45 days prior to the current study to assess for stability.


Instruction: Generate impression based on findings.

Input: 79 year old history of left mastectomy in 1999 now with positive contralateral (right) axillary node and supraclavicular nodes seen on CT. Recent MRI showed linear non-mass enhancement in the right upper outer breast measuring up to 3.9 cm. Patient presents for second look MRI directed ultrasound. On physical exam, there is no palpable mass.A targeted right ultrasound was performed for the area of concern seen on MRI. Targeted ultrasound of the right breast upper outer quadrant from the 9:00 through 12:00 locations was performed. There is no mass or suspicious areas seen to correspond to the findings on MRI.Incidental note is made of a dilated debris-filled duct in the periareolar region measuring 1.2 x 0.5 x 1.1 cm.

Output: No sonographic abnormality corresponding to the MRI findings in the right upper outer breast. Recommend MRI guided biopsy of the non-mass enhancement. Findings were discussed with the patient at the time of the exam. The BI-RADS on this report reflects findings on this exam only. This does not reflect MRI findings or known malignant right axilla lymph node.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Recurrent pancreatitis with history of strictures. Please note that the study is limited as it was truncated early due to patient lack of cooperation. As a result post contrast secretin images and in phase out of phase images were not obtained. Due to patient motion the postcontrast images are nondiagnostic. The coronal T2 images are the most diagnostic images obtained.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. No discrete suspicious lesion is evident within the limitations described above. Cholelithiasis within a normally distended gallbladder. No intra or extrahepatic biliary ductal dilatation. A common bile duct stent is suspected.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is atrophic. The main pancreatic duct is significantly dilated up to 10 mm with side branch ectasia at the tail. It transitions near the pancreatic head. In the adjacent uncinate process/pancreatic head there is a lobular multiseptated lobular cystic lesion measuring approximately 2.4 x 1.4 cm in cross section (series 401/10). Communication with the main pancreatic duct is not definitive due to motion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis. Small volume perihepatic and perisplenic ascites.BONES, SOFT TISSUES: Anasarca. Mild superior endplate deformities of the lower thoracic and lumbar spine.OTHER: At least moderate pleural effusions with compressive atelectasis.

Output: 1.Limited examination due to patient's motion and as above.2.Significant dilatation of the main pancreatic duct with pancreatic atrophy and side branch ectasia to the level of the pancreatic head where there is a lobular multiseptated cystic lesion without demonstrable communication with the main pancreatic duct. Correlation with EUS findings and tissue sampling is recommended. Enhancement is unable to be adequately assessed, and this lesion remains indeterminate.3.Anasarca, small volume ascites and moderate pleural effusions. Cholelithiasis within a normally distended gallbladder.


Instruction: Generate impression based on findings.

Input: 36-year-old pregnant female with history of 2 prior C-sections. Known placenta previa. Suspicion for placenta accreta. Evaluate. PELVIS:UTERUS, ADNEXA: There is an intrauterine pregnancy. Examination is not protocoled for evaluation of fetal anatomy, but no gross abnormality is identified.The placenta is low-lying in the anterior lower third of the uterus. The placenta completely covers the internal cervical os indicating placental previa.The uterine wall is markedly thinned in the anterior lower third and there is loss of the normal contour with convex anterior bulging in this region. There is no definite placental invasion of the myometrium, however there are a few scattered areas within the myometrium is slightly indistinct (series 9 image 46, series 10 image 24).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No definite placenta accreta, however there are a few regions particularly on the left lateral aspect of the prior cesarean scar where the placental myometrial junction is slightly less distinct.2.Placenta previa.


Instruction: Generate impression based on findings.

Input: Chest compression on delivery and use of the cooling protocol. Concern for hypoxic ischemic encephalopathy. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The degree of myelination pattern is normal for a term neonate. The midline structures and craniocervical junction are within normal limits. 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 and skull are grossly unremarkable. There is a small amount of left parietal subgaleal fluid.

Output: No evidence of acute hypoxic-ischemic 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: History of left lumpectomy for DCIS in 2011. Patient received radiation and hormonal therapy. History of breast cancer in brother diagnosed at age 40. Scattered fibroglandular tissue is present bilaterally. Scarring from prior lumpectomy in the left upper inner quadrant is unchanged. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable post surgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 47-year-old male with left shoulder injury. Concern for rotator cuff tear versus strain. Unable to abduct left arm. ROTATOR CUFF: There is a full-thickness complete or near complete tear of the infraspinatus tendon with approximately 3 cm of retraction. There is edema within the infraspinatus muscle suggesting that this may represent an acute injury. There is thickening and increased signal intensity indicating moderate to severe tendinosis of the supraspinatus tendon. There is also a linear focus of fluid signal intensity within the insertional fibers of the tendon indicating a partial thickness tear which appears to be concealed and measures approximately 6 to 7 mm. The supraspinatus muscle appears intact. There is thickening and increased signal intensity within the subscapularis tendon likely representing a combination of tendinosis and redundancy due to internal rotation of the humeral head. Additionally, there is a small 6 to 7 mm focus of linear signal abnormality within the insertional fibers of the subscapularis tendon indicating a small insertional tear. The more superficial fibers extending to the greater tuberosity are indistinct which may represent additional tearing. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. BICEPS TENDON: There is thickening and increased signal intensity within the tendon of the long head of the biceps within the rotator interval indicating moderate tendinosis.ADDITIONAL

Output: 1. Full-thickness near complete or complete tear of the infraspinatus with retraction and additional rotator cuff abnormalities as described above.2. Osteoarthritis of the acromioclavicular and glenohumeral joints.3. Tearing of the superior glenoid labrum.4. Biceps tendinosis.


Instruction: Generate impression based on findings.

Input: 44 year old male with head and neck cancer. Status post chemo RT CT of the soft tissues of the neck.Images through the skull base are within normal limits.Images through the soft tissues of the neck demonstrate no definitive evidence of any masses or pathologic adenopathy. There is however slight fullness at the level of right posterior triangle which is contiguous with extensive areas of post operative change, surgical clips and effacement of fascial plane. I cannot entirely rule out possibly off a node within this region please correlate with clinical examination and if concern for lymphadenopathy in this location exist an MRI is recommended. Although no definitive evidence of lymph node can be detected on this exam.The bony density of the area of the study is negative for metastatic disease however extensive degenerative changes are noted.Limited images of the apices of the lung are negative for metastatic lesion. Please review dedicated report of CT of chest performed the same date.CT of brain with infusion.This examination is negative for metastatic lesion to the brain or the calvarium. This study is essentially within normal limits.

Output: 1.No definitive evidence of any masses or pathologic adenopathy.2.Unremarkable CT of brain with infusion.


Instruction: Generate impression based on findings.

Input: There is minimal residual decreased diffusion restriction within the right parietal and insular cortex with some associated right parietal cortical enhancement likely representing subacute infarction. There are numerous foci of supratentorial and infratentorial T2 hyperintensity as well as multiple foci of cerebellar and brainstem encephalomalacia compatible with chronic infarcts and small vessel ischemic disease. There are a few unchanged foci of susceptibility effect within the bilateral occipital lobes compatible with chronic microhemorrhages.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The distal vertebral and proximal basilar flow voids are again diminutive. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants. There is a small retention cyst within the right maxillary sinus.

Output: 1.Subacute right insular and parietal cortical infarcts. 2.Extensive chronic small vessel ischemic disease and numerous chronic brainstem and cerebellar infarct.3.Unchanged foci of chronic micro-hemorrhages in the bilateral occipital lobes.4.Unchanged near complete occlusion of the distal vertebral and proximal basal arteries.5.No MRI evidence of neuro-sarcoidosis.


Instruction: Generate impression based on findings.

Input: Back and right leg pain. Four views of the lumbar spine are provided. Five lumbar-type vertebrae are present in addition to a transitional lumbosacral vertebra which will be designated "T." Please note that this labeling convention is different than that used for a recent MRI exam.Vertebral body heights are preserved. There is mild rightward curvature of the lumbar spine as well as slight pelvic tilt with elevation of the left hemipelvis. There is minimal anterolisthesis of L3 that appears stable between neutral, flexion, and extension views when accounting for slight differences in technique. There is approximately 3 mm of anterolisthesis of L5 relative to "T" appearing stable between neutral, flexion, and extension views. Severe degenerative disc disease affects L3-L4, L4-L5, and L5-T with slight progression at L3-L4 compared to 2011. Relatively mild degenerative disc disease affects the upper lumbar spine. Multilevel facet joint osteoarthritis is present and particularly affects the lower lumbar levels.

Output: Degenerative disc disease and other findings as described above.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There are no areas of abnormal signal or pathological enhancement to suggest demyelinating disease. There is unchanged cavum septum pellucidum and vergae. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. CERVICAL SPINE

Output: 1.No abnormal signal or pathological enhancement of the brain or spinal cord to suggest demyelinating disease. 2.There is new disc desiccation and disc height loss with mild disc bulge at L4/5 without significant resulting stenosis.3.Note that although there are no new gross abnormalities of the optic nerves, full characterization would require orbital MRI with contrast.


Instruction: Generate impression based on findings.

Input: Reason: evaluate bilateral hamstring origins History: pain with sitting at ischial tuberosity BONE MARROW: No bone marrow signal abnormality is identified.SOFT TISSUES: There is diffuse fatty infiltration of the imaged musculature of the pelvis including the paraspinal musculature. There is a partial thickness tear of the right hamstring tendon at the level of its origin off the right ischial tuberosity. There is partial thickness tearing of the left hamstring, involving both the conjoined and semimembranosus tendons, with approximately 2 cm retraction of the proximal tendon fragment. Additionally, there is a 1.5 cm round focus of fluid signal intensity within the left quadratus femoris muscle at the level of the myotendinous junction which may represent an interstitial tear. There is an additional smaller rounded focus of fluid signal intensity is identified within the distal fibers of the quadratus femoris muscle proximal to its insertion on the femur which may also represent an additional interstitial tear.JOINTS: Mild osteoarthritis affects the hips bilaterally. There is a small amount of fluid within both hips which is not necessarily of any clinical significance. There is a subcentimeter focus of fluid signal intensity within the superior acetabulum which may represent subchondral cyst formation. Severe degenerative disc disease affects the imaged lower lumbar spine.ADDITIONAL

Output: 1. Partial thickness tearing of both of the hamstring tendons at the level of their origin on the ischial tuberosity, left greater than right, with slight retraction on the left as described above. Interstitial tearing of the quadratus femoris muscle on the left. 2. Nonspecific signal abnormality within the posterior aspect of the right apex of the peripheral zone of the prostate gland. Correlation with PSA is recommended. Other findings as described.


Instruction: Generate impression based on findings.

Input: Reason: Known cavernous malformation with prior bleed, please evaluate and compare to outside images uploaded to PACS from March and December 2015, please History: Left lower extremity numbness There is a right precentral gyrus cavernous malformation measuring 1.5 x 1.3 cm (series 41 image 23), previously 1.8 x 1.9 cm on 12/2015 study. The lesion shows mixed T2 and T1 hyperintensity internally, with strong susceptibility effect, and a rim of susceptibility extending to the edge of the gyrus. There is less edema surrounding this lesion. There is mild enhancement of the lesion, but no associated developmental venous anomaly is detected. No abnormal diffusion restriction. There are nonspecific T2 periventricular and subcortical white matter hyperintensities. No evidence of midline shift. Ventricles, sulci, and cisterns are normal without evidence of ventriculomegaly. Scattered opacification of ethmoid air cells. There is left maxillary sinus mucosal thickening and complete opacification of the right maxillary sinus. Mastoid air cells are clear. Orbits are intact. Osseous structures are unremarkable.

Output: Right precentral gyrus cavernous malformation with interval decrease in size. No apparent associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:9/19/1943)Reason: assess for T11 compression fx History: back painPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU MAGDALENA ANITESCU MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a subcutaneous well-circumscribed lesion present behind the T9 spinous process measuring 25 x 16 mm sagittal dimensions. It is predominantly low signal on T1 and intermediate signal on T2 STIR. Most likely this represents a sebaceous cyst. It was also present in the MRI of the lumbar spine from 3/14/2012 and has not changed.There is a small central disc protrusion present at C2-3. There is a small right paramedian disc protrusion at T3-4 there is a right paramedian disc extrusion at T4-5, T5-6 and T6-7 which impress on the ventral aspect of the thecal sac but do not effaces spinal fluid behind the spinal cord.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge and some disc desiccation at this level associated with facet and ligamentum flavum hypertrophy. There is some triangulation of the thecal sac. The fat at the lateral recess is not effaced on either left or right side. This has not changed since the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some mild disc desiccation at this level. There is ligamentum flavum hypertrophy at this level. This has not changed since the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with some ligamentum flavum hypertrophy. There is some mild crowding of the nerve roots at this level. This has not changed since the prior exam.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lumbar spine in the form of facet hypertrophic change but also some disc desiccation and disc bulges without significant compromise to spinal canal or neural foramina. This is stable compared2.There are small disc protrusions and extrusions in the thoracic spine without significant compromise to the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Nuchal/occipital headache. The cerebellar tonsils appear to have gradually diminished inferior extension, measuring up to 5 mm, previously 7 mm in 2014 and 9 mm in 2013, but maintain mildly pointed configurations. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The pineal region cerebrospinal fluid spaces appear unchanged. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The cerebellar tonsils appear to have gradually diminished inferior extension, measuring up to 5 mm, previously 7 mm in 2014 and 9 mm in 2013, but maintain mildly pointed configurations. 2. Unchanged appearance of the pineal region cerebrospinal fluid spaces.


Instruction: Generate impression based on findings.

Input: Resection of ovarian metastases. There are postoperative findings related to recent right frontal craniotomy for resection of a right frontal lobe metastasis. There is an intermediate T1 and low T2 signal epidural collection with susceptibility effect in the right frontal convexity anterior to the craniotomy margin that measures up to 20 mm in thickness. There is fluid and hemostatic agent within the right middle frontal gyrus resection cavity, which displays fine linear enhancement along the anterior margin. In addition, there is mild diffuse restricted diffusion surrounding the resection cavity that is out of proportion to the extent of susceptibility effects from blood products. There is also persistent extensive vasogenic edema surrounding the resection cavity. Likewise, there is considerable vasogenic edema associated with the left frontal lobe and right peritrigonal metastases. Overall, there is resultant 8 mm of midline shift to the left, subfalcine and uncal herniation, and partial effacement of the right lateral and third ventricles, which is unchanged. A subcentimeter metastasis in the right cerebellar hemisphere is associated with mild surrounding vasogenic edema. The major cerebral flow voids are intact.

Output: 1. Recent postoperative findings with a right frontal convexity epidural hematoma that measures up to 20 mm in thickness.2. Fine linear enhancement along the anterior margin of the right frontal lobe resection cavity may represent residual neoplasm or post-treatment effects, although the extensive vasogenic edema and remaining intracranial metastases persist and contribute to 8 mm of midline shift to the left, subfalcine and uncal herniation, and partial effacement of the right lateral and third ventricles, which is unchanged. 3. Mild acute ischemic changes surround the right frontal lobe resection cavity, but no evidence of acute territorial cerebral infarction.


Instruction: Generate impression based on findings.

Input: 63-year-old male with HCC, HCV, status post TACE/RFA 2 lesions. Evaluate liver lesions, masses, HCC screening, vessel patency, coronary calcification. ABDOMEN:LIVER, BILIARY TRACT: Again noted cirrhotic liver and an ablated lesion in the segment 7 measuring 3.3 x 2.4 cm image #271, series #10. No evidence of enhancement of this lesion. A more superiorly located hepatic cyst is also unchanged.There are 2 new arterially enhancing and then washing out lesions in the right lobe of the liver consistent with hepatocellular carcinoma. One of these lesions measures 2.1 x 1.7 cm on image #56, series #10. The second lesion measures 1.6 x 1.7 cm on image #59, series #10. Another subcentimeter arterial enhancing lesion near the gallbladder on image #47, series #10 does not demonstrate definite washout, however, demonstrates restricted diffusion and also suspicious for hepatocellular carcinoma. Another similar lesion is best seen on image #72, series #10, in the left lobe of the liver.SPLEEN: Mild splenomegaly, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts unchanged.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.Post ablation changes in the right lobe of the liver. New at least 2 arterially enhancing and washing out on delayed phase images consistent with hepatocellular carcinoma. There are a few other enhancing lesions at the arterial phase with restricted diffusion, also suspicious for hepatocellular carcinoma even though they don't meet the criteria for HCC.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 9-year-old male status post trauma. In the right cerebellopontine angle, there is a low density lesion approximating CSF attenuation consistent with an arachnoid cyst or epidermoid cyst. This lesion causes surrounding bony remodeling, however there is no evidence of bony destruction. There is mild mass effect upon the cerebellum, however no edema is noted in the adjacent brain parenchyma. A follow-up MRI is recommended for further evaluation. The remainder of the cerebral and cerebellar hemispheres and brainstem are normal in morphology and attenuation. No intracranial hemorrhage or edema is noted. 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: Right cerebellopontine angle arachnoid cyst or epidermoid cyst. An MR is recommended for further evaluation. These findings were discussed with Dr. Amanda Johnson at 11:25 a.m. on 8/26/08.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with diffuse hyperreflexia and gait instability. Assess for cervical spine lesion. A trace retrolisthesis of C4 relative to C5 is seen. There is a mild reversal of the normal cervical lordosis.Vertebral body heights are preserved. Marrow signal characteristics are within normal limits. No pathologic marrow enhancement is observed.The visualized spinal cord demonstrates normal caliber, morphology and signal characteristics. No pathologic cord or leptomeningeal enhancement is identified.C2-3: Left facet hypertrophy. Minimal left foraminal narrowing. No significant spinal canal stenosis. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C4-5: Right facet hypertrophy. Mild posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac. No significant generalized spinal canal stenosis. Mild right foraminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. C7-T1: Unremarkable.

Output: 1.Relatively mild multilevel cervical spondylosis with no evidence of any significant spinal canal stenosis and only mild scattered foraminal narrowing.2.No specific evidence of any spinal cord lesion is seen.


Instruction: Generate impression based on findings.

Input: History of chronic liver disease with hepatic dome lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is slightly nodular in contour. It measures 17 cm in length. There are findings of portal hypertension including ascites, splenomegaly and perisplenic collateral vessels including splenorenal shunting.No suspicious arterial enhancing lesion, washout, restricted diffusion or T2 hyperintense liver lesion. The previously seen CT abnormalities are not well seen on this study and likely reflect transient hepatic attenuation differences related to perfusional anomalies.Distended gallbladder and gallstones.SPLEEN: Splenomegaly measuring 18.3 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Gastroesophageal varices are noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small pleural effusions.

Output: 1.No suspicious liver lesion. The previously seen CT abnormalities likely reflect transient hepatic attenuation differences/perfusional anomalies.2.Findings of cirrhosis and portal hypertension including ascites, splenomegaly, perisplenic collaterals including splenorenal shunting.


Instruction: Generate impression based on findings.

Input: Clinical question: r/o TIA/CVASigns and Symptoms: transient disorientation on 7/28, < 20 min, no loss of strength, elevated LDL, family h/o CVA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no evidence for acute ischemic cerebral infarction.