Instruction: Generate impression based on findings.

Input: Meningioma resection. There are postoperative findings related to recent biparietal craniotomy with scattered pneumocephalus. There is residual enhancing tumor along the left anterolateral aspect of the resection cavity that measures up to 20 mm in width. There is also restrcited diffusion along the margins of the resection cavity that measure up to 35 mm. Otherwise, there is no significant interval change in the extent of confluent T2 hyperintensity in the bilateral posterior cerebral hemisphere white matter, which may represent vasogenic edema, as well as unchanged left parieto-occipital encephalomalacia. There are mild foci of susceptibility effect in the brain parenchyma surrounding the tumor, which may represent blood products. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The posterior superior sagittal sinus is obliterated. There is a partially-empty sella. There is mild mucosal thickening in the left sphenoid sinus. There is persistent right tympanomastoid fluid.

Output: 1. Postoperative findings related to recent partial resection of the posterior falcine meningioma with areas of acute ischemia along the margins of the resection cavity.2. Persistent right tympanomastoid fluid may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: 72-year-old man with history of metastatic lung cancer. A few areas of FLAIR hyperintensity in the bilateral cerebellar hemispheres (5/7 and 9) correspond to areas of prior infarct. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. A few, punctate foci of susceptibility artifact (7/71 and 79) likely represent hemosiderin deposition from prior microhemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.The sella and orbits are within normal limits. There are mucosal retention cysts in the right maxillary sinus. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Brain: Compared to 1/12/2016, there is no significant change in areas of multiple small foci of restricted diffusion within the pons with surrounding associated T2/FLAIR signal abnormality consistent with edema. Some of these foci demonstrate peripheral enhancement on post-contrast imaging, while some are more homogeneously enhancing. Since the prior study from 1/12/2016, there is no new enhancement or new focus of edema to suggest worsening disease. The ventricles and sulci are normal in size. No midline shift or herniation.Spine: There is no abnormal enhancement within the spinal cord. There is no abnormal meningeal enhancement within the spine. Vertebral body heights and alignment in the cervical, thoracic, and lumbar spine is normal. Alignment is normal. There is no significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are grossly unremarkable.

Output: 1. Compared to 1/12/2016, there is no significant change in multiple foci of enhancement in the pons with restricted diffusion and surrounding edema. Findings are most favored to represent an infectious process with small abscesses.2. No new foci of enhancement or edema in the brain.3. No lesions within the spine are appreciated.


Instruction: Generate impression based on findings.

Input: Evaluate acute stroke and assess for early hemorrhagic conversion; right gaze deviation, left hemianopsia. Brain MRI:Motion artifacts degraded exam quality.There are multifocal restricted diffusion areas on the right frontal lobe, parietal lobe, temporal lobe and occipital lobe indicating acute ischemic infarction. There is no evidence of hemorrhagic transformation.Underlying brain show multiple scattered high signal intensities on periventricular white matter indicating non specific small vessel 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 and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate decreased in-flow signal intensity on the right MCA comparing to that of the left MCA indicating slow or decreased flow through the right MCA. Bilateral PCAs are fetal origin.Multiple tandem luminal narrowing (less than 50%) of vertebrobasilar system.Left MCA and bilateral ACAs appear to be normal.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 6mm segmental luminal stenosis of the right extracranial ICA just above the bifurcation, based on the MRA it appears to be about 90% stenosis. Right vertebral artery is dominant and the left vertebral artery is not clearly visualized with tortuosity indicating proximal left vertebral artery stenosis.The distal right vertebral artery appears to be irregular and there are multifocal luminal stenosis. Normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries.

Output: 1. Right MCA territorial (right PCA is fetal origin) acute ischemic infarction without evidence of hemorrhagic transformation.2. More than 90% luminal stenosis of the right ICA just above the bifurcation.3. Decreased in flow related enhancement on the right MCA than that of the left MCA indicating decreased or slower flow. 4. Atherosclerotic changes of the vertebrobasilar system indicating intracranial atherosclerosis.


Instruction: Generate impression based on findings.

Input: Reason: 39 y.o female with h/o Ulcerative colitis, but low iron and B12 studies. Please eval for any small bowel involvement that would suggest Crohn disease. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates subtle, decreased signal on in-phase T1 images suggestive of iron deposition.SPLEEN: The spleen demonstrates decreased signal on T2-weighted images suggestive of iron deposition.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A suprarenal IVC filter is noted. Postcontrast images demonstrate a large filling defect within the infrarenal IVC which appears to extend into the right common, internal, and external iliac veins compatible with nonobstructive venous thrombus. There is an additional tubular structure running along the IVC which also has an intraluminal flow void suspicious for additional thrombosis perhaps of the right gonadal vein.BOWEL, MESENTERY: The proximal small bowel is well distended with enteric contrast. The distal small bowel is not fully distended with enteric contrast which mildly limits evaluation. The small bowel is normal in caliber with a normal mucosal fold pattern and without abnormal enhancement. The terminal ileum is unremarkable. The descending and transverse colon are normal in caliber and morphology. Beginning at the splenic flexure, the descending and sigmoid colon are featureless without haustration. The descending colon, sigmoid colon, and rectum demonstrate mild to moderate increased mucosal enhancement and circumferential bowel wall thickening compatible with stated history of colitis. No significant pericolonic inflammatory changes or fluid collections are identified. No fistulae.BONES, SOFT TISSUES: There is diffuse, mildly decreased signal in the bone marrow suggestive of iron deposition.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: There is diffuse, mildly decreased signal in the bone marrow suggestive of iron deposition.OTHER: No significant abnormality noted.

Output: 1.Inflammation of the distal colon beginning at the splenic flexure through the rectum compatible with colitis.2.Normal-appearing small bowel without specific evidence of Crohn's disease.3.Nonocclusive venous thrombus within the infrarenal IVC and its tributaries as well as possibly in the right gonadal vein.4.Findings suggestive of secondary hemosiderosis.Findings discussed with LABAS, JENNIFER at 11:00 AM on 11/17/2015.


Instruction: Generate impression based on findings.

Input: 80 year-old female with hypertension, two weeks of forget fullness and falls. Evaluate for recent stroke. There is no evidence of any definitive interval change since prior examination. No evidence of any active stroke is detected. There is no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Further lobulation but an MRI is recommended.

Output: Stable CT of brain since prior study.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:11/12/1947)Reason: pt with MS, concern for flare History: pt with MS, concern for flare PROVIDER/ATTENDING NAME: YASMIN H. KARIMI MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord is small and atrophic appearing but has normal signal characteristics. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.There are dorsally located subcutaneous cystic lesions present at the level of the the upper cervical spine and lumbar spine. One at the level of the upper cervical spine measures 13 x 24 mm sagittal dimensions whereas the one in the midthoracic spine level measures 30 x 19 mm sagittal dimensions. These are predominantly hyperintense on T2 and hypointense on T1 and have a thick wall most likely represent sebaceous cystsThere are small pleural effusions present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some facet and ligamentum flavum hypertrophy at this level. There is a disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some facet and ligamentum flavum hypertrophy at this level. There is a disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Findings are suggestive of spinal cord atrophy.2.There are some mild degenerative changes present lower lumbar spine without significant compromise spinal canal or neural foramina3.There are small pleural effusions present.


Instruction: Generate impression based on findings.

Input: 31-year-old female with history of bowel resection 10 years ago for obstruction. Evaluate for evidence of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesion in the left kidney is too small to characterize but likely a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ileocolic anastomosis is present in the right lower quadrant. No abnormal bowel wall thickening or enhancement to suggest inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is enlarged by multiple fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites, likely physiologic.

Output: 1. No specific evidence of inflammatory bowel disease.2. Fibroid uterus.


Instruction: Generate impression based on findings.

Input: Male, 42 years old, with multiple sclerosis and paresthesias. Brain morphology is within normal limits. No focal lesions or areas of parenchymal signal abnormality are detected. No evidence of restricted diffusion is seen.No edema or mass effect is identified. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricles are normal in size and morphology.A small mucus retention cyst is evident at the roof of the left maxillary sinus, and mild mucosal thickening is seen along the floor of the right maxillary sinus.

Output: Unremarkable examination with no lesions characteristic for demyelinating disease.


Instruction: Generate impression based on findings.

Input: Reason: r/o meniscal tear History: pain. MENISCI: The medial meniscus is intact without discrete tear.There is diffuse degenerative tearing of the anterior and posterior horns of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Diffuse thinning of the articular cartilage of the medial compartment. Full-thickness thinning of the lateral compartment with bone-on-bone apposition and underlying moderate bone marrow edema and large subchondral cyst formation within the lateral femoral condyle and lateral tibial plateau. Fissuring and small foci of full-thickness defects within the patellofemoral compartment.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Severe lateral compartment osteoarthritis with associated medial meniscus degenerative tearing, full thickness articular cartilage thinning, subchondral edema and cyst formation. Mild to moderate patellofemoral and medial compartment osteoarthritis. 2.Loose body in the posterolateral aspect of the joint. 3.Moderate sized joint effusion with synovitis.4.Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: Left knee pain. Left knee patellar chondral defect? MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: Although I see no fluid-filled defects of the articular cartilage of the patella, focal low signal intensity within the articular cartilage of the medial facet of the patella may represent degeneration. The articular cartilage of the femoral trochlea appears normal. The remaining articular cartilage appears normal. Bone marrow signal intensity is within normal limits.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Small focus of low signal intensity within the articular cartilage of the medial facet of the patella may represent focal degeneration, but this is equivocal, and I see no fluid-filled articular cartilage defects.


Instruction: Generate impression based on findings.

Input: There is a well-defined spherical 5 mm diameter periapical lesion mildly increased T2 signal in the left maxilla associated with the root of left second maxillary molar tooth. There is mild mucosal thickening along the floor of the left maxillary sinus. The other paranasal sinuses are unremarkable. The bilateral mastoids air cells and the middle ear cavity are grossly unremarkable. The orbits appear to be intact. The previously demonstrated left frontal convexity extra-axial subcentimeter lesion is not as apparent on this exam due to technique. There are foci of T2 hyperintensity in the left frontal lobe deep white matter.

Output: 1. A subcentimeter periapical lesions associated with tooth #14 likely represents a periapical abscess, perhaps with mild reactive mucosal inflammation in the inferior left maxillary sinus.2. The previously demonstrated left frontal convexity extra-axial subcentimeter meningioma is not as apparent on this exam due to technique.3. Left frontal lobe white matter lesions that may represent chronic manifestations of lupus cerebritis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with numbness and paresthesia of the left big toe. Mild curvature of the lumbar spine is seen in the coronal plane. There is a grade 1 anterolisthesis of L4 relative to L5.The L2 vertebral body is compressed with approximately 50% loss of vertebral body height centrally. There is no associated marrow edema. The remaining vertebral bodies show preservation of height.Degenerative endplate signal abnormality is seen at L2-3. Elsewhere, marrow signal characteristics are unremarkable. No evidence of marrow edema is seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.T12-L1: Mild facet arthropathy and ligamentum flavum thickening. Mild bulging disc. No significant spinal canal or foraminal stenosis.L1-2: Mild facet arthropathy. Loss of disc T2 signal with preserved disc height. Minimal disc bulging. No significant spinal canal or foraminal stenosis. L2-3: Moderate facet arthropathy with bilateral facet effusions. Ligamentum flavum thickening. Loss of disc height with disc bulging and osteophytic spurring. The lateral recesses are narrowed but no significant generalized spinal canal stenosis is seen. The neural foramina are mildly narrowed. L3-4: Moderate facet arthropathy with bilateral facet effusions. Ligamentum flavum thickening. Loss of disc height and disc bulging. The lateral recesses are narrowed but there is no significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L4-5: Advanced facet arthropathy and ligamentum flavum thickening. Loss of disc height and disc bulging. Effacement of both the dorsal and ventral thecal sac results in a mild to moderate generalized spinal canal narrowing. The descending L5 nerve roots may be somewhat impinged. Mild bilateral foraminal narrowing. L5-S1: Moderate facet arthropathy. Loss of disc height with disc bulging and a right paracentral/subarticular disc protrusion. As a result, the descending right S1 nerve root may be slightly impinged. No significant generalized spinal canal stenosis is seen. The neural foramina are not significantly narrowed.

Output: 1.Multilevel disc degeneration is seen. At L3-4, the lateral recesses are narrowed and there is a moderate right foraminal narrowing. At L4-5, there is a mild to moderate generalized spinal canal stenosis with possible impingement of the descending L5 nerve roots. At L5-S1, there is a right paracentral/subarticular disc protrusion which may impinge upon the descending right S1 nerve root.2.Facet arthropathy is seen at most levels. In addition, there is a compression deformity of the L2 vertebral body which is likely chronic given lack of marrow edema.


Instruction: Generate impression based on findings.

Input: Low back pain, pain in the legs For the purposes of numbering, 5 lumbar type vertebral bodies are presumed to be present with S1-S2 disc being diminutive. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge without significant spinal canal stenosis and minimal bilateral neural foraminal narrowing.L5-S1: Small right foraminal disc protrusion and annular fissure similar to prior with mild to moderate right neural foraminal stenosis. There is contact of the exiting right L5 nerve root. No significant central canal stenosis. Minimal left foraminal narrowing. Minimal facet arthropathy in the lower lumbar spine. Paraspinous soft tissues are otherwise unremarkable.

Output: Mild degenerative changes in the lumbar spine including right foraminal disc protrusion at the L5-S1 level similar to prior study from 12/13/2013 with mild to moderate right-sided neural foraminal stenosis. There may be impingement of the right L5 nerve root. There is no significant central canal stenosis at any level in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Images are somewhat motion a graded secondary to uncontrolled shaking of the legs. Given this caveat:Brain: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. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.Cervical spine:Alignment is normal. The marrow signal is benign. 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. There are no degenerative changes or stenoses.Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There is no abnormal enhancement. There are no degenerative changes or stenoses.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. There is no abnormal enhancement.L5/S1: There is a small central disc extrusion that extends slightly below the disc level without significant associated mass effect and no resulting stenosis.There are no other degenerative changes and there are no stenoses.

Output: 1.Negative contrast-enhanced brain MRI.2.Negative contrast enhanced cervical spine MRI.3.Negative contrast enhanced thoracic spine MRI.4.At L5/S1 there is a small central disc extrusion that extends slightly below the disc level without significant associated mass effect and no resulting stenosis. Otherwise negative contrast enhanced lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: There are minimal nonspecific T2/FLAIR hyperintensity surrounding the lateral ventricles. There are nonspecific few scattered subcortical white matter in the frontal lobes bilaterally. Ventricular size is normal with no midline shift. There is no abnormal enhancement.There are no diffusion abnormalities. A punctate susceptibility signal is seen in the left cerebellum with associated punctate hyperintensity in T1, representing mineralization rather than old the blood products. Vascular structures are unremarkable. There is no acute hemorrhage or mass effect. There is a mucous retention cyst in the left maxillary sinus.There is partially empty sella.

Output: No evidence of mass lesion. No acute hemorrhage or edema.Comment: Surveying intracranial arterial aneurysm needs MR angiography. Brain MRI may not exclude the possibility of intracranial arterial aneurysm. CT angiography can also be considered for excluding intracranial arterial aneurysm.


Instruction: Generate impression based on findings.

Input: There is encephalomalacia involving the right posterior frontal and anterior parietal lobes including the right pre-and postcentral gyri. There is susceptibility effect compatible with chronic blood products within this region. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is advanced parenchymal volume loss involving the cerebellum and mild volume loss involving the cerebral peduncles and brainstem which may related. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is evidence of prior left frontal craniotomy. Diffuse mild thickening of the calvarium is noted. 12 mm subcutaneous cystic lesion at the level of the left zygomatic arch, possibly sebaceous cyst.MRA HEAD

Output: 1. Right frontoparietal encephalomalacia including the pre-and postcentral gyri. There is also evidence of chronic hemorrhage within this region.2. No evidence of acute ischemia, mass, or mass effect.3. Disproportionate volume loss involving the cerebellum which is nonspecific but may be related to anti-epileptic medications and/or chronic alcohol use, for example. There is calvarial thickening which can also be seen with anti-epileptic medications.4. Small subcutaneous cystic lesion at the level of the left zygomatic arch region, possibly sebaceous cyst.5. Intracranial MRA is unremarkable with no evidence of flow-limiting stenosis, dissection, or aneurysm. Please note MRA neck was requested but not obtained as patient refused to proceed further with the studies. As such, evaluation for arterial dissection in the neck was not performed.6. Degenerative changes in the cervical spine with disk osteophyte complexes and uncovertebral hypertrophy from C3-C4 to C6-C7. No high-grade spinal canal stenosis at any level. Neural foraminal narrowing at multiple levels as detailed above. Overall no significant change since MRI cervical spine from 5/7/2013.7. Unchanged trace prominence of the central canal (tiny syrinx) at the C6 level measuring up to 2 mm which can be a normal variant at this level and of uncertain clinical significance. Otherwise, no cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Meningioma resection surveillance. There are Postoperative findings related to right parafalcine meningioma resection with unchanged encephalomalacia in the underlying right parietal lobe. However, there is interval increase in size of a nodular enhancement in the surgical bed along the right aspect of the posterior superior sagittal sinus, which measures 16 x 18 mm in axial cross-section, previously 12 x 13 mm. The tumor protrudes in to the subgaleal space through th calvarial defect. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged patchy nonspecific scattered cerebral white matter T2 hyperintensity beyond the region of the surgical bed. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are bilateral lens implants. There are persistent secretions in the left frontal sinus.

Output: Postoperative findings related to right parafalcine meningioma resection with interval increase in size of residual tumor.


Instruction: Generate impression based on findings.

Input: Signs of optic nerve compromise: decreased vision OD. Brain: There is a low T1 and high T2 signal right sellar tumor with suprasellar extension and susceptibility effect as well as possible peritumor cyst formation that measures up to 23 mm and exerts marked mass effect upon the optic apparatus and inferior right frontal lobe. There is also mass effect upon the right cavernous sinus. The tumor also abuts and perhaps encases a portions of the adjacent right internal carotid artery. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is engorgement of the right superior ophthalmic vein due to mass effect upon the right cavernous sinus. The right intraorbital optic nerve appears to be mildly atrophic. The left intraorbital optic nerve appears to be grossly intact. The globes, extraocular muscles, lacrimal glands, and orbital fat are intact bilaterally.

Output: A right sellar tumor with suprasellar extension measuring up to 23 mm exerts mass effect upon the optic apparatus and likely represents a pituitary macroadenoma with prior intratumoral hemorrhage. The right intraorbital optic nerve appears to be mildly atrophic perhaps due to chronic pressure-induced effects by the tumor. Assessment is otherwise limited due to the lack of intravenous contrast, acknowledging pregnancy status.Discussed with Dr. Zeyer at 2 PM on 7/1/16.


Instruction: Generate impression based on findings.

Input: 22-year-old male with left buttock abscess. Evaluate for fistulous tracts. Large condylomata are present at the anal verge that are inflamed and indurated on physical examination. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: Several enlarged lymph nodes, a left inguinal node on image 146/191 measures 1.5 x 1.5 cm, and a left obturator node measures 0.9 x 2.4 cm. These are unchanged since 8/2/08.BOWEL, MESENTERY: There is a mixed attenuation mass in the perianal region with a focus of rim enhancement surrounding fluid attenuation, compatible with an abscess. This lesion most likely contains a solid component and fluid that may be multiloculated. The lesion has increased in size since the 8/2/08 examination. The lesion in the left medial buttock measures 3 x 7.3 cm and axial image 156/171. This lesion extends craniocaudally approximately 8 cm on coronal image 26/103.No evidence of a fistula, however, MRI may be better to further determine presence of fistula/abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the dependent pelvis.

Output: Increased size of left buttock mixed attenuation mass which most likely represents an abscess with associated inflammatory changes. No evidence of fistulas, however, MRI may be better to further determine disease.


Instruction: Generate impression based on findings.

Input: Reason: Prostate cancer, will have RAL Prostatectomy History: see above PELVIS:PROSTATE: Resident on-call and a selective dilators and is an IUD is is in the biopsy came back criteria for Gleason 8Prostate Size: 5.2 x 3.7 x 3.4 cmPeripheral Zone: There is a large lesion within the right prostate involving the right peripheral zone and posterior transitional zone extending from the base to the apex. This lesion measures up to 2.2 x 1.5 cm in the mid gland. At the apex at extends anteriorly, with extracapsular extension, abutting the right puborectalis. This lesion is dark on T2 and ADC, demonstrates early enhancement and diffusion restriction.Central Gland: See above.Seminal Vesicles: No significant abnormalityExtracapsular Extension: Multiple foci of extracapsular extension, particularly involving the right apical region anteriorly.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly enlarged bilateral pelvic lymph nodes with a right external iliac node measuring 1.4 x 1.1 cm (2001/112).BONES, SOFT TISSUES: Findings of active disease is seen on prior CT.OTHER: No significant abnormality noted.

Output: 1.Large lesion in the anterior prostate with extracapsular extension likely corresponds to patient's biopsy-proven prostate cancer.2.Enlarged bilateral pelvic lymph nodes are nonspecific.


Instruction: Generate impression based on findings.

Input: Craniopharyngioma treated with surgery and radiation: surveillance. There are stable findings related to craniopharyngioma treatment. There is no definite evidence of recurrent tumor. The remaining pituitary gland appears unchanged. The infundibulum is not discernible and may be interrupted. There is unchanged thinning of the optic chiasm, but no mass effect upon the optic apparatus. The cavernous sinuses are intact.

Output: Post-treatment findings without evidence of recurrent craniopharyngioma.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain History: left knee pain. Right elbow pain. Left knee:There is sharpening of the tibial spines indicating minimal osteoarthritis. There is subtle irregularity along the weightbearing surface of the medial femoral condyle corresponding to the patient's postsurgical changes seen on recent MRI examination. Note is made of chondrocalcinosis.Right elbow:No acute fracture or malalignment. There s no large joint effusion.

Output: 1. Minimal osteoarthritis and postsurgical changes affecting the left knee. Chondrocalcinosis.2. Normal-appearing right elbow without findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 66 year old female with history of bilateral breast cancer. She is status post bilateral lumpectomies and sentinel lymph node biopsies in 2012 (right breast invasive ductal carcinoma and DCIS; left breast invasive ductal carcinoma and DCIS). Patient received bilateral XRT. History of left breast cancer in 2004. Status post left lumpectomy, XRT and hormonal therapy. She has a family history of breast cancer in two sisters and ovarian cancer in her mother. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Postsurgical changes consistent with bilateral lumpectomies are unchanged in appearance. Multiple susceptibility artifacts are seen in both breasts. 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: 57-year-old male with hip pain. Evaluate for labral tear Patient motion artifact results in slightly suboptimal image quality.ACETABULAR LABRUM: There is linear increased signal abnormality transit traversing the anterior superior acetabular labrum extending from the 9 o'clock position to 11 o'clock position consistent with a tear.ARTICULAR CARTILAGE AND BONE: There is near full-thickness articular cartilage degeneration along the superior aspect of the acetabulum. There is increased signal abnormality within the superior left acetabulum and superior lateral femoral head/neck, likely degenerative in etiology. Mild osteoarthritic changes affect the left hip. There is osteophyte formation resulting in prominence of the anterior aspect of the left femoral head/neck junction consistent with a small CAM deformity. The alpha angle measures approximately 56 degrees.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance. The bladder is incompletely distended limiting evaluation. Metallic susceptibility artifact from a lower lumbar spinal fixation device limits evaluation of the lower lumbar spine. There is increased signal abnormality within the paraspinal musculature which is nonspecific.ADDITIONAL

Output: Small CAM deformity and left hip osteoarthritic changes with associated acetabular labral tear as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: h/o oral cancer now with recurrence, FNA right masticator space, Dr Christoforidis to perform History: facial nerve paralysis Serial CT images obtained during the aspiration and biopsy procedure for the infratemporal fossa mass demonstrate the needle placement within the infratemporal fossa lesion. Following needle removal images obtained demonstrate no complications.Whereas the foramen ovale on the prior exam measured 10x14mm it now measures 28x17 mm axial dimension suggesting significant interval enlargement of the right infratemporal fossa mass extending to the right middle cranial fossa.Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the chin lesion.

Output: 1.Significant interval enlargement of the right infratemporal fossa mass extending to the right middle cranial fossa.2.Infratemporal fossa lesion aspiration under CT guidance.3.Infratemporal fossa lesion biopsy under CT guidance.4.Chin lesion aspiration under CT guidance.


Instruction: Generate impression based on findings.

Input: Reason: Left adrenal nodule ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 1.7 x 1.3 cm lesion in the left adrenal gland demonstrates loss of signal on opposed phase imaging, consistent with an adenoma (801/31). The right adrenal is unremarkable.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesion in the left kidney likely represents a cystRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small fat-containing ventral hernia.BONES, SOFT TISSUES: Bilateral breast implants.OTHER: No significant abnormality noted.

Output: Left adrenal lesion is consistent with a benign adrenal adenoma.


Instruction: Generate impression based on findings.

Input: Headache and presyncope. There is a right transoccipital ventricular catheter that terminates in the left lateral ventricle. Artifact associated with the shunt catheter hardware obscures a portion of the right cerebral and cerebellar hemispheres. Otherwise, the ventricular system does not appear to be particularly dilated. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mildly prominent perivascular spaces in the frontal lobes. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. The shunted ventricular system does not appear to be particularly enlarged. 2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 65 year-old woman lingular revision, left-sided numbness and vomiting x 3 days Portable CT examination of brain without infusion was performed.No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. Further evaluation with an MRI is recommended. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits.Calvarium, mastoid air cells and limited view of paranasal sinuses are unremarkable.

Output: Normal MRI of brain.


Instruction: Generate impression based on findings.

Input: Altered mental status for preoperative planning. This is a limited stealth MRI of the brain for preoperative planning. There is an irregular, heterogeneously enhancing mass in the right temporal lobe with internal necrotic as well as nodular components, measuring approximately 56 x 38 x 42 mm (AP x TR x CC). There are at least three adjacent small satellite lesions including one along the lateral dural surface of the right inferior temporal lobe . There is associated T2 signal abnormality surrounding the mass. There is regional mass effect on the right lateral ventricle and right aspect of the midbrain, with a right to left midline shift of 11 mm. There is right uncal herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Limited stealth MRI of the brain for preoperative planning. 2. A 56 mm heterogeneously enhancing mass in the right temporal lobe with three satellite lesions, exerts local mass effect on the right lateral ventricle and right aspect of the midbrain and produces a right to left midline shift of 11 mm and mild uncal herniation. Finding is favored to represent high-grade glial neoplasm although metastasis remains a less likely possibility. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of HCV cirrhosis/HCC, pre-liver transplant candidate, please evaluate for metastases LUNGS AND PLEURA: Moderate size right pleural effusion.No evidence of pulmonary edema or pulmonary masses.Mild scarring at the left lung base.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild cardiac enlargement with valvular calcification and mild/moderate coronary calcification.Mild cardiac enlargement. No significant pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Contour abnormality of the liver compatible with cirrhosis.Marked splenomegaly.Recently demonstrated intrahepatic lesions on an MRI exam cannot be evaluated without intravenous contrast.

Output: Moderate-sized right pleural effusion. No pulmonary lesions identified.


Instruction: Generate impression based on findings.

Input: Vaginal bleeding. Vaginal delivery 3/1/2016, complicated by postpartum hemorrhage status post D&C x2 for retained products of conception. PELVIS:UTERUS, ADNEXA: Anteverted uterus. It measures 12.4 x 8.2 cm in the sagittal plane.The endometrial cavity is dilated measuring 4.2 cm in the sagittal plane with heterogeneous low T1 weighted and intermediate and high T2-weighted luminal contents. Postcontrast images demonstrate a nodule of enhancement in the right aspect of the fundal endometrial cavity along the endometrial surface measuring 1.1 cm which is intrinsically T2 hyperintense (series 701/27). The adjacent myometrium demonstrates mildly heterogeneous hypo-enhancement. No intramural enhancing component is evident to suggest increta of residual placental tissue. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mildly heterogeneous postpartum uterus with a dilated endometrial canal containing a 1 cm focus of T2 hyperintensity which enhances on postcontrast images suggestive of retained products of conception. No significant intrinsic T1 weighted hyperintensity to suggest acute blood product. No intramural enhancing component is evident to suggest increta of residual placental tissue.


Instruction: Generate impression based on findings.

Input: Hypoglycemia (Persistent low blood sugars, without hx of diabetes). Evaluate for insulinoma. ABDOMEN:LIVER, BILIARY TRACT: Layering gallstones within the gallbladder without evidence of cholecystitis. The common bile duct is normal in caliber. There is a prominent 3.1 x 2.9 cm projection adjacent to the caudate lobe that follows signal intensity of the liver on all sequences, compatible with a papillary process of the liver, normal variant.SPLEEN: No significant abnormality noted.PANCREAS: There is an enhancing lesion within the pancreas that is T2 hyperintense and restricts diffusion measuring 2.5 x 1.9 cm (series 6, image 22). The pancreatic duct is not well-visualized, but is not grossly dilated.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: Left lower lobe atelectasis. Suggestion of trace bilateral pleural effusions.

Output: 1.Enhancing mass in the pancreas as described above, likely an insulinoma given clinical history.2.Cholelithiasis, without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Reason: r/o anatomic abnormality, space occupying lesion History: HA/AMS 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, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 57-year-old with biopsy proven DCIS in the left breast presents for MR-directed ultrasound of the left breast for an enhancing mass located posterior to the known DCIS in the recent MRI (12/8/2015). Focused ultrasound of the left breast at 12:00 position is performed. Detected is an irregularly shaped hypoechoic mass measuring 5 x 3 mm at 12:00 position, 4 cm from the nipple, likely corresponding to the enhancing mass seen on the MRI.

Output: MR-directed ultrasound of the left breast detected a sonographic correlate of the enhancing lesion at 12:00 position. Ultrasound-guided biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Headache on steroids, history of thrombosis. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged mild scattered foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRV: There is no evidence of cerebral venous thrombosis.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. Unchanged mild scattered foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic small vessel ischemic disease, for example. 2. No evidence of cerebral venous thrombosis.


Instruction: Generate impression based on findings.

Input: 80 year-old male postop day number 1 status post ex lap with distal subtotal gastrectomy now with delay status post fall with altered mental status and hit head. Negative LOC. Evaluate for acute process/bleed. There is no evidence of intracranial hemorrhage, mass or edema. MRI of the brain could be obtained if there remains clinical concern for acute ischemic disease. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Burn injury Humerus: A mild amount of edema is present within the lateral subcutaneous tissues of the mid humeral diaphysis. The underlying muscle signal and caliber is normal. The bone marrow signal of the humerus is normal.Forearm: No abnormal signal intensity is identified within the subcutaneous tissues or muscles of the forearm. The bone marrow signal of the radius and ulna are normal.Hand: A mild amount of edema is noted within the subcutaneous tissues overlying the dorsal first and second interspace and the volar aspect of the head of the metacarpal. The signal intensity of the hand musculature is normal. The bone marrow signal of the hand and wrist is normal.

Output: A minimal amount of subcutaneous edema overlying the lateral soft tissues of the humerus and along the volar and dorsal aspect of the first second metacarpal. The signal intensity of the bone marrow and musculature of the upper extremity is normal.


Instruction: Generate impression based on findings.

Input: Pain in the sacral area and left hip BONE MARROW: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.

Output: Negative pelvic MRI. Specifically no imaging abnormalities in the sacrum or left hip


Instruction: Generate impression based on findings.

Input: 42-year-old female with lateral knee pain, rule out meniscal tear MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The bone marrow signal is within normal limits. The articular cartilage of the patellofemoral and tibiofemoral joints is intact.LIGAMENTS: The ACL is intact, although there appears to be slight laxity of the fibers which may in part be due to positioning. The PCL is intact. The MCL and LCL are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal.ADDITIONAL

Output: Intact menisci, cruciate and collateral ligaments with questionable minimal laxity of the ACL. Please correlate to the patient's physical exam.


Instruction: Generate impression based on findings.

Input: 89 years Female (DOB:11/16/1926)Reason: eval for organic causes of seizure PROVIDER/ATTENDING NAME: TIEN S DONG EVAN H. LYON The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are several punctate foci of susceptibility effect and subcortical white matter predominantly in the right hemisphere. Additional punctate foci of signal hypointensity on susceptibility imaging are identified in the cerebellum and left internal capsule.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some scattered punctate foci of signal hyperintensity are present in the brainstem.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 partial opacification of the right maxillary sinus with a small air-fluid level. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a moderate degree and a few punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 2.No evidence for acute cerebral ischemic infarction.3.No abnormal enhancing mass lesion is appreciated within the brain parenchyma to explain patient's seizures.4.Multiple microhemorrhages in the right hemispheric subcortical white matter and cerebellum are nonspecific in distribution.5.Examination is somewhat compromised due to patient motion artifact which may obscure more subtle abnormalities6.Opacification of the right maxillary sinus with a small air-fluid level is present most likely is inflammatory in nature. The possibility of a superimposed acute sinusitis cannot be excluded. Another possibility is that this represents retained secretions. Please correlate with clinical symptoms.


Instruction: Generate impression based on findings.

Input: 75-year-old male with abdominal bloating, pancreatic tail cyst ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense cysts are noted throughout the liver, some of which are subcentimeter, likely reflecting benign cysts.The gallbladder is contracted.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstrated are T2 hyperintense cystic lesions in the head, body and tail of the pancreas. Multilobulated cystic lesion in the tail of pancreas measures approximately 2.8 x 2.2 cm (series 4, image 25), previously 2.1 x 1.8 cm. There is intrinsic T1 hyperintense material layering within the cystic lesions. There is a septated cystic focus in the body of the pancreas measuring 1.3 x 1.3 cm (series 4, image 29). There is a T2 hyperintense cystic lesion in the head of the pancreas.Additional T2 hyperintense foci communicating with the main pancreatic duct are compatible with sidebranch type IPMN and/or side branch ectasia. There is no abnormal enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense cysts in the right kidney not significantly changed when compared to CT dated 11/21/2012. Subcentimeter T2 hyperintense cysts are noted in the left kidney. No hydronephrosis or perinephric inflammation.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.Cystic lesions in the head, body and tail of the pancreas demonstrating communication with the main pancreatic duct compatible with sidebranch type IPMN. There has been interval increase in size of the lesion in the tail when compared to CT 11/21/2012. No abnormal enhancement is present.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with posterior headache for two months, history of meningoencephalitis, history of low-grade B-cell lymphoma. Assess for infection, vasculitis, CNS lymphoma. Innumerable punctate foci of susceptibility are seen scattered through the cerebral hemispheres with a fairly symmetric distribution and a frontal lobe predominance. Prior exams did not included susceptibility-weighed images, so assessment for interval changes cannot be made. Also seen is a relatively small number of scattered foci of T2 hyperintensity involving the cerebral white matter. These are predominantly subcortical, though the anterior right corpus callosum is also involved. None of the above lesions is associated with significant edema or mass effect. The T2 hyperintense lesions have significantly improved from the exam of 4/26/15, and appear relatively similar to the exam of 5/10/15. No evidence of any pachymeningeal or leptomeningeal enhancement is seen. No large parenchymal enhancing lesions are seen. There is a punctate focus of enhancement in the right superior frontal gyrus (image 286 series 1201), and another associated with a right frontal white matter T2 lesion (image 234 series 1201). There may also be subtle speckled enhancement associated with the anterior right corpus callosum.No definite restricted diffusion is seen. No acute intracranial hemorrhage or any pathologic extra-axial fluid collection is evident. The ventricular system is normal in size and morphology.Bone marrow signal is within normal limits. Mucosal thickening is evident in the right sphenoid sinus. Multiple enlarged lymph nodes are seen in the visualized neck soft tissues.

Output: Since the prior exam obtained in April, 2015, the size and number of scattered T2 hyperintense white matter lesions in the cerebral hemispheres have significantly diminished. Relatively few lesions persist on the current exam, and these are largely subcortical with the exception of the right corpus callosum, and they exert no mass effect. Susceptibility imaging was not performed on the prior studies, but on today's exam, there are innumerable punctate foci of susceptibility indicating chronic microhemorrhage distributed relatively symmetrically in the cerebral hemispheres, with preference for the frontal lobes. There also appear to be a few small foci of enhancement as described above, some of which are associated with T2 lesions. The appearance and distribution of the findings necessitate a fairly broad differential diagnosis including the sequelae of prior infection (perhaps viral), post-infectious or immune mediated inflammation, and especially a primary or secondary CNS vasculitis. Presence of innumerable microhemorrhages argues against demyelinating disease. The findings are distinctly uncharacteristic for primary CNS lymphoma. The possibility of intravascular (angiocentric) lymphoma would, however, be a reasonable consideration as this condition can mimic vasculitis on imaging.


Instruction: Generate impression based on findings.

Input: Status post transanal endoscopic microsurgery in 11/13 to remove an invasive adenocarcinoma, comp located by abscess formation, please evaluate tumor presence in the rectum PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BOWEL, MESENTERY, LYMPH NODES: Linear T1 hypointense/T2 hyperintense structure near right rectum that crosses midline, thin somewhat stellate configuration, given these characteristics most likely minimal free fluid (coronal image 11 series 9), image 11 series 8 and image 11 series 13. No enlarged mesorectal or inguinal lymphadenopathy seen otherwise. No enhancing rectal lesion seen. BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No enlarged pelvic or inguinal lymphadenopathy seen.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: seizure History: seizure hx of cancer of colon cancer on chemo, w/ mets to liver lung, breast The exam was incomplete since the patient developed a seizure within the MR scanner. Therefore, limited examinations including diffusion-weighted sequence, susceptibility imaging sequences and T1 axial and sagittal imaging were obtained.There is no evidence of acute ischemic or hemorrhagic lesion.T1 axial and sagittal scan do not show any structural abnormalities.Ventricular system is unremarkable.

Output: No evidence of acute ischemic or hemorrhagic lesion.Incomplete examination due to developing seizure during the examination.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with seizures. Functional mapping for presurgical evaluation is requested. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Primary visual cortical activity maps along the calcarine sulci.All tested language paradigms produced reliable language related cortical activation. Language is left dominant. The putative Broca's area is identified within the left inferior frontal gyrus. The putative Wernicke's area is identified along the posterior aspect of the left superior temporal sulcus.

Output: Technically successful functional MRI for cortical mapping of sensorimotor, visual and language functionality.


Instruction: Generate impression based on findings.

Input: Neck pain and increased clumsiness in her hands, as well as gait instability concerning for cervical myelopathy. There is multilevel degenerative spondylosis. At C2-3, there is a small right facet spur that slightly encroaches upon the neural foramen. At C3-4, there is facet and uncovertebral hypertrophy result in moderate to severe bilateral neural foraminal stenosis. A small posterior disc-osteophyte does not significantly narrow the spinal canal. At C4-5, there is on significant neural foraminal or spinal canal stenosis. At C5-6, there is severe bilateral neural foraminal stenosis due to facet and uncovertebral hypertrophy. A small posterior disc-osteophyte mildly effaces the anterior thecal cerebrospinal fluid space. At C6-7, there is bilateral facet and uncovertebral hypertrophy that results in moderate left and mild right neural foraminal narrowing. A small posterior disc-osteophyte mildly effaces the anterior thecal cerebrospinal fluid space. At C7-T1, there bilateral neural foramina are mildly effaced by facet joint hypertrophic changes. There is no spinal cord compression or signal abnormality in the cervical spine. The vertebral body heights are preserved. There is no significant spondylolisthesis. The vertebral bone marrow signal is unremarkable. The paraspinal soft tissues are unremarkable.

Output: Multilevel degenerative spondylosis, as described in the findings section, but no evidence of spinal cord lesions.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of lower lobe, right bronchus or lung [C34.31], Reason for Study: ^Reason: newly diagnosed squamous cell cancer of the lung , eval for mets History: none No evidence of acute ischemic or hemorrhagic lesion on scan.There is well enhancing, slightly expansile T1 low, T2 high skull lesion (5.9 mm x 11.3 mm x 11.8 mm) at the left parietal bone. This is a new lesion comparing to prior scan.There is no associated soft tissue mass lesion. There is no definitive evidence of inner or outer table disruption. Considering the patient's clinical history and interval development, differential diagnosis include metastatic lesion. Other differential diagnosis include benign lesions such as epidermoid cyst.Underlying brain shows patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating non specific small vessel ischemic disease, progressed since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cysts were seen within left maxillary sinus and bilateral posterior ethmoid sinuses.

Output: 1. Left parietal skull lesion with enhancement. Differential diagnosis include metastatic lesion and epidermoid cyst. Head CT scan may be useful for additional imaging evaluation.2. Non specific small vessel ischemic disease.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:6/5/1961)Reason: Re-evaluate for disease progression- known history of brain metastases with recent falls History: Stage IV melanoma with recent fallsPROVIDER/ATTENDING NAME: JASON JOHN LUKE JASON JOHN LUKE The patient status post right parietal craniotomy.There are numerous foci of the susceptibility effect scattered in both hemispheres of the brain and in the cerebellum without any significant contrast enhancement. Compared to the previous exam these do not appear to have changed one in the left parietal lobe currently measures 5 mm and previously measured the same.The patient is status post right-sided parietal craniotomy. There is encephalomalacia present along the right inferior parietal lobule extending to the right temporal lobe associated with susceptibility effect.There is redemonstration of diffuse periventricular and subcortical white matter confluent signal changes which were also present on the previous exams to a similar extent.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacities in the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.There are multiple hemorrhagic type lesions scattered throughout the brain which appear relatively stable compared to the exam from July. The patient is known to have metastatic melanoma to the brain.2.Extensive and diffuse white matter signal changes have been present on prior exams and are most likely treatment related.


Instruction: Generate impression based on findings.

Input: Reason: r/o neuropathy History: new onset hyperreflexia The brain parenchyma appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: Normal MRI brain.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 16 year old male with known hypertrophic cardiomyopathy and family history of sudden cardiac death. A recent echocardiography showed hyperdynamic left ventricular function, severe asymmetric hypertrophy, no left ventricular outflow tract gradient despite a mild systolic anterior motion of the anterior leaflet of the mitral valve was noted. Referred Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 95 ml/m2 (normal range: 74+/-15), the LVEDV is 190 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 100 g/m2, and the LV mass is 199 g. There is severe asymmetric hypertrophy, while the maximal thickness was measured at the anterior basal septum (26mm). There is minimal flow acceleration at the left ventricular outflow tract and there is no SAM (systolic anterior movement of the anterior leaflet of the mitral valve). There are no regional wall motion abnormalities present, but myocardial deformation is abnormal within the hypertrophied segments. There are two focal areas of late gadolinium enhancement, one in the basal-to-mid segments of the inferior wall and the second one in the mid segment of the anterior wall in a patchy pattern at the insertion points. Based on the full-width half maximum technique, 5-10% of the to myocardial mass has late gadolinium enhancement. Both enhancements are non-transmural and are atypical for myocardial infarction. These enhancements suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-times are diffusely increased, while the maximal times were noted at the septum and at the mid segments of the inferior wall (~1150-1200ms). No myocardial iron overload. No intracavitary thrombus.Left AtriumThe left atrium is normal in size (87ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 168 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. the LVEF is 67%. There is severe asymmetric hypertrophy, with a maximal thickness of 26mm at the anterior basal septum. 5-10% of the myocardial mass has evidence of late gadolinium enhancement, likely due to underlying fibrosis.2. The native myocardial T1-times are diffusely increased, while the maximal times were noted at the septum and at the mid segments of the inferior wall (~1150-1200ms), also suggesting the presence of underlying myocardial fibrosis. 3. The right ventricle is normal in size and systolic function, the RVEF is 52%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Difficulty walking. Cerebral palsy, diplegic. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse paucity of periventricular white matter in the bilateral cerebral hemispheres, particularly posteriorly, with corresponding marked thinning of the posterior corpus callosum and prominence of the posterior lateral ventricles. In addition, there is associated generalized diminished white matter volume extending more peripherally into the posterior cerebral hemispheres, resulting in relatively prominent sulci. There is also diffuse T2 hyperintensity in the periventricular white matter bilaterally. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The posterior fossa contents are unremarkable. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening of the maxillary and ethmoid sinuses.

Output: Findings compatible with periventricular leukomalacia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 24-year-old female with a history of inflammatory arthritis complains of persistent right foot pain with activity. No swelling/stiffness. The flexor tendons appear intact. The extensor tendons appear intact. The peroneal tendons appear intact. The achilles tendon is within normal limits. The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The visualized components of the deltoid ligament appear intact. There is mild nonspecific increased signal abnormality within the posterior talus. The remainder of the bone marrow signal is within normal limits. The imaged musculature is within normal limits. There is no pathologic enhancement on post contrast sequences. There are no focal fluid collections to suggest abscess formation. There is a small amount of fluid within the tibiotalar joint without evidence of a large effusion.

Output: No erosions or other findings of inflammatory arthritis are evident. Mild increased bone marrow signal abnormality within the posterior talus is nonspecific but can be seen in flexor hallucis longus tendinosis.


Instruction: Generate impression based on findings.

Input: NECK: There are extensive postoperative findings related to right orbital and sinonasal exenteration with myocutaneous flap reconstruction. There is no measurable tumor in the roof of the left posterior nasopharynx along the surgical margin. The previously demonstrated punctate right temporal scalp subcutaneous tissues nodule, the right temporal fossa enhancing lesion and right squamosal temporal bone calvarial lesion with extension into the overlying scalp are also no longer discernible. The right mandibular body lesion has not significantly changed in size, measuring up to 18 mm. There is unchanged asymmetric enhancement diffusely in the right foramen rotundum, without appreciable mass effect. There are persistent obstructed secretions in the frontal and sphenoid sinuses and mucosal thickening and fluid in the left maxillary sinus. There is nonspecific high T2 signal in the bilateral mastoid air cells. There is no evidence of significant lymphadenopathy in the upper neck. The salivary glands appear unchanged.BRAIN: There is a new lobulated peripherally enhancing lesion in the anterior right temporal lobe measuring up to 33 mm with extensive surrounding vasogenic edema and mild uncal medialization, partial effacement of the right lateral ventricle and midline shift to the left, measuring approximately 2 mm. There are otherwise unchanged scattered T2 hyperintensities in the subcortical and periventricular white matter, which are nonspecific. There are no other enhancing intracranial lesions.

Output: No measurable residual tumor in the left posterior nasopharynx along the surgical margin and in the right scalp and skull, but unchanged mandibular body metastasis.Persistent mild asymmetric enhancement in the right foramen rotundum may be post-treatment in nature.Interval development of what likely represent radiation necrosis in the anterior right temporal lobe, with extensive vasogenic edema. Otherwise, no evidence of brain metastases.4. Findings suggestive of acute left maxillary sinusitis with otherwise persistent obstructed secretions adjacent to the exenteration flap.


Instruction: Generate impression based on findings.

Input: Suspicious left mid pole lesion seen on prior ultrasound. History of heart transplant. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. Several subcentimeter simple cysts are noted. No intrahepatic biliary ductal dilatation. Partially contracted gallbladder with numerous small gallstones. No extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. Subcentimeter punctate cystic lesions in the pancreas. The pancreatic duct is normal in caliber. These likely reflect small sidebranch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal mid/upper lesion measuring 2.0 x 1.8 cm (series 10/25), demonstrating mild post-contrast enhancement (series 100, image 118), suspicious for renal cell carcinoma. Several simple and minimally complex renal cysts are present. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild gynecomastia.OTHER: No significant abnormality noted.

Output: Left renal mid/upper 2.0 cm lesion suspicious for renal cell carcinoma, possibly papillary type.Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of ESRD, diabetes, hypertension left meningioma status post resection in 2005. New mental status changes Postoperative changes of left frontal -- parietal craniotomy for removal of meningioma is again demonstrated. Residual vasogenic edema/encephalomalacia remains stable since prior study.No evidence of any new area of hemorrhage or edema is detected. No evidence of hydrocephalus.Further evaluation with an MRI is recommended to determine recurrence or residual tumor.

Output: Stable exam since prior study.


Instruction: Generate impression based on findings.

Input: Reason: rule out worsening spinal stenosis History: bowel incontinence, weakness, pain There are 4 nonrib bearing lumbar vertebrae with sacralization of L5. For the purposes of this dictation, consistent with prior reports, the lowest visualized intervertebral disc space is labeled L4-S1.Vertebral body heights are within normal limits. Minimal anterolisthesis of L2 relative to L3. Minimal retrolisthesis of L3 relative to L4. Multilevel disc desiccation with disc space loss at L4-S1. Mildly increase STIR signal at L4-S1 is similar to the prior exam and likely degenerative. Mild prominence of the epidural fat is unchanged. No abnormal signal within the cord or conus which ends at L1.T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. Mild ligamentum flavum hypertrophy and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Diffuse disc bulge with uncovering of the disc and superimposed central extrusion extending 8 mm superiorly which is decreased and posterior extent from the prior exam. Moderate ligamentum flavum thickening and facet arthropathy, left greater than right. Moderate spinal canal stenosis is improved from the prior exam. Mild bilateral neural foraminal stenosis is unchanged.L3-L4: Diffuse disc bulge with uncovering is unchanged. Moderate ligamentum flavum thickening and facet arthropathy is unchanged. Mild spinal canal stenosis is unchanged. Moderate left and mild right neural foraminal stenosis is unchanged.L4-S1: Diffuse disc bulge, asymmetric to the right, is unchanged. Mild facet arthropathy and ligamentum flavum thickening is unchanged. No significant spinal canal stenosis. Narrowing of the right lateral recess with impingement of the descending right S1 nerve root is unchanged. Moderate bilateral neural foraminal stenosis is unchanged.Paraspinous soft tissues are within normal limits. Small left renal cyst.

Output: 1. Transitional lumbosacral anatomy as detailed above. If surgery is to be contemplated, correlation with imaging of the entire spine is recommended.2. Multilevel degenerative changes with significant improvement in spinal canal stenosis at L2-L3. Additional degenerative disc disease and neural foraminal narrowing is unchanged.


Instruction: Generate impression based on findings.

Input: Low back pain and radicular symptoms Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disk bulge. No spinal canal or neural foraminal stenosis.L4-L5: Dorsal annular fissure with minimal central disk protrusion. No spinal canal or neural foraminal stenosis.L5-S1: Dorsal annular fissure and central disk protrusion. There is partial effacement of the subarticular zones, left greater than right. No central spinal canal stenosis. Mild bilateral neural foraminal stenosis. Mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits. There is an approximately 3.2 x 2.5 cm lesion involving the uterine wall with low T1 and T2 signal.

Output: 1. Mild degenerative changes with small disk protrusions at L4-L5 and L5-S1. There is effacement of the subarticular zone at the L5-S1 level which contacts the descending left S1 nerve root. There is no significant central canal stenosis at any level. There is mild bilateral neural foraminal narrowing at L5-S1; otherwise, no significant neural foraminal stenosis. 2. Mild facet arthropathy at L5-S1 which may be contributing to patient's low back pain.3. Partially visualized 3.2 x 2.5 cm lesion involving the uterus may represent a fibroid, consider ultrasound for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer to brain with recent increase in symptoms: Lightheadedness, blurry vision, nausea, and headache. There are postoperative findings related to right parietal lobe tumor resection with unchanged predominantly nonspecific enhancement along the margins and surrounding confluent T2 hyperintensity. There is interval decrease in size of the left cerebellar hemisphere enhancing tumor with susceptibility effect, which measures 11 x 15 mm in axial cross-section, previously 17 x 22 mm. There are small developmental venous anomalies in the left cerebellar hemispheres and right superior frontal gyrus. There are a few unchanged scattered foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits are grossly unremarkable. There is an unchanged subcentimeter T1 hyperintense focus in the right parietal calvarium, which likely represents a hemangioma.

Output: 1. Postoperative findings related to right parietal lobe tumor resection with unchanged nonspecific enhancement along the margins, which may represent granulation tissue versus less likely recurrent tumor.2. Interval decrease in size of the left cerebellar hemisphere metastasis.


Instruction: Generate impression based on findings.

Input: Reason: Please evaluate large intramuscular plexiform neurofibroma in left thigh; is it attached to a major nerve? History: young woman with NF1 who has developed a rapidly growing mass in left thigh Within the semitendinosus muscle of the left thigh, is a lobulated mass which demonstrates homogeneously low T1 signal and heterogeneously high T2 signal with intermediate T2 signal internally, consistent with an atypical peripheral nerve sheath tumor. The mass measures approximately 3.6 x 2.3 x 4.7 cm (transverse by AP by CC) and demonstrates heterogeneous enhancement. The lesion does not appear to originate from the major neurovascular bundle in the posterior thigh.A second presumed peripheral nerve sheath tumor is present adjacent to the right gluteal muscles, seen only on the AP coronal view, but is incompletely evaluated.

Output: Peripheral nerve sheath tumor within the left semitendinosus muscle, which does not appear to originate from the major neurovascular bundle in the posterior thigh. However, atypical appearance on T2 and post gadolinium imaging raises concern for the possibility of a malignant nerve sheath tumor, and clinical correlation is advised.


Instruction: Generate impression based on findings.

Input: 56 year old woman with history of asthma, possible remote intraoperative myocardial infarction who presents with palpitations, and shortness of breath. Cardiac MRI is done toe valuate for ischemia and presence of infarct MEDICATIONS: albuterol, amlodipine, atorvastatin, hydrochlorathiazide, gabapentin 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 58%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 137 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 57 ml (normal range 31+/-10), the LV mass index is 38 g/m2, and the LV mass is 71 g. There are no regional wall motion abnormalities present. 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 55%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 150 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 68 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.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 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. 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 58%).4. Normal RV size and systolic function (RVEF 55%).


Instruction: Generate impression based on findings.

Input: 43 yo female with left breast 12 o'clock position breast cancer with possible intraductal extension on ultrasound. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Within the left breast 1 o'clock position, mid depth there is an irregular mass with associated postbiopsy changes and metallic artifact from a marker clip, corresponding with patient's known biopsy proven breast cancer. This mass measures 18 x 18 x 20 mm (AP x TR x CC). Approximately 26 mm inferior to the index mass, there is an additional enhancing mass measuring 7 x 4 x 5 mm (AP x TR x CC). Measuring both masses, entire extent of disease is 45 mm in the craniocaudal dimension.No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1.Mass in the left 1 o'clock position, corresponding with patient's known biopsy proven cancer. 2.Additional smaller mass inferior to the index mass, for which MRI-directed ultrasound and possible biopsy is recommended. 3.No abnormal enhancement in the right breast.4.No abnormal lymph nodes in either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is an area of focal full-thickness cartilage defect involving the femoral trochlea centrally with degenerative cystic changes underlying the defect. Heterogeneous signal within the patellar cartilage likely reflects degenerative change and may be a small partial-thickness defect of the medial femoral condyle. The articular cartilage of the lateral and patellofemoral compartments is intact.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Full-thickness cartilage defect of the femoral trochlea centrally with additional degenerative changes noted in the patellofemoral articulation. The remaining articular cartilage of the medial lateral compartments is intact.2. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9], Reason for Study: ^Reason: assess vasculature, space occupying lesion? Cerebellar? History: see MRA Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickenings on frontal, ethmoid and sphenoid sinus.Brain MRAMotion artifacts degraded image quality significantly.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. No evidence of occlusion or luminal stenosis on bilateral distal ICAs, MCAs, ACAs and vertebrobasilar system. Medium to small vessels (distal to the MCA M1 segment for example) cannot be evaluated with this scan. No evidence of intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial arterial major artery occlusion. No evidence of intracranial arterial aneurysm. Comment: if precise evaluation of intracranial arterial system is clinically indicated, CTA of head can be considered.


Instruction: Generate impression based on findings.

Input: Reason: 14 year old with intractable migraines s/p LP presenting with back pain, neck pain: please evaluate for focal defect History: Back pain, neck pain, headache, photo/phonophobia The craniocervical junction appears within normal limits. Vertebral body heights in the cervical, thoracic, and lumbar spine are normal. Disc spaces are preserved. Alignment is maintained. No evidence of epidural hematoma or fluid collections in the paraspinous soft tissues are appreciated. No cord signal abnormality. There is diffuse engorgement of the epidural venous plexus in the cervical, thoracic, and lumbar spine. No significant spinal canal or neural foraminal stenosis is appreciated. Paraspinous soft tissues are grossly unremarkable.

Output: No findings to suggest epidural hematoma or fluid collection in the paraspinous tissues to suggest a CSF leak. No significant spinal canal stenosis. There is diffuse prominence/engorgement of the epidural venous plexus in the cervical, thoracic, and lumbar spine which can be seen post lumbar puncture/with intracranial hypotension. Brain MRI can be considered as clinically indicated although no evidence of brain sagging based on the limited visualization of the posterior fossa.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastases to lumbar spine, evaluate disease in cervical spine. Signs and symptoms: As above. Nonenhanced cervical MRI:Patient was unable to continue with exam after a suboptimal sagittal T1 and T2-weighted series were acquired. No intravenous contrast was given.This very limited and suboptimal study demonstrate normal anatomical alignment of vertebral column however with mild reversal of cervical lordosis. No evidence of fracture or malalignment and no definitive evidence of metastatic lesion on the acquired images. There is no evidence of a spinal canal compromise at any level. The signal intensity of the cord cannot be assessed due to extensive motion artifact however the caliber of the cord remains within normal and there is no detectable mass effect on the cord.

Output: 1.Limited nonenhanced exam is performed due to patient's inability to continue.2.No convincing evidence of metastatic lesion or mass effect on the cord.3.Consider repeat exam when patient's condition permits.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:10/28/1950)Reason: status epilepticus History: first seizure in patient with known vasculopathy, HTN and multiple lacunar infarctsPROVIDER/ATTENDING NAME: FERNANDO D GOLDENBERG AGNIESZKA ANNA ARDELT MRI of the brainA punctate focus of diffusion restriction is present in the left frontal lobe .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are small foci of T2 and FLAIR signal hyperintensity present in the thalami, basal ganglia and the brainstem.There are multiple punctate foci of signal loss on susceptibility weighted imaging present in the thalami, basal ganglia and brainstem and cerebellar hemispheres.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is not readily identified on this exam.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very small. MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The left vertebral artery is occluded proximally and reconstituted through collaterals distally.The right vertebral artery has a 60% stenosis at its origin

Output: 1.Occlusion of the left vertebral artery. 2.60% stenosis at the origin of the right vertebral artery.3.Acute microinfarct in the left frontal lobe 4.Old lacunar infarcts in the basal ganglia, thalami and brainstem5.There is a mild to moderate degree of microhemorrhages in the deep gray nuclei and posterior fossa structures was pattern is suggestive of hypertensive microhemorrhages.6.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Redemonstrated is mild levorotoscoliosis with its apex centered at approximately L3. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. Other than a right simple renal cyst, the visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present throughout from L2 through S1. Disc height loss is noted at is: significant at L2/3, mild at 3/4, moderate at L/5, and mild at L5/S1. Mild edematous discogenic reactive endplate changes (Modic type I) are evident at L2/3 and L4/5.Redemonstrated is posterior scalloping of the T11 and T12 vertebral bodies with CSF signal intensity extending into the left neural foramen at the T11-T12 foramen and extending along the leftward epidural space. These findings are unchanged in appearance and are thus felt to represent benign change, given the 7 year stability.At the L1-L2 level, bilateral neural foramen are patent without evidence of central canal stenosis, unchanged. At the L2-L3 level there is new asymmetric bulge to the right, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy with mild right neural foraminal stenosis.At the L3-L4 level there is new mild disc bulge, however the bilateral neural foramen and central canal remain patent without evidence of stenosis. At the L4-L5 level there are new changes as follows: Large right foraminal/lateral disc extrusion with associated free fragment posterolaterally effacing the adjacent nerve roots, central disc protrusion, mild disc bulge, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is mild central, mild bilateral lateral recess, and severe right lateral neural foraminal stenosis.At the L5-S1 level, bilateral neural foramen are patent without evidence of central canal stenosis. Facet osteoarthritis seen in the left greater than right at this level. In the left lateral aspect of the disc there is high signal compatible with an annular tear. These findings are unchanged.

Output: 1.At the L2-L3 level there is new asymmetric bulge to the right with mild right neural foraminal stenosis.2.At the L4-L5 level there are new changes as follows: Large right foraminal/lateral disc extrusion with associated free fragment posterolaterally effacing the adjacent nerve roots, central disc protrusion, mild disc bulge, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is mild central, mild bilateral lateral recess, and severe right lateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Yearly follow-up of swan-neck deformity, Ehler- Danlos syndrome Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is reversal of cervical lordosis centered at the C5-C6 level which straightens in the extension position. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc bulge. No significant compromise to the spinal canal or neural foramina.C4-5: Minimal disc bulge and disc desiccation. No significant compromise to the spinal canal or neural foramina.C5-6: There is partial effacement of the ventral thecal sac related to the reversal of cervical lordosis and minimal bulge. Disc desiccation. No significant compromise to the spinal canal or neural foramina.C6-7: Minimal disc bulge and disc desiccation. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No significant spinal canal stenosis or neural foraminal stenosis at any level in the cervical spine. No cord signal abnormality.2. Kyphotic angulation at the C5-6 level, which straightens in the extension position, is unchanged.