Instruction: Generate impression based on findings.

Input: Clinical question: Central hypogonadism. Signs and symptoms: Central hypogonadism. Pre-and post-enhanced pituitary MRI:Examination demonstrates a well demarcated round nonenhancing lesion at the level of the pars intermedia of the pituitary gland measuring approximately 4 x 3.8-mm on coronal post enhanced images and 3 millimeters in AP axis on sagittal post enhanced series. The lesion is nearly isointense on T2-weighted images and is more suggestive of a small microadenoma however possibility of a cyst cannot be entirely excluded. There is no detectable mass effect with this finding and pituitary stalk remains in the midline.The maximum height of pituitary gland measures between 4.4 and 4.7 -mm on coronal and sagittal series and demonstrate uniform enhancement otherwise. Pituitary gland demonstrate normal signal intensity and normal pattern of enhancement.There is no detectable signal or morphological abnormality or the hypothalamic region.Bilateral cavernous sinuses demonstrate normal morphology, signal intensity and pattern of enhancement.Diffusion weighted images are negative. Flair, T2 and susceptibility MRI images demonstrate normal signal intensity brain parenchyma. There is prominence of lateral ventricles is noted. Post enhanced images are negative.Signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are beginning normal and with normal pattern of enhancement.Unremarkable images through the orbits.Diffuse chronic sinusitis and well pneumatized bilateral mastoid air cells and middle ear cavities.

Output: 1.Pre-and post enhanced pituitary MRI demonstrate a well-demarcated approximately 4 mm nonenhancing lesion in the left paramedian. Finding is likely representing a small pituitary microadenoma. The less likely possibility of a cyst cannot be entirely excluded. Uniform pattern of enhancement of pituitary otherwise and with height measurements of 4.4 to 4.7-mm on coronal and sagittal post enhanced series.2.Unremarkable pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 40-year-old female with elbow pain and spasm. Evaluate for biceps or brachialis tendinitis versus myositis. LIGAMENTS: Although this is a non arthrogram study, the ulnar collateral ligament appears intact. The lateral ulnar collateral ligament also appears intact. TENDONS: The common extensor and flexor tendons are normal in appearance. The biceps brachii and brachialis tendons appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No near full-thickness or full-thickness articular cartilage defects are identified SURROUNDING STRUCTURES: The visualized musculature is within normal limits.ADDITIONAL

Output: Postsurgical changes without findings to account for patient's elbow pain.


Instruction: Generate impression based on findings.

Input: 33 years Female (DOB:12/2/1982)Reason: elevated LH, rule out pituitary tumor History: rule out pituitary tumorPROVIDER/ATTENDING NAME: SUSAN SAM SUSAN SAM MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The posterior lobe of the pituitary is high signal on T1-weighted imaging. On coronal imaging there is an appearance of a possible Rathke's cleft cyst, however, comparison with the sagittal images indicates that this is a continuation of the posterior lobe of the pituitary. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: MRI of the pituitary is within normal limits.


Instruction: Generate impression based on findings.

Input: T2N0 right oral tongue squamous cell carcinoma treated with CRT completed in 6/2009 with right partial glossectomy for salvage in 10/2009 with recurrent right oral tongue tumor treated with chemoradiation. There are post-treatment findings in the oral cavity, including radiation effects and partial right glossectomy and neck dissection with radial forearm flap reconstruction. There is no residual measurable lesion in the oral cavity. There is also no evidence of significant lymphadenopathy in the neck. The remaining salivary glands are unremarkable. The thyroid gland also appears unremarkable. There are upper thoracic spinal rods that produce susceptibility effect in the region. There is a right maxillary sinus retention cyst.

Output: Post-treatment findings without residual measurable lesion in the oral cavity or evidence of significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Chiari malformation and low lying conus with new symptoms: headaches, frequent urination, leg pain, and back pain. Brain: There are postoperative findings related to Chiari decompression with cerebrospinal fluid flow present across the anterior and posterior neo-foramen magnum. There is nearly resolved diffuse posterior fossa subdural effusion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged linear T2 hyperintensity in the left centrum semiovale that is likely related to a prior surgical tract. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a right maxillary sinus retention cyst.Spine: There are postoperative findings in the lumbar spine. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L2-3 level. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Expected findings related to related to Chiari decompression.2. No evidence of syringohydromyelia.3. The conus medullaris is positioned at the L2-3 level.


Instruction: Generate impression based on findings.

Input: Female, 9 years old, history of medulloblastoma status post resection x2, radiation therapy, and chemotherapy. Now off therapy, evaluate for disease. Brain:Redemonstrated are changes from prior posterior fossa tumor resection. A small hemosiderin stained resection cavity within the inferior aspect of the cerebellum is unchanged in size and morphology as is mild T2 hyperintensity within the parenchyma surrounding the cavity is stable. No evidence of pathologic enhancement is seen within or around the treatment bed.Within the supratentorial brain, there is no concerning parenchymal signal abnormality or pathologic enhancement. No evidence of edema or mass effect is seen. No abnormal extra-axial collections are noted. The fourth ventricle remains chronically dilated while the remainder of the ventricular system is within normal limits. Hemosiderin staining along a right parietal approach shunt tract and in the adjacent right occipital horn are stable in appearance.Spine:The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic intramedullary or leptomeningeal enhancement is seen. No evidence of any intraspinal mass is noted.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. Marrow signal characteristics are predominately fatty compatible with prior radiation. Otherwise, no concerning marrow replacement, edema or pathologic marrow enhancement is seen.

Output: 1.Stable findings related to prior surgery and treatment within the posterior fossa. No evidence to suggest recurrent disease is seen.2.No evidence of metastatic disease in the spine.


Instruction: Generate impression based on findings.

Input: Prior subarachnoid hemorrhage, from the right distal ICA (posterior communicating artery) aneurysm rupture which was treated with stent-assisted coiling technique. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Evolving right frontal lobe ventriculostomy track hematoma and the left frontal lobe ventriculostomy tube track also seen.Ventricular system appears to be enlarged in bilateral lateral ventricles and 3rd ventricle without showing any evidence of focal occlusion.Bilateral lateral ventricle frontal horn distance measured at the level of foramen of Monro is 47 mm which was measured around 41 mm. Frontal horn distance measured at levodopa on coronal scan is now 15.3 mm and was a 42.9 mm. Therefore, there is evidence of ventriculomegaly with associated periventricular high signal intensities on FLAIR images as well as T2-weighted images which indicate possible ventriculomegaly related edema.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 ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.There is no evidence of recanalization of the right distal ICA aneurysm which was coiled using stent-assisted coiling technique.There is no evidence of new aneurysm or arterial luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Evolving right frontal ventriculostomy tube track hematoma.3. Ventriculomegaly with periventricular edema comparing to prior scan.4. No evidence of recanalization of the right distal ICA aneurysm treated with stent assisted coiling technique.


Instruction: Generate impression based on findings.

Input: Cardiopulmonary arrest with no brainstem reflexes. Please evaluate for anoxic brain injury.Additional clinical history from electronic medical records: 5 wk old girl. Ex34wk mono-mono twin discharged from NICU 2 weeks ago. Presented with cardiopulmonary arrest at home with at least 40 minutes to ROSC. Now intubated and unresponsive with no brainstem reflexes. Brain death exam with apnea test #1 consistent with brain death. Compared to the previous head CT scan, there is heterogeneous, large volume hemorrhage throughout the ventricular system, associated with new ventricular dilatation/hydrocephalus. The hemorrhage in the left lateral ventricle is contiguous with the left caudothalamic groove/thalamus region. Diffusion-weighted imaging additionally shows mild cortical diffusion restriction especially along the pre and post central MRI as well as left occipital lobe and in the thalami. The basal cisterns remain open. Major intracranial vascular flow voids are present.There is edema/effusion involving the scalp. Fluid signal in the mastoid air cells and paranasal sinuses is nonspecific.

Output: 1.Extensive intraventricular hemorrhage with also intraparenchymal component along the left caudothalamic groove. There is associated hydrocephalus.2.Multifocal areas of diffusion restriction are compatible with diffuse hypoxic/ischemic injury.Dr. Monther Qandeel discussed the above findings with Dr. Zong over the phone on 5/13/2016 12:15 PM.


Instruction: Generate impression based on findings.

Input: Hodgkin lymphoma with mastoiditis. There is fluid within the right middle ear and mastoid air cells with extensive mucosal thickening. There is also diffuse enhancement of the bone marrow in the right lateral and central skull base, with mild overlying dural enhancement diffusely. Furthermore, there is diffuse enhancement of the soft tissues in the right prevertebral and paravertebral spaces. There is apparent signal abnormality in the upper right internal jugular vein. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Findings compatible with right otomastoiditis associated with right skull base osteomyelitis and right prevertebral and paravertebral space inflammation, which may be associated with focal right internal jugular venous thrombosis versus compression. No evidence of intracranial abscess or acute infarct. Discussed Dr. Pulimi at 11:20 AM on 2/1/16.


Instruction: Generate impression based on findings.

Input: No intracranial mass or mass effect. No evidence of infarct or hemorrhage. No extra-axial collections. No hydrocephalus. Sulcation and myelination are within normal limits. Midline structures including the corpus callosum are within normal limits. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. No findings to suggest cortical dysplasia, gray matter heterotopia, or other abnormalities to suggest seizure focus are appreciated. Major flow-voids are preserved. Cerebellar tonsils are in normal position without evidence of Chiari malformation, as questioned. CSF flow sequence demonstrates good biphasic flow at the foramen magnum ventrally and dorsally.CERVICAL SPINE

Output: 1. MRI of the brain is within normal limits. No findings to suggest seizure focus. Cerebellar tonsils are in normal position without evidence of Chiari malformation.2. Unremarkable exam of the spine with no evidence of tethered cord.3. Urinary bladder is distended with prominence of the ureters and renal collecting system. Findings are nonspecific. Correlate with post voiding ultrasound as clinically indicated.


Instruction: Generate impression based on findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 53 seconds

Output: Successful left wrist radiocarpal joint arthrogram.


Instruction: Generate impression based on findings.

Input: Reason: l knee ACL tear + meniscal pathology History: + Lt anterior drawer and McMurry MENISCI: Medial meniscus and lateral meniscus are normal in morphology and signal characteristics.ARTICULAR CARTILAGE AND BONE: Articular cartilages appear intact. There is cystic lesion in the proximal tibia, likely representing intraosseous ganglion cyst. Fabella is noted. LIGAMENTS: Thinning and increased signal particularly at the origin of the ACL is noted (series 5 image 18). Although some fibers appear intact but partial tear is of concern. PCL, MCL, and LCL appear intact.EXTENSOR MECHANISM: Patellar ligament and quadriceps tendon appear intact.ADDITIONAL

Output: Thinning and increased signal of the ACL with some intact fibers, partial tear is of concern.


Instruction: Generate impression based on findings.

Input: 41-year-old female. 1 cm liver lesion seen on CT. Please characterize. ABDOMEN: Corresponding to density seen on CT, there is a 1 cm T2 hyperintense lesion in the posterior right hepatic lobe which has peripheral nodular enhancement and likely represents a hemangioma.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1 cm heaptic lesion corresponding to recent CT likely represents a hemangioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 51 year old female status post lumpectomy and XRT for DCIS, here for screening.Family history of breast cancer diagnosed in sister at age of 35. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally. Despite a partial contrast extravasation, there is still contrast visualized within breast blood vessels and tissues. Postsurgical changes seen in the left upper outer breast compatible with history of lumpectomy. No suspicious nodular enhancement near the lumpectomy site. In the right 10 o'clock position there is a small intramammary lymph node, also present on prior mammograms.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Postsurgical 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: 54 years old patient with a newly diagnosed larynx cancer. CT scan of the head and neck requested to evaluate the extent of the cancer and to rule out brain metastases. Neck CT:At the supraglottic level of the larynx, we note a complete obliteration of the epiglottic fat by an enhanced mass, which extends from the vocal cords inferiorly to the superior tip of the epiglottis superiorly. There is involvement of the aryepiglottic folds, resulting in effacement of the piriform sinuses. There is effacement of the bilateral valleculae, and likely involvement of the most inferior aspect of the tongue base. The lesion measures 45-mm as largest cranio-caudal diameter and 21 x 34 mm axially . The lesion is homogeneously enhanced with a central focal low attenuation probably related to focal necrosis.Inferiorly, at the glottic level, we note thickening of the vocal cords, probably related to infiltration of the mass, but without any evidence of subluxation or complete invasion of the arytenoid or cricoid cartilage.The thyroid cartilage appears heterogeneous with mild scalloping on the surface abutting the mass; although this may represent variant of cartilage ossification, focal infiltration of the cartilage near the anterior commissure is suspected. A gadolinium injected MRI of the neck can be considered for better definition of cartilage invasion.Presence of 3 to 4 small lymph nodes measuring less than 1 cm in short axis diameter are considered nonpathological based on CT criteria (level II and III). There is a slightly bigger 12-mm diameter lymph node located on the left side at the level 3 and level 4 junction.Presence of a 8mm diamter lymphatic node in the superior mediastinum is nonspecific.No obvious noduel is seen in the lung apices. Please correlate with chest CT scan.Study of the bone structure shows degenerative disease of the spine related to the age of the patient.Head CT: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.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.No enhancing intracranial abnormalities are seen.

Output: 1. Presence of a large laryngeal supraglottic mass occupying and obliterating completely the preepiglottic space, infiltrating inferiorly to the vocal cords and extended superiorly to the level of the hyoid cartilage as described above.2. Probable invasion of the anterior aspect of the thyroid cartilage. Better evaluation of the cartilage invasion can be obtained by an enhanced MRI of the neck.3. Presence of a slightly enlarged lymph node at left level 3 and 4 junction. Multiple other small lymph nodes are still within normal limits based on CT criteria.4. Negative brain CT scan.Electronically Signed: 7/7/2010 9:48 AM Raghid Kikano, MD


Instruction: Generate impression based on findings.

Input: 64 year old female with exertional chest discomfort and family history of cardiac amyloid referred for cardiac MRI. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 74 ml/m2 (normal range: 65+/-11), the LVEDV is 132 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 47 ml (normal range 31+/-10). The wall thickness is normal. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no myocardial iron overload. The native T1 myocardial relaxation time is normal (<1050ms).Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 132 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 57 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumNo significant pericardial disease.Extracardiac FindingsScoliosis. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with normal systolic function (LVEF 65%). No late gadolinium enhancement to suggest underlying infiltrative, inflammatory or fibrotic disease.2. Normal size right ventricle with normal systolic function (LVEF 57%).


Instruction: Generate impression based on findings.

Input: 7-year-old boy with history of craniopharyngioma status post cyst fenestration and proton therapy. Now with crossed eyes and headaches. Bilateral transfrontal catheters terminate in the mixed cystic and solid craniopharyngioma, their position is unchanged. Since the prior exam the majority of the cystic components of the tumor have resolved and the tumor has overall decreased in size with the enhancing portion surrounding the optic chiasm measuring approximately 20 mm in AP dimension (series 1001, image 8) and 17 mm in craniocaudal dimension (series 1101, image 5), previously 25 x 23 mm. There is no new mass effect on the optic chiasm. Patchy T2 signal abnormality in the optic apparatus is grossly unchanged. The brain parenchyma otherwise appears unremarkable and there are no other areas of abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Interval decrease in cystic components of the craniopharyngioma and an overall decrease in total craniopharyngioma size.2.Stable ventricular size.


Instruction: Generate impression based on findings.

Input: Left breast IDC and DCIS status post lumpectomy and complete axillary lymph node dissection in 2010. Patient received radiation, chemotherapy and hormonal therapy. Patient presents for consultation for possible bilateral mastectomy. Personal history of ovarian cancer. History of breast cancer in paternal aunt and cousin. There is heterogeneous amount of fibroglandular tissue in the right breast and scattered fibroglandular tissue in the left breast. Minimal parenchymal enhancement is noted bilaterally.Left breast: Expected postsurgical changes from a lumpectomy and axillary dissection are present. No suspicious enhancing masses, non-mass enhancement or foci are present.Right breast: Susceptibility artifact from a biopsy clip is present at the 8 o'clock position, mid depth. An exophytic skin lesion is present at the 6 o'clock position of the right breast for which clinical correlation is recommended. No suspicious enhancing masses, non-mass enhancement or suspicious foci are present. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the left breast. Exophytic skin lesion at the 6 o'clock position of the right breast. Clinical correlation is recommended. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Ms. Duran is a 45 year old female with a personal history of left breast lumpectomy in 2011 for IDC/DCIS treated with chemotherapy, radiation, and tamoxifen therapy. Family history of breast cancer in maternal aunt. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution.A linear marker is placed on the scar overlying the left breast. There are stable post-lumpectomy changes present in the left breast, including architectural distortion, increased density, and surgical clips. Bilateral clips from benign MRI biopsies are unchanged in position. There are no new masses, suspicious microcalcifications or areas of architectural distortion identified in either breast.

Output: Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. All results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 46-year-old female with medial and lateral joint line tenderness. MENISCI: There is globular increased signal abnormality within the base of the anterior horn of the medial meniscus which does not clearly extend to either articular surface. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the medial facet of the patella. There is articular cartilage degeneration along the medial and lateral facets of the patella as well as along the trochlea.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Parameniscal cysts along the anterior aspect of the anterior horn of the medial meniscus, although no definite meniscal tear is identified. Focal full-thickness articular cartilage defect of the medial facet of the patella.


Instruction: Generate impression based on findings.

Input: History of left breast excisional biopsy in 2006 and benign right breast needle biopsy in 2004. Strong family history of breast cancer in maternal aunt, cousin and great grandmother There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Enhancing focus in the right breast at the 7:00 position is less conspicuous than the prior exam. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: CERVICAL: There is mild motion degradation of some sequences limiting evaluation. There is multilevel disk desiccation and loss of disk height. The vertebral body heights are preserved. The cervical osseous marrow signal is heterogeneous and somewhat low on T1, nonspecific. There is mild straightening. The cord caliber and signal are within normal limits. C2-3: Disk osteophyte complex and right uncovertebral hypertrophy causing no spinal stenosis.C3-4: Disk osteophyte complex and bilateral right greater than left uncovertebral hypertrophy causing minimal spinal canal stenosis and moderate-severe bilateral neural foraminal stenosis.C4-5: Disk osteophyte complex and right uncovertebral hypertrophy causing mild-moderate spinal canal stenosis with focal ventral indentation on the cord and moderate-severe right neural foraminal stenosis but no significant cord signal abnormality.C5-6: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing no significant spinal canal stenosis and moderate bilateral neural foraminal stenosis.C6-7: Disk osteophyte complex and left greater than right uncovertebral hypertrophy causing moderate left and mild right neural foraminal stenosis with no significant spinal canal stenosis.C7-T1: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing severe bilateral neural foraminal stenosis. No significant spinal canal stenosis.T1-2: Disk bulge with no significant spinal canal stenosis and moderate right neural foraminal stenosis.T2-3: Trace bulge with no spinal stenosis.LUMBAR: The last well formed disk space is referred to as L5-S1. There is minimal 4-mm retrolisthesis of T12 on L1. The osseous marrow signal is heterogeneous and somewhat low on T1, nonspecific. There is disk desiccation at essentially all levels in the lumbar spine with variable degrees of loss of disk height. The vertebral body heights are preserved. The conus terminates at mid L2 level and is within normal limits of signal, and morphology. There is a thin linear hyperintense T1 structure in the distal dorsal thecal sac measuring less than 2 mm in thickness, likely representing a fatty filum.T10-11: Mild diffuse disk bulge with no significant spinal stenosis.T11-12: Diffuse disk bulge with no significant spinal stenosis.T12-L1: Mild diffuse disk bulge, uncovering of the disk, causing no significant spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: Mild disk bulge and facet arthrosis with small facet joint effusions, ligamenta flava thickening and prominence of posterior epidural fat causing no significant neural foraminal stenosis and minimal spinal canal stenosis.L3-4: Diffuse disk bulge, and moderate facet arthrosis with small facet joint effusions and prominence of posterior epidural fat causing mild to moderate spinal canal stenosis and mild right neural foraminal stenosis.L4-5: Diffuse disk bulge with left paracentral annular fissure and moderate facet arthrosis causing no significant spinal stenosis.L5-S1: No disk herniation or spinal stenosis.

Output: 1.Multilevel cervical spondylosis, worst at C4-5 are there is mild to moderate spinal canal stenosis without cord signal abnormality. Please see details above.2.Multilevel lumbar spondylosis with prominent posterior epidural fat in the mid to lower lumbar spine causing mild to moderate spinal canal stenosis at L3-4. Please see details above.3.Fatty filum is present which can be an incidental finding with normal conus termination, however it can also be associated with tethered cord. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 41-year-old female with multicentric left breast cancer, assess response. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is an irregularly shaped enhancing mass, measuring 31 x 14 x 12 mm (previously 32 x 24 x 22 mm) (AP x LR x CC)with clip artifact at posterior aspect and anterior-lateral aspect, in the left breast atposterior 12 - 1 o'clock position. Immediately anterior to the proven cancer, there is another irregularly shaped highly suspicious mass, measuring 25 x 15 x 11 (previously 27 x 23 x 19 mm) (AP x LR x CC). Additionally, there is a suspicious enhancing mass at anterior 12 o'clock position, measuring 6 x 7 x 7 mm (previously 11 x 16 x 15 mm) (AP x LR x CC). And there are multiple small enhancing foci in the retroareolar region, anterior upper inner and upper outer region and middle 6 o'clock position. Those foci are all suspicious for malignancy. Overall extent of these lesions is 83 x 55 x 69 mm (previously 83 x 59 x 74 mm) (AP x LR x CC).There are at least two normal morphology left axillary lymph nodes.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identifiedin right axillary region.

Output: Interval response to treatment with measurements provided above.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male 13 years old with Li Fraumeni syndrome presents for cancer screening. SOFT TISSUES OF THE NECK: No significant abnormality noted.CHEST:LUNGS AND PLEURA: No pulmonary nodule or pleural effusion.MEDIASTINUM AND HILA: The heart size is normal and there is no pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary or internal mammary lymphadenopathy. The bone marrow signal intensity is within normal limits for the patient's age.ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites.SPLEEN: Normal in size and appearance.PANCREAS: No focal pancreatic lesion or pancreatic ductal dilatation.ADRENAL GLANDS: The adrenal glands are normal in size and signal characteristics.KIDNEYS, URETERS: No renal lesions or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits for the patient's age.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Mildly distended and normal in appearance.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits for the patient's age.OTHER: There is a small amount of pelvic free fluid.FEMURS: Well-defined, lobular medullary lesions in the distal right femoral diaphysis extending over a cranial-caudal distance of 10.6 cm are mildly hyperintense on T1 relative to skeletal muscle and homogeneously hyperintense on T2-weighted images. They are unchanged in size and appearance and consistent with nonossifying fibromas which were more clearly evaluated on the femur radiographs.

Output: Nonossifying fibromas in the right distal femur. No suspicious lesions.


Instruction: Generate impression based on findings.

Input: Both the cervical and lumbar spine MRIs demonstrate diffuse marrow heterogeneity demonstrating atypical T1 hypointensity admixed with speckled foci of enhancement within the visualized marrow spaces. This finding is consistent with a diffuse marrow replacement process and would be consistent with the EMR history of myelofibrosis with myeloid metaplasia.Cervical spine:There is reversal of normal upper cervical curvature. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Trace anterolisthesis C2 on C3 and left facet hypertrophy without stenosis.C3/4: Posterior osteophyte disc complex and uncinate hypertrophy without stenosis.C4/5: Posterior osteophyte disc complex and uncinate hypertrophy (right greater than left). There is mild right neural foraminal stenosis. C5/6: Posterior osteophyte disc complex, uncinate hypertrophy (right greater than left), and ligamentum flavum thickening. There is moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and uncinate hypertrophy without stenosis.C7/T1: UnremarkableLumbar spine:There are no acute fractures. The conus is normal in signal and morphology and terminates at an appropriate level. Note is made of bilateral renal cysts as demonstrated on previous abdomen MRI. Otherwise the visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement of the conus or cauda equina.T12/L1: UnremarkableL1/2: UnremarkableL2/3: Mild disc bulge and mild bilateral facet hypertrophy without stenosis.L3/4: Trace retrolisthesis L4 on L5, mild disc bulge, moderate left facet hypertrophy, and mild right facet hypertrophy without stenosis. There are bilateral facet effusions, left greater than right.L4/5: Asymmetric bulge to the right, moderate to severe left facet hypertrophy and moderate right facet hypertrophy. There is a 7 x 6 mm synovial cyst posterior lateral to the right facet joint. There is minimal right neural foraminal stenosis.L5/S1: Grade 1 anterolisthesis L5 on S1, bilateral pars interarticularis defects, diffuse annular disc bulge with disc uncovering, severe left facet hypertrophy, and moderate to severe right facet hypertrophy. There is mild to moderate left neural foraminal and mild right neural foraminal stenosis.

Output: 1.Both the cervical and lumbar spine MRIs demonstrate diffuse marrow heterogeneity demonstrating atypical T1 hypointensity admixed with speckled foci of enhancement within the visualized marrow spaces. This finding is consistent with a diffuse marrow replacement process and would be consistent with the EMR history of myelofibrosis with myeloid metaplasia.2.C4/5: Mild right neural foraminal stenosis. 3.C5/6: Moderate right neural foraminal stenosis.4.L4/5: Minimal right neural foraminal stenosis.5.L5/S1: Grade 1 anterolisthesis L5 on S1 secondary to bilateral pars interarticularis defects. There is mild to moderate left neural foraminal and mild right neural foraminal stenosis.6.Facet hypertrophy with facet effusions as described in detail above.


Instruction: Generate impression based on findings.

Input: 76 year old man with recent diagnosis of 2-vessel coronary disease (left circumflex, left anterior descending) and LV dysfunction referred for cardiac MRI to assess viability and function prior to surgery. Left VentricleThe left ventricle is normal in size with moderate-severely reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 168 ml (normal range 109+/-23), the LV end systolic volume index is 54 ml/m2 (normal range 18+/-5), the LVESV is 106 ml (normal range 31+/-10), the LV mass index is 60 g/m2 (normal range 67+/-11), and the LV mass is 117 g (normal range 114+/-24). There is akinesis of the mid and apical anterior and anteroseptal walls. There is thinning of the affected septal wall segments as well, consistent with previous myocardial infarction. Image quality was limited by respiratory motion, but in some views there appears to be a small apical outpouching with likely element of contractility likely representing a cardiac diverticulum rather than an aneurysm.There is near transmural late gadolinium enhancement in the mid and apical anterior wall, and mid and apical anteroseptum and inferoseptum consistent with nonviable myocardium. The remainder of the myocardium is viable.There is no evidence of LV thrombus.Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 59 ml/m2 (normal range 69+/-14), the RVEDV is 115 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 65 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild atherosclerosis of the descending aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with moderate-severely reduced systolic function (EF 37%).2. There are multiple regional wall motion abnormalities in the distribution of the left anterior descending artery with associated wall thinning (mid-distal anterior wall and anteroseptum). There is transmural late gadolinium enhancement in these segments consistent with established nonviable myocardium due to previous myocardial infarction.3. The remainder of the myocardium is viable. 4. On limited views, there is a possible small apical diverticulum noted. 5. No evidence of LV thrombus. 6. Normal size right ventricle with mildly reduced systolic function.7. Atherosclerosis of the descending aorta.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified nature of brain [239.6], Reason for Study: ^Reason: pre-op planning for surgery on 9/3 History: Headache The brain MRI was performed with the multiple fiducial markers attached on scalp. There is about 21.9 mm sized left cuneus lesion with peripheral enhancement with significant surrounding edema.The left lateral ventricle occipital horn was displaced slightly anteriorly due to mass effects.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Peripheral enhancing intra axial lesion with extensive surrounding vasogenic edema on the left cuneus of parietal lobe and mass effects as described above.


Instruction: Generate impression based on findings.

Input: History of nasopharyngeal cancer: aneurysm and microhemorrhage surveillance. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are numerous intraparenchymal foci of infratentorial and supratentorial susceptibility effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is a 3 mm diameter posteromedially directed right anterior genu of the internal carotid artery aneurysm. There is no evidence of significant steno-occlusive lesions.

Output: 1. Numerous intraparenchymal foci of infratentorial and supratentorial susceptibility effect are related to prior embolic microhemorrhages. 2. Unchanged 3 mm diameter posteromedially directed right anterior genu of the right internal carotid artery aneurysm.


Instruction: Generate impression based on findings.

Input: Cervical radiculopathy. Pain in neck and right arm. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is marked disc space narrowing at C3-4 and moderate disc space narrowing at C4-5 and C5-6. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable, but there is suggestion of thyroid nodules. Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is no neuroforaminal narrowing or spinal stenosis. C3-C4: There is a posterior disc osteophyte complex and uncovertebral hypertrophy with severe spinal canal stenosis and impingement upon the spinal cord, with increased T2 signal in the spinal cord at this level. There is also moderate to severe bilateral neural foraminal narrowing.C4-C5: There is a posterior disc osteophyte complex and uncovertebral hypertrophy with indentation of the spinal cord. There is also moderate to severe left and moderate right neural foraminal narrowing. C5-C6: There is a posterior disc osteophyte complex and uncovertebral hypertrophy with slight impingement upon the spinal cord. There is also severe right and moderate to severe left neural foraminal narrowing. C6-C7 and C7-T1: There is no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multilevel spondylosis with considerable spinal stenosis bilateral foraminal narrowing at C3-4 through C5-6, with associated myelomalacia or edema at the C3-4 level.2. Suggestion of thyroid nodules. Thyroid ultrasound may be useful for further evaluation, if needed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 70 year old man with history of hypertension, diabetes, hyperlipidemia and recent CABG (RIMA to LAD, LIMA to obtuse marginal) with known occlusion of the RCA, referred for assessment of ischemic burden and viability in the RCA territory.MEDICATIONS: aspirin, atorvastatin, metoprolol, losartan, metformin, glimepiride First Pass PerfusionDuring hyperemia, there is a severe perfusion defect involving the basal inferoseptal, inferior, and inferolateral walls and the mid inferolateral walls, which extends slightly beyond the below described myocardial infarction. There is also a mild perfusion defect involving the basal anteroseptum, anterior, and anterolateral walls. Viability/ Myocardial ScarThere is a predominantly non-transmural myocardial infarction (i.e. <50% of wall thickness) involving the basal to anterolateral, inferolateral, and inferior walls. These territories have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 61 g/m2, and the LV mass is 130 g. There is thinning and associated akinesis of the basal to mid inferior and inferolateral walls.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 20 ml/m2 (normal range 31+/-9), and the RVESV is 43 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely . There is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is mild atherosclerosis of the descending aorta.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large myocardial infarction involving the basal to mid inferior and inferolateral wall. The territory has an intermediate probability of viability and a small amount of peri-infarct ischemia which extends into the basal inferoseptum.2. There is mild ischemia involving the basal anteroseptum, anterior, and anterolateral walls. Most of this territory is free of myocardial infarction and is predominantly viable. 3. Normal LV size with low normal systolic function (LVEF 51%) with akinesis of the basal to mid inferior and inferolateral walls.4. Normal RV size and systolic function (RVEF 69%).5. Mild to moderate mitral regurgitation.6. Mild atherosclerosis of the descending aorta.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 66-year-old female with family history of breast cancer and ovarian cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Scattered foci of nodular enhancement bilaterally are not significantly changed from prior exams. Several T2 bright cysts are seen more prominent in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with pancytopenia and severe back pain. Assess for metastatic disease. Please note that image quality is compromised by low signal-to-noise ratio and perhaps some degree of motion artifact. Within this limitation, the following observations are made.In the cervical region, vertebral bodies demonstrate diffusely low T1 signal suggestive of marrow replacement. Scattered areas of T2 hyperintensity and enhancement are also evident within the C2, C5 and T1 vertebral bodies. These are confined to the marrow space and, within the limitations of exam quality, no evidence of any paraspinal or epidural component is seen.In the thoracic lumbar region, again diffuse marrow replacement on T1-weighted images is seen. There is, however, a more extensive diffuse pattern of pathologic marrow enhancement involving the majority of the marrow space with some geographic regions of hypoenhancement. Again, within the limitations of image quality, no significant paraspinal or epidural disease component is seen.The visualized spinal cord, conus and cauda equina demonstrate normal intensity pathology. No convincing evidence of leptomeningeal enhancement is seen. No intraspinal masses are detected.Spinal alignment is anatomic. Vertebral body heights are preserved.In the cervical region, mild disc osteophyte formation, uncovertebral hypertrophy and facet hypertrophy result in foraminal narrowing at C4-5, C5-6, and C6-7. No high-grade spinal canal stenosis is detected.In the thoracic region, no significant degenerative disc disease, spinal canal stenosis or foraminal narrowing is seen.In the lumbar region, the following level specific findings are noted:L1-2: Unremarkable. L2-3: Mild facet hypertrophy. Minimal bulging disc. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy. Mild bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet hypertrophy. Bulging disc. Mild generalized spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: Diffuse marrow replacement and pathologic marrow enhancement is seen, particularly involving the thoracic and lumbar spine. The possibility of an infiltrative hematologic process or hematologic malignancy is favored.No evidence of any vertebral body compression deformity is seen. Within the limitations of a somewhat degraded examination, no significant epidural soft tissue process is detected.Mild degenerative findings are evident as noted above, but no areas of high-grade spinal canal or neuroforaminal stenosis are suspected.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: Eval meningiomas. History: meningiomas. Multiple extra axial enhancing mass lesions are seen. Though the number of lesions appears to be unchanged, some of lesions especially one on the right frontal lobe in front of the pre-central gyrus (14.8mm x 15.4mm, was 13.7mm x 13.4mm) as well as a couple of falx lesions especially anterior aspect of the falx (11.4mm, was 11.1mm and 9mm was 7.6mm) demonstrate interval increase in size.Other lesions do not show any significant interval change in terms of size since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion.Redemonstrated and unchanged right posterior temporal lobe susceptibility lesion since prior scan.About 4 mm sized enhancing lesion within the left internal auditory canal is again seen, unchanged in size and enhancement pattern.Right frontal parietal craniotomy with multifocal underlying foci of encephalomalacia indicating postoperative changes, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Subtle interval increase of measured maximum diameter of extra axial enhancing lesions most likely meningiomas including right frontal precentral gyrus lesion and anterior aspect of falx lesions. Other lesions do not show any significant interval changes.2. No evidence of acute ischemic or hemorrhagic lesion.3. Right temporal susceptibility lesion as well as left internal with technical enhancing lesion do not show any significant interval change since prior scan.


Instruction: Generate impression based on findings.

Input: Left breast lumpectomy for an ADC. Now presents with recurrent right chest wall moderately differentiated adenocarcinoma. Pay particular attention to right anterior lateral chest wall mass and metastatic workup. CHEST:LUNGS AND PLEURA: One mild interstitial opacity in the right apex and in the subpleural left anterior chest consistent with scarring.MEDIASTINUM AND HILA: Small thyroid cyst in the left lobe.Moderately enlarged lower right paratracheal lymph node with a short axis measurement of 18 mm.Extensive and severe coronary artery calcification.CHEST WALL: Focal enhancing nodular lesion in the subcutaneous tissues of the right anterior chest wall at the level of the clavicle on image 17/140 measuring 10 x 18 mm, consistent with a metastasis.Low density, probably necrotic lymph node, best seen on the coronal sections on image 59/119, measuring 14 x 26 mm.Right Mammoplasty.Surgical clips in the left breast and skin thickening.Kyphosis with associated degenerative disease but no visible skeletal metastases.ABDOMEN:LIVER, BILIARY TRACT: Multiple well-defined hypodense hepatic lesions compatible with cysts, and a large partially loculated lesion with slightly ill-defined margins measuring 27 x 37 mm on image 73/40.. This may represent an atypical cyst but further imaging with PET or MRI would be necessary to exclude a metastasis with confidence.Moderate dilation of intrahepatic ducts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Nodular enlargement of the right adrenal gland measuring 16 x 18 mm on image 84/140.KIDNEYS, URETERS: Multiple bilateral renal cysts.PANCREAS: Multiple large cysts in the head, body and tail of the pancreas of uncertain etiology, possibly due to intraductal capillary mucinous neoplasms , though probably benign.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Enhancing subcutaneous lesion in the right anterior chest wall with a locally necrotic enlarged lymph node, consistent with metastases.2. Additional indeterminate abnormalities in the abdomen as detailed above.


Instruction: Generate impression based on findings.

Input: 66 years Female (DOB:11/29/1949)Reason: please evaluate AVfistula for changes, prior to SRS History: Pulsatile tinnitus (has improved since last scan)PROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is a redemonstration of an asymmetrically prominent right hypoglossal artery branch of the ascending pharyngeal artery when compared to the left side. The hypoglossal branch appears to anastomose with the odontoid arch system.. Then goes on to anastomose with the C2 artery. The previously noted prominence of the inferior petrosal sinus is not present on the current exam.There is prominence of the clival branch of the right meningohypophyseal trunk of the right internal carotid artery.The anterior communicating artery is identified. An incompletely visualized vessel originating from the ACOMA is suspected to represent the median artery. The anterior communicating artery is large. This appearance has not changed since the prior exam dilated component of the anterior communicating artery The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.There is extracranial origin of the posterior inferior cerebellar artery bilaterally.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.A large right hypoglossal branch of the ascending pharyngeal artery is present. This is a nonspecific finding. There is no convincing evidence for arteriovenous fistula or vascular lesion. Other explanations may be collateralization or congenital cause or a vascular lesion below the field-of-view on this exam. The change since the prior exam could imply a decrease in flow from a prior lesion.


Instruction: Generate impression based on findings.

Input: Ms. Liu is a 37 year-old female with presenting for MRI-guided biopsy of her right breast. Recent MRI performed on 11/04/2016 demonstrated an area of non-mass enhancement in the right lateral breast. On subtraction images, the previously identified area of non-mass enhancement is seen in the right lateral breast. Of note, there are now multiple additional areas of heterogenous non-mass enhancement seen in the right breast; all of which favor a finding of benign parenchymal breast tissue. However, given that the original finding is re-identified on today's examination, a decision to go forward with the MRI-guided biopsy was made. PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 5 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show no hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a right unilateral mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed in the right lateral breast with no evidence of any complications due to the procedure. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Sheth.

Output: Successful MR guided core needle biopsy of the non-mass enhancement in the right lateral breast with clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 54-year-old female with history of palpable lump in right breast for 1 year. Patient with strong family history of breast cancer in mother and aunt There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal lymph nodes are identified in either axillary region.RIGHT BREAST: There is an oval, lobulated, heterogeneously enhancing mass at 3 o' clock with dark T2 signal measuring 12 x 7 x 11 mm (AP x ML x CC). Additionally, in the right retroareolar region there is an intensely enhancing, multilobulated, possibly intraductal mass measuring 19 x 9 x 9 mm (AP x ML x CC) . This retroareolar mass is approximately 16 mm anterior to the aforementioned 3 o' clock mass.LEFT BREAST: There are multiple enhancing foci in the left retroareolar region; the largest focus measures 6 x 4 x 5 mm (AP x ML x CC).

Output: 1.Heterogeneously enhancing 3 o'clock right breast mass as detailed above. Further evaluation of this mass with ultrasound-guided biopsy is recommended.2.Multiple, possibly intraductal enhancing retroareolar foci. Further evaluation with MR directed sonography of the largest focus as detailed above is recommended. If this focus is not visualized on the ultrasound, MR follow-up in 6 months is recommended given the multiplicity of these foci.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: A 53 year old male with history of inappropriate sinus tachycardia with ablation (endo and epicardial approach) in 12/2013 who developed constrictive pericarditis which was treated surgically with pericardial stripping by robotic approach (9/2014): extensive fibrosis was seen near epicardial ablation site (sinus node region). Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 94 g (normal range 164+/-36). No interventricular septal bounce. There is basal inferior mid myocardial and lateral epicardial enhancement which may be from prior myocarditis and/or ablation.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Aneurysmal interatrial septum bowing to the left.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 179 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation, not quantified but visually estimated to be mild.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The thoracic aorta 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 discontinuation of the anterior pericardium consistent with prior partial pericardectomy. The pericardium is slightly thickened along the right atrium and is of low signal; however, does not appear calcified on recent chest radiograph. Fine calcification may be better detected with CT, if necessary. No pericardial enhancement.Extracardiac FindingsPost surgical findings in the thorax with increased signal favoring scar and or atelectasis of the lingula, leftward mediastinal shift and adhesions in the anterior mediastinum. Incidental azygous lobe.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 65%. There is abnormal septal motion of unclear significance. LV enhancement may be sequela of prior ablation or inflammatio2. 2. The right ventricle is normal in size with normal systolic function, the RVEF is 56%. 3. No evidence of pericardial constriction. Normal sized right atrium with leftward aneurysmal interatrial septum, enlarged left atrium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Paresthesia History: above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild disk dessication present at multiple levels.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.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.No lesions are appreciated in the brain or cervical spine to explain the patient's symptoms of paresthesia.


Instruction: Generate impression based on findings.

Input: 16-year-old male with lateral left knee pain. MENISCI: The medial and lateral menisci are within normal limits.ARTICULAR CARTILAGE AND BONE: The articular cartilage is within normal limits. A small focus of edema-type signal within the posterior aspect of the tibial epiphysis, subjacent to the attachment of the posterior collateral ligament, may not be of any clinical significance.LIGAMENTS: The cruciate and collateral ligament complexes appear intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No meniscal tear or other specific findings to account for patient's lateral knee pain.


Instruction: Generate impression based on findings.

Input: Reason: biochemical recurrence after radical prostatectomy History: biopsy proven disease PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Not applicable.Central Gland: Not applicable.Seminal Vesicles: Not applicable.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No specific evidence of local recurrence within the prostatectomy bed. The vesicourethral anastomosis appears within normal limits.Partially visualized scrotal hydrocele.

Output: Status post prostatectomy without specific evidence of local residual disease.


Instruction: Generate impression based on findings.

Input: Evaluate for carcinomatous meningitis, syrinx, and cause of pain: Seizure, status post resection of ganglioma, bilateral leg pain L>R, and headache. The spinal cord displays normal signal and morphology. There is no evidence of mass lesions within the spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: No evidence of intraspinal lesions.


Instruction: Generate impression based on findings.

Input: Reason: concern for DDD, osteoarthritic changes of spine History: pain shooting down LEFT leg 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. L5 is presumed to be a transitional vertebra with sacralization of L5.There is redemonstration of a perineural cysts in the sacral canal. One measures 12 x 16 mm axial dimensions at the S2 level.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 mild/moderate degree bilateral facet hypertrophy at this level which has not changed since the prior exam. There is one or 2 mm anterior subluxation of L4 on L5 present which is also unchanged. There is disk desiccation at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disk desiccation, diffuse disk bulge and facet and ligamentum flavum hypertrophy present at this level with mild triangulation of the thecal sac appeared this has not change substantially when compared to the previous exam.At L2-3 there is diffuse disk bulge present associated with ligamentum flavum hypertrophy and some mild facet hypertrophy.At L1-2 there is no significant compromise to spinal canal or neural foramina.Sclerotic foci in the right iliac bone and another one in the left bone are stable.

Output: 1.Please note that there is a transitional vertebra present. L5 is sacralized. 2.There is redemonstration of multilevel degenerative changes in the lumbar spine were sent L4-5 and L3-4 but without significant compromise of spinal canal or exiting nerve roots.3.There are perineural cysts in the sacral spinal canal present. These are stable when compared to the previous exam.


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:7/10/1966)Reason: assess for FLAIR changes compatible with SAH History: increasing RBCs on LPPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI MRI of the brainThere are several periventricular and and subcortical white matter signal hyperintensities identified on FLAIR MRI without diffusion restriction.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.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Embolic occlusion coils are present at the patient's right anterior choroidal bilobed aneurysm (which is embedded into the medial aspect of the right temporal lobe) and the patient's mid-basilar aneurysm. The anterior choroidal artery remains patent. The appearance is stable since prior exams with a minimal remnant.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. There is redemonstration of a left superior cerebellar origin 1 mm aneurysm. There is redemonstration of a 1 mm left PCOMA aneurysm.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is identified. The posterior communicating arteries are small. The left vertebral artery is slightly smaller than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusion.2.Status post embolic coil occlusion of a right anterior choroidal artery aneurysm with no evidence for recanalization at this time and no change since the prior MRA. This aneurysm is embedded in the right temporal lobe.3.Status post embolization of a basilar/left AICA origin aneurysm with minimal evidence for recurrence.4.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. This indicates evolution of previously noted microinfarcts.5.There is redemonstration of a left superior cerebellar origin 1 mm aneurysm.6.There is redemonstration of a 1 mm left PCOMA aneurysm.7.Several periventricular and subcortical white matter lesions are present which are stable relative to the prior exam


Instruction: Generate impression based on findings.

Input: There is minimal retrolisthesis at C5-6, which appears to be new. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. Spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. At C2-3, there is mild disc osteophyte complex, with no significant spinal canal or foraminal stenosis. At C3-4, there is disc bulge, with moderate to severe spinal canal stenosis, but no neural foraminal stenosis. At, C4-5, there is an eccentric left disc bulge, with mild spinal canal stenosis. At C5-6, there is moderate to severe spinal canal stenosis due to disc bulge and grade 1 retrolisthesis at C5-6. There is mild left neural foraminal stenosis. At C6-7, there is no significant spinal canal or neural foraminal stenosis. The right thyroid lobe is absent. There is a retropharyngeal right internal carotid artery.

Output: Multilevel degenerative spondylosis with moderate to severe canal stenosis at C3-4 and C5-6 due to disc-osteophyte complexes.


Instruction: Generate impression based on findings.

Input: 41-year-old female with decreased range of motion of the right shoulder status post MVA 6/2015. Some sequences are limited by patient motion artifact.ROTATOR CUFF: There is thickening and intermediate signal intensity of the infraspinatus tendon indicating moderate tendinosis. There may also be mild tendinosis and bursal surface fraying of the anterior fibers of the supraspinatus tendon, but this is equivocal. We see no fluid-filled rotator cuff tear. There is minimal fatty atrophy along the myotendinous junction of the infraspinatus. Otherwise the infraspinatus and supraspinatus muscles are normal. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal for age. There is a trace amount of fluid/edema within the subacromial/subdeltoid bursa that could conceivably represent a very mild bursitis, but this is equivocal.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is no evidence of a joint effusion. Given the limitations of a non-arthrogram study, the glenoid labrum appears intact. The cartilage of the glenohumeral joint is within normal limits.BICEPS TENDON: The tendon of the long head of the biceps tendon is within normal limits. There is a small amount of fluid within the tendon sheath which is of doubtful clinical significance, although this could conceivably represent a very mild tenosynovitis. ADDITIONAL

Output: 1. Rotator cuff tendinosis and possible mild bursal surface fraying, but no fluid-filled rotator cuff tear is evident.2. Poor definition of the coracohumeral ligament with partial loss of the normal underlying fat is not necessarily of clinical significance, but can be seen in patients with adhesive capsulitis.3. Minimal fluid within the subacromial-subdeltoid bursa and biceps tendon sheath which may not be of any clinical significance, but may represent a mild synovitis.


Instruction: Generate impression based on findings.

Input: 12 years Male (DOB:11/23/2003)Reason: r/o brain abnormalities, h/o seizure and fall, epileptiform on EEG History: seizure and fallPROVIDER/ATTENDING NAME: LILY YUEN JULIA M HENRY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a cystic lesion present along the medial right temporal lobe abutting and above the right hippocampus and adjacent and behind the right choroid fissure which measures 12 x 23 mm axial dimensions. It abuts the temporal horn of the right lateral ventricle. It is not associated with any significant contrast enhancement. It follows spinal fluid on all pulse sequencesNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a cyst present within the right medial temporal lobe. Most likely represents an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Male, 50 years old, with increasing headache and dizziness. Evaluate metastasis. T2 hyperintense signal surrounding the laser ablated right posterior parietal lesion has improved. On postcontrast images, there is a thin ring of enhancement surrounding the treatment bed with no evidence of residual or recurrent nodular tumor.Postoperative findings are redemonstrated within the right parietal lobe. The hemosiderin stained resection cavity and surrounding T2 signal abnormality have not substantially changed. A small focus of enhancement at the anterior medial margin of the cavity is nonspecific and not significantly changed.A 3 mm focus of enhancement along the right superior frontal sulcus is unchanged relative to the prior examination. No definite new enhancing lesions are seen. Ill-defined T2 hyperintensity within the right periatrial region, and within the pons, are redemonstrated. No other areas of significant edema or mass effect are detected. Ventricular size and morphology remain within normal limits.

Output: 1.Expected findings status post laser ablation of a lesion in the right posterior parietal lobe. No evidence of residual or recurrent tumor is seen at this location.2.Redemonstrated of postoperative findings in the right parietal lobe without significant interval change.3.A punctate focus of enhancement along the right superior frontal sulcus is unchanged and likely represents a metastatic focus. No definite evidence of any new metastatic lesion is seen.


Instruction: Generate impression based on findings.

Input: Reason: Chiari malformation. Follow-up of cervical spine T2 hyperintensity, syrinx, follow up exam , evaluate for change History: chiari, syrinx , follow up. Images are slightly limited by patient motion. Stigmata of Chiari I malformation are again seen, with peglike tonsils extending up to 22 mm below the level of the foramen magnum. There is again severe crowding at the level the foramen magnum. CSF flow imaging again demonstrates diminished biphasic CSF flow at the level of the foramen magnum, more conspicuous posteriorly, although with focal attenuation along the slightly retroflexed dens tip as well. Overall, this appearance appears similar to prior exam.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening throughout the visualized paranasal sinuses.CERVICAL SPINE

Output: 1.Redemonstration of stigmata of Chiari I malformation with significant caudal extension of the cerebellar tonsils. Retroflexed dens also contributes to narrowing at the level of the foramen magnum, with persistent decreased biphasic flow especially posteriorly at this level.2.Stable appearance of ill-defined T1-hypointense and T2 hyperintense signal at the lower C2 level within the cord, unchanged since baseline exam. Given the Chiari I malformation, this most likely relates to soft syrinx. No pathological enhancement identified, although continued follow-up is recommended to exclude possibility of space-occupying lesion.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: Redemonstrated is subarachnoid hemorrhage along the right frontal lobe convexity, right paramedian interhemispheric fissure and a trace amount in the right Sylvian fissure. It is difficult to compare to prior study, but appears to be similar in distribution. There are either two adjacent foci or one linear focus of diffusion restriction within the right frontal centrum semiovale. There is a new focus of diffusion restriction in the left parietal lobe, which is new compared to 4/16/2015. The previously seen foci of diffusion restriction in the left cerebellar hemisphere have resolved.The ventricles and sulci are unchanged. The basal cisterns remain patent. There is no midline shift or mass effect. There are tiny bilateral cerebellar ischemic strokes, which are chronic. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild to moderate chronic small vessel ischemic changes. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the right maxillary sinus and complete opacification of the left maxillary sinus. There are bilateral lens implants.MRA HEAD: Redemonstrated is a 1-2 mm atherosclerotic aneurysm at the anterior genu of the right internal carotid artery, without change. The anterior communicating artery again demonstrates a tiny bulge on the right, likely representing an infundibulum and likely at the origin off a perforating branch. The intracranial internal carotid arteries are otherwise normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis.MRV HEAD: The left transverse sinus is hypoplastic, which a normal anatomic variant. The superior sagittal sinus, right transverse sinus, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. The inferior sagittal sinus is not visualized. There is flow related artifact at the junction of the bilateral transverse and sigmoid sinuses. There is no evidence of venous thrombosis.

Output: 1. Small infarct in the right frontal centrum semiovale as well as a new small infarct in the left parietal lobe.2. Redemonstration of subarachnoid hemorrhage along the right frontal convexity, right paramedian interhemispheric fissure and right Sylvian fissure. 3. Stable 1-2 mm atherosclerotic aneurysm at the anterior genu of the right internal carotid artery. 4. Tiny infundibulum arising from the right side of a small caliber anterior communicating artery, likely at the origin of a perforating vessel.5. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery [I63.549], Reason for Study: ^Reason: acute ischemic stroke History: Increased left arm/leg weakness from baseline There are restricted diffusion lesions on the right periventricular white matter indicate acute ischemic infarction. Scattered susceptibility artifacts within the restricted diffusion lesions on gradient echo images indicate possible hemorrhagic conversion.Minimal FLAIR high signal intensity lesion on periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Near complete opacifications on the right mastoid air cells and partial opacifications on the left mastoid air cells are seen.

Output: 1. Acute ischemic infarction with focal hemorrhagic conversion on the right basal ganglia and corona radiata.2. Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Patient with right parotid swelling and pain x 2 years. Now constant and seems localized to tail. Negative for stones on endoscopy. Assesses for neoplasm versus inflammationion. There is a skin marker overlying the right parotid tail, where there is a lobulated enhancing structure that measures up to 15 mm in length and 4 mm in width. There is an also unchanged 5 mm diameter nodule more superiorly along the superficial aspect of the parotid gland. Otherwise, the parotid glands display diffuse fat infiltration and the right parotid gland is slightly larger than the left parotid gland. There is no evidence of radioattenuating calculi or ductal dilatation. There is no evidence of significant cervical lymphadenopathy. The thyroid gland appears are unremarkable. There is an unchanged irregular band of stranding in the left posterior lower neck subcutaneous tissues. The major cervical flow voids are intact. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable.

Output: A nonspecific structure that measures up to 15 mm within the right parotid tail and an unchanged 5 mm diameter nodule along the superficial aspect of the parotid gland may represent a lymph nodes. The rest of the right parotid gland otherwise appears to be unremarkable.


Instruction: Generate impression based on findings.

Input: Low back pain, evaluate for infection at the operative site Compared to 8/21/2015, previously seen epidural hematoma extending from L4-L5 to L5-S1 level has been evacuated. Current study demonstrates a fluid collection dorsal to the thecal sac at the L4-L5 level extending to the L5-S1 level with moderate to severe degree of mass effect on the thecal sac right greater than left. This collection measures approximately 2.7 x 2.7 x 2.3 cm in the AP, transverse, and craniocaudal dimensions.There is peripheral enhancement associated with this collection, with susceptibility artifact slightly limiting evaluation. Also noted is enhancement involving the epidural space along the right lateral aspect of the spinal canal in the epidural space along the right L5 to S1 levels. This enhancement is increased since prior postoperative study from 8/21/2015 and may represent granulation tissue.Small more superficial fluid collection is also seen in the midline posteriorly along the surgical tract. Enhancement of the paraspinous soft tissues is also increased since prior which may reflect postsurgical change.Again seen are earlier postsurgical changes of L4-L5 bilateral laminectomy with placement of bone graft material and an interspinous clamp. There is minimal anterolisthesis at L4-L5, otherwise alignment is anatomic. Vertebral body heights are intact. Multilevel disc desiccation with degenerative disc disease, most severe at L4-L5. Endplate degenerative changes at L4-L5. Normal signal within the distal cord and conus which ends at L1-L2. Again seen is mild clumping of the cauda equina below L2-L3 which likely reflects arachnoiditis.Degenerative changes including mild bilateral neural foraminal stenosis at L3-L4 as well as moderate to severe right and mild to moderate left L4-L5 neural foraminal stenosis are again seen related to disc bulge and facet arthropathy.Numerous bilateral renal cysts.

Output: Again seen are prior postsurgical changes of L4-L5 laminectomy and interspinous fusion with interval evacuation of epidural hematoma since MRI from 8/21/2015. Current study demonstrates a fluid collection dorsal to the thecal sac extending from L4-L5 to L5-S1 at the level of the laminectomy/facetectomies with mass effect on the thecal sac resulting in moderate to severe spinal canal stenosis, right worse than left. There is mild peripheral enhancement associated with this collection as well as enhancement involving the epidural space particularly on the right L5 to S1 levels. This enhancement is nonspecific and may reflect granulation tissue, with infection not excluded. The fluid collection may represent a pseudomeningocele, with superimposed infection again not excluded.Moderate to severe right L4-L5 neural foraminal stenosis which may be impinging on the L4 nerve root again seen and similar to prior.


Instruction: Generate impression based on findings.

Input: There is redemonstration of patient's known multifocal anaplastic astrocytoma with localized mass effect. An expansile infiltrating T1 hypointense and T2 hyperintense mass involves a majority of the left pons, left midbrain, and extends into the left thalamus. There is no enhancement of the tumor or restricted diffusion. Based on multiple different measurements on FLAIR and T2 sequences, this lesion is not significantly changed in size.There is minimal questionable FLAIR hyperintensity in the right ventral pons and some expansile convexity which may reflect subtle tumor infiltration. Abnormal T2 signal of the left lateral cerebellar hemisphere is unchanged. Review of rCBV maps does not demonstrated significant hyperperfusion of the tumor in any area.Again seen are postoperative changes of a small right occipital burr hole and a small area of encephalomalacia along the right lateral cerebellum which likely reflects site of prior biopsy. Again seen are a few scattered small foci of susceptibility which is nonspecific but may be related to microhemorrhage secondary to radiation therapy. Peripheral foci of susceptibility weighted abnormalities in the right lateral cerebellar hemisphere are likely post operative.The ventricles and sulci are unchanged. There is no herniation. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There is a small mucus retention cyst in the right maxillary sinus.

Output: 1. Multifocal anaplastic astrocytoma is unchanged in size compared to the most recent study as detailed above.2. Postoperative changes of a right lateral cerebellar biopsy.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There are numerous subcentimeter subcutaneous T2 hyperintense nodules that likely represent neurofibromas. There are tiny disc osteophyte complexes at C5-C6 and C6-C7 without significant spinal canal or neural foramen stenosis.

Output: 1.No appreciable lesions within the spinal canal or neural foramina within the limitations of a non-contrast exam. Minimal degenerative changes without significant spinal canal or neural foramina stenosis.2.Numerous subcutaneous nodules compatible with neurofibromas.


Instruction: Generate impression based on findings.

Input: 68 year old woman with dyspnea, referred for evaluation of underlying ischemia.MEDICATIONS: Tricor, lovastatin, Toprol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 61 ml (normal range 31+/-10), the LV mass index is 40 g/m2, and the LV mass is 73 g. There are no regional wall motion abnormalities present. The native myocardial T1 relaxation time is 1006ms, which is within the normal range.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 164 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 80 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA large hiatal hernia is noted. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 59%).4. Normal RV size and systolic function (RVEF 51%).5. See extra cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Minimal mucosal thickening is noted within a couple left ethmoid air cells as well as the maxillary sinuses without superimposed fluid levels. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Minimal mucosal thickening is noted within a couple left ethmoid air cells as well as the maxillary sinuses without superimposed fluid levels. 2.Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings of encephalitis.


Instruction: Generate impression based on findings.

Input: 98-year-old with altered mental status x 3 days with similar episode 3 weeks and 1 week ago. Please evaluate for bleeding or mass effect. History of dementia, arrhythmia. Diffuse areas of subcortical and periventricular white matter hypodensity likely represents small vessel ischemic disease of indeterminate age and appears approximately similar to the prior examination. However, if there is concern for an acute infarction, an MRI may be considered for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift.Ex vacuo dilation of the ventricles and prominence of the sulci indicates marked corticomedullary volume loss.Thickening of the diploic space with patchy areas of sclerosis raises the question of Paget's disease. The left-sided mastoid air cells are underpneumatized. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No definite acute findings. Small vessel ischemic disease of indeterminate age, similar to the prior study. However if there is concern for an acute infarction, an MRI may be considered for further evaluation.