Instruction: Generate impression based on findings.

Input: There is redemonstration of small focus of evolving restricted diffusion in the right inferior parietal lobe, that measures 12 mm and a punctate lesion of restricted diffusion in the left inferior parietal lobe. Additional focus of restricted diffusion is also visualized within the subcortical white matter of the right pre-cuneus and within the pons. These foci are unchanged since the previous study and are associated with hyperintensity in the T2/FLAIR sequences.. There are no new foci of restricted diffusion.There are T2/FLAIR hyperintensities in the pons and in the right middle cerebral peduncle with no restricted diffusion, unchanged since the previous study. There are punctate foci of T2/FLAIR hyperintensities in the periventricular and subcortical white matter representing chronic small vessel ischemic changes.Again noted diffuse punctate susceptibility signals throughout the brain, likely representing hemosiderin deposition. The pattern is suggestive of amyloid angiopathy.There is diffuse leptomeningeal FLAIR hyperintensity which may suggest meningoencephalitis, encephalitis, or vasculitis.Ventricular size is stable. No evidence of acute hemorrhage. Basal cisterns are patent. The T2 flow-voids are unremarkable.There is diffuse edema in the visualized cervical spinal cord.There is mucosal thickening in the maxillary sinuses and opacities in the mastoid air cells, most likely due to the patient being intubated.

Output: 1.A small focus of infarction in the right inferior parietal lobule and microinfarcts in the right and left parietal lobes are stable and compared to the prior exam.2.Findings suggest a leptomeningeal disease. Differential considerations include meningoencephalitis, encephalitis, or vasculitis.3.Diffuse edema in the visualized spinal cord extends to the lower medulla.4.Multiple microhemorrhages are identified in subcortical white matter with a pattern of distribution suggestive of amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: 81 years, Female, with memory loss. FLAIR sequences and diffusion weighted imaging are significantly technically degraded. No intracranial hemorrhage. No intracranial mass or mass-effect. Mild global brain parenchymal volume loss including bilateral hippocampi is noted. Several foci of T2 hyperintensity are also noted in the bilateral subcortical and periventricular white matter as well as more confluent areas of T2 signal abnormality in the pons, which are nonspecific, but compatible with chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Bilateral ocular lens replacements are noted. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Slightly limited examination due to technically degraded FLAIR sequence. The patient will be asked to return for repeat sequence at no additional charge.1. No evidence of intracranial hemorrhage, mass or mass effect.2. Mild global brain parenchymal volume loss including bilateral hippocampi.3. Foci of increased T2 hyperintensity in the supratentorial white matter and pons are nonspecific, but likely related to chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 84 years, Female, severe dizziness. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. High-resolution images of the temporal bones specifically demonstrate no mass involving the cerebellopontine angles or internal auditory canals. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Punctate foci of susceptibility effect are seen in the right occipital lobe and in the right cerebellar hemisphere which are compatible with chronic microhemorrhages. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Bone marrow signal and remainder of the extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct, intracranial mass, or abnormal enhancement to explain patient's symptoms.2. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Minimal degenerative changes are seen including small disc osteophyte complex at the C6-C7 level, as well as mild ligamentous flavum thickening at the C4-C5, C5-C6, and C6-C7 levels. There is very mild spinal canal stenosis at the C6-C7 level. There is otherwise no significant spinal canal or neural foraminal stenosis at any level.THORACIC SPINE

Output: 1. There is an expansile enhancing lesion, highly suspicious for metastasis, involving the T6 spinous process which extends into the lamina and minimally into the dorsal epidural space. There is no significant spinal canal stenosis at this level. Bone scan or PET may be helpful to identify additional osseous metastatic foci, but are not appreciated on the current study.2. Degenerative changes in the mid to lower lumbar spine without significant spinal canal stenosis at any level. There has been mild progression of these changes since prior lumbar spine MRI from 10/22/2012. Please see additional details of the degenerative findings above including neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with bilateral lower extremity paresthesias. Brain:Image quality is reduced by motion artifact on several sequences. Within this limitation, no evidence of significant parenchymal edema, mass effect or restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is seen. Relatively few scattered small foci of nonspecific FLAIR hyperintensity are seen within the cerebral parenchyma. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.Lumbar spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement, edema or abnormal enhancement is seen. The visualized distal spinal cord shows normal signal intensity and morphology. The nerve roots of cauda equina are unremarkable. No pathologic intrathecal enhancement is observed. No epidural lesions are detected. A renal cyst is evident on the right.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. L4-5: Facet arthropathy. Minimal disc bulging with a central annular fissure. No significant spinal canal stenosis. Mild left foraminal narrowing. L5-S1: Facet arthropathy. Loss of disc height and disc bulging asymmetric to the left. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: 1.A few scattered small foci of nonspecific signal abnormality are evident in the cerebral parenchyma. No specific intracranial findings are seen which would account for the patient's symptoms.2.Relatively mild degenerative findings are noted in the lumbar spine. There are no areas of high-grade spinal canal stenosis. Mild to moderate foraminal narrowing is evident as above.


Instruction: Generate impression based on findings.

Input: 79 years, Female, memory impairment, increasing dementia. No restricted diffusion to suggest acute ischemia. There is chronic infarct involving the left MCA territory primarily involving the left middle and inferior frontal gyri, which was seen on prior study from 2013 with interval evolution. There is susceptibility effect within this region which may be related to small amount of chronic blood products and/or mineralization. Additional chronic cortical bilateral occipital infarcts are again seen. There is a chronic appearing left parietal infarct which was not present previously. There is encephalomalacia involving the right inferior temporal lobe, predominantly involving the fusiform gyrus, which may also be related to prior ischemia versus other injury and present previously. There is associated ex vacuo dilatation of the right temporal horn which is unchanged. There is also suggestion of a small right cerebellar infarct not clearly evident on prior study. Scattered foci of T2/FLAIR hyperintensity are also seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes and similar to prior. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. Global parenchymal volume loss is again evident and appropriate for patient's age. No disproportional volume loss involving the hippocampi. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Mild mucosal thickening involving the right maxillary, right sphenoid, and bilateral anterior ethmoid sinuses. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Multiple cortical infarcts in the bilateral cerebral hemispheres are again seen. A left parietal lobe infarct and small right cerebellar infarct appear chronic but are new since 5/3/2013. 2. No intracranial mass or mass effect. No hydrocephalus. Global parenchymal volume loss appears age-appropriate.


Instruction: Generate impression based on findings.

Input: Right lower extremity radiculopathy 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 in the lumbar spine is benign. Sagittal images demonstrate a round lesion with low T1 and T2 signal involving the T11 vertebral body, which is not incompletely evaluated. The conus medullaris is normal in position.Individual levels 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: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is a small posterior annular fissure with small central disc protrusion. No significant spinal canal or neural foraminal stenosis.Multiple small perineural cysts are incidentally noted. Paraspinous soft tissues are within normal limits.

Output: 1. There is no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine. 2. Small central disc protrusion at L5-S1, which was present on prior MRI hip study from 7/30/2015.3. Partially imaged approximately 1 cm T11 vertebral body lesion is nonspecific.


Instruction: Generate impression based on findings.

Input: 72-year-old female with HCV cirrhosis status post TACE/RFA of HCC. Evaluate for recurrence ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology. Posttreatment changes from segment 5 TACE/RFA without residual arterial nodular enhancement or washout. Again noted is rim enhancement ablation cavity consistent with hyperemia.Unchanged segment 6 hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: Unchanged T2 hyperintense lesion within the uncinate process of the pancreas, likely a side branch IPMN and measures 9 x 8 mm. No evidence of pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes are again noted, stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post procedure changes of ablation of segment 5 HCC without measurable arterial enhancement or washout to suggest recurrent or residual tumor.2.Cirrhotic liver morphology.


Instruction: Generate impression based on findings.

Input: 44 year old female with stroke. Non-infused CT of brain.A focal area of lucency in the white matter of left frontal lobe extends from the level of floor of the anterior cranial fossa superiorly to the high convexity. This produces no definitive evidence of mass effect and is believed to represent an area of encephalomalacia. No definitive evidence of any cortical component is detected. There are no old films available for comparison. The size and distribution of this lesion is unusual for a subcortical stroke. Further evaluation with an MRI is recommended. CT examination of brain is otherwise unremarkable.CTA of the neck.There is good visualization of bilateral common carotid arteries, carotid bifurcations and bilateral internal carotid arteries in the cervical region. No evidence of any stenosis at any of these locations is detected.A dominant right vertebral artery and slightly smaller left vertebral artery is demonstrated and appear normal throughout their course and across the skull base. No pathology is Limited images of the aortic arch and the origins of the great vessels as well as the right brachia cephalic and bilateral subclavian arteries are unremarkable. The basilar artery and its branches are also visualized on reformatted coronal images and are within normal limits. Both supraclinoid internal carotid arteries and bilateral anterior cerebral arteries and middle cerebral arteries are also demonstrate no areas of a stenotic lesion.

Output: 1.Focal area of subcortical left frontal lucency as detailed double. Further evaluation with an MRI is recommended.2.Essentially unremarkable CTA examination of the cervical region and intracranially.3.4.


Instruction: Generate impression based on findings.

Input: 58-year-old male with left knee pain continued despite injections and physical therapy. Evaluate left knee for meniscus tear. MENISCI: There is globular signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration which extends to the tibial and femoral articular surfaces consistent with complex degenerative tearing extending to involve the body of the meniscus. The anterior horn appears intact. There is globular increased signal abnormality within the anterior horn and body of the lateral meniscus consistent with intrasubstance degeneration. The signal appears to extend to the tibial and femoral articular surfaces and body of the meniscus suggestive of degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage degeneration along the medial facet of the patella. There is a partial-thickness defect of the articular cartilage along the medial facet of the patella more centrally. There is near full-thickness articular cartilage degeneration along the medial facet of the femoral trochlea. There is near full-thickness thinning of the articular cartilage along the lateral facet of the patella and lateral femoral trochlea with underlying subchondral signal abnormality. There is near full-thickness articular cartilage degeneration along the lateral tibial plateau. There is near full-thickness to full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex degenerative tearing of the medial and lateral meniscus as described above. 2. Tricompartmental degenerative changes, including near full-thickness to full-thickness articular cartilage degeneration, as described above. 3. Small joint effusion and moderate-sized Baker's cyst.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate for age. 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. Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities, masses, or abnormal enhancement identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's seizures.


Instruction: Generate impression based on findings.

Input: Reason: h/o discitis with vertebral osteo. please look for improvement History: back pain improved. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. There is mild loss of virtual body height at L4.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level with narrowing of the neural foramina bilaterally (left worse than right) and encroachment of the left-sided exiting nerve roots. At L3-4 there is T2 signal hyperintensity within the disk associated with endplate irregularity. There is associated signal changes within the adjacent virtual bodies. There is associated signal change in the surrounding perivertebral musculature and effacement of surrounding fat planes. No epidural fluid collection is clearly appreciated.At L2-3 there is loss of the space height, disk desiccation and a diffuse disk bulge which was also present on the prior exam. It is associated with partial effacement of the fat of the right lateral recess and encroachment of the right-sided exiting nerve roots within the neural foramen. Overall there is no significant change in compared to prior exam.At L1-2 there is no significant compromise to spinal canal or neural foramina.At T11-T12 there is redemonstration of loss of disk space height as well as signal hyperintensity within the right half of the disk and endplate irregularity. There is some mild loss of height of the right half of the T12 vertebral body which was also present on the prior exam.

Output: 1.The patient was unable to continue with examination for axial imaging. As a result this is a limited study. If clinically appropriate and the patient is able to tolerate the exam and the renal function is appropriate, MRI of the lumbar spine with gadolinium may be of benefit to further evaluate the extent of the disease.2.Findings are suggestive of diskitis osteomyelitis at L3-4. Since the prior exam there is been some regression of the signal abnormalities at the adjacent vertebral bodies suggesting evolution but not significant progression.3.Since the prior exam there is been some mild compression of the L4 vertebral body.4.There is redemonstration of findings suggestive of chronic inflammatory reaction at the T11-T12 vertebra.5.There is redemonstration of encroachment of the nerve roots right neural foramen and right lateral recess at L2-3 associated with mild spinal stenosis.6.There is redemonstration of encroachment on the left-sided exiting nerve root at L4-5 related to disk disease.


Instruction: Generate impression based on findings.

Input: T4aN2b base of tongue squamous cell carcinoma status post treatment. There is no measurable tumor in the right tongue region. Likewise, there is no evidence of residual significant lymphadenopathy in the neck. For example, a necrotic right level 2B lymph node measures 4 mm in short axis and an ill-defined right level 2A lymph node measures 6 mm in short axis. The thyroid salivary glands are unremarkable. The larynx appears to be intact. There is multilevel degenerative cervical spondylosis with mild spinal canal narrowing at C3-4 and C4-5. The orbits and imaged intracranial structures are unremarkable.

Output: No evidence of measurable tumor in the right tongue base and no evidence of significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with question of visual field defect. Rule out acute cause. Signs and symptoms: Visual field deficit? Transient? Acute. Signs and symptoms: Visual field defect? Transient? No definitive evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain essentially within normal for patient stated age. Further evaluation with an MRI is recommended. Calvarium, paranasal sinuses and mastoid air cells are within normal limits.

Output: Negative CT of brain.


Instruction: Generate impression based on findings.

Input: History of leptomeningeal carcinomatosis related to breast cancer. There is no evidence of recurrent abnormal leptomeningeal enhancement. There is also no evidence of abnormal intraparenchymal enhancement. There is unchanged nonspecific patchy T2 hyperintensity in the periventricular white matter, particularly in the parietal regions, which may be treatment-related. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There are inflammatory changes in the left paranasal sinuses.

Output: 1. No evidence of recurrent leptomeningeal carcinomatosis.2. No evidence of intraparenchymal metastases.3. Findings suggestive of left-sided sinusitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Trauma. Signs and symptoms: Trauma. Nonenhanced lumbar MRI:There is normal signal intensity and anatomical alignment of vertebral column.Unremarkable lower most visualized thoracic spine and including thoracic cord from T10 inferiorly.T12-L1 demonstrate small Schmorl's nodes along the inferior endplate of T12 and superior endplate of L1 similar to prior exam. No spinal stenosis or neural foraminal compromise.L1-L2 demonstrate a small Schmorl's node along the superior endplate of L2 and unremarkable otherwise.L2-L3 demonstrate mild ligamentum flavum hypertrophy and mild facet disease without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Subtle increased T2/T2 STIR signal intensity within the facet space could represent minimal facet effusion (axial T2 series 701 image 17).L4-L5 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease without hypertrophy changes. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate mild ligamentum flavum and facet degenerative changes and mild disc desiccation without spinal stenosis or neural foraminal compromise. Unremarkable paraspinal soft tissues.

Output: 1.Examination demonstrate no evidence of posttraumatic findings, no spinal stenosis or neural foraminal compromise at any level.2.Mild degenerative changes of lower lumbar spine as detailed per level above.3.No appreciable interval change since prior exam from May 2015.


Instruction: Generate impression based on findings.

Input: 21-year-old female with chronic daily headaches since age 13 There is no evidence of acute intracranial hemorrhage, mass or edema. No areas of abnormal enhancement are identified. The gray-white matter differentiation is preserved.Crowding of the foramen magnum is partially visualized suggesting a Chiari one malformation. Further correlation with MRI is recommended. 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: Likely Chiari 1 malformation. Recommend further correlation with MRI.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for ischemia History: altered mental status and known old CVA MRI brain:There is atrophy of the cerebellum and brainstem. Within the pons there is a rounded lesion with peripheral punctate foci of susceptibility measuring approximately 8 mm in diameter which is best seen on the CT scan where it is a hyperdense lesion.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are asymmetric - right larger than left.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.

Output: 1.There is cerebellar and brainstem atrophy present. One possibility is that this represents a spinocerebellar atrophy.2.There is a lesion present within the pons associated with some calcifications (better identified on CT). It does not appear to represent a cerebral cavernous malformation. Perhaps a post contrast CT would be helpful.


Instruction: Generate impression based on findings.

Input: There has been suboccipital craniectomy with resection of the posterior C1 arch. Fluid intensity material is noted within the operative site, and changes within the overlying subcutaneous tissues are consistent with the patient's postprocedural status. The cerebellar tonsils are elongated, extending pathologically below the level of the foramen magnum, demonstrating a pointed morphology. There is abnormal T2 hyperintensity within the cervical cord beginning at the cervicomedullary junction and extending inferiorly to the T1 level. Cephalad to the C5 level, this is subtle and patchy, whereas from C5/6 through T1, it is more discrete and results in cord expansion. The odontoid tip is retroflexed causing mild abutment of the anterior cervicomedullary junction. Sagittal CSF flow studies were acquired in 4 different acquisitions utilizing 3 different velocity encoding settings. None demonstrate significant biphasic CSF flow involvement at the level performed in magnum and herniated tonsils.There appears to be a partially imaged left pleural effusion.There is straightening the cervical spine which is most likely positional. There are no fractures or subluxations. The marrow signal is benign. There are no degenerative stenoses.

Output: 1.There has been suboccipital craniectomy with resection of the posterior C1 arch. The cerebellar tonsils are elongated, extending pathologically below the level of the foramen magnum, demonstrating a pointed morphology. 2.There is abnormal T2 hyperintensity within the cervical cord beginning at the cervicomedullary junction and extending inferiorly to the T1 level. Cephalad to the C5 level, this is subtle and patchy, whereas from C5/6 through T1, it is more discrete and results in cord expansion. Although this may represent a presyrinx state, the region of cord expansion can be followed for interval changes to assess for possible concurrent neoplasm.3.Sagittal CSF flow studies were acquired in 4 different acquisitions utilizing 3 different velocity encoding settings. None demonstrate significant biphasic CSF flow involvement at the level performed in magnum and herniated tonsils.4.There appears to be a partially imaged left pleural effusion.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of bronchus and lung, unspecified siteClinical question: Staging SCLCSigns and Symptoms: new SCLC The CSF spaces are appropriate for the patient's stated age with no midline shift. Exam is degraded by patient motion.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for brain metastases.3.Exam is degraded by patient motion. As a result more subtle abnormalities may be obscured.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarction. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is a nonspecific punctate focus of susceptibility artifact in the left parietal lobe, which represent a chronic microhemorrhage. The brain parenchyma otherwise appears unremarkable. There is what appears to be a right occipital subgaleal fluid collection that measures 9 mm in thickness. There are mucosal retention cysts within the bilateral maxillary sinuses.

Output: 1. No evidence of acute ischemia.2. Small right occipital subgaleal fluid collection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Epidural/retropharyngeal abscess in the setting of MSSA. Evaluate for interval change. There is persistent low T1 and T2 signal as well as enhancement within the dens. The dens also appears to have irregular contours, which is not significantly changed. However, the T2 signal abnormality and enhancement more inferiorly in the bone marrow of C2 and surrounding soft tissues has decreased. The small residual effusions in the atlantoaxial interval and retropharyngeal effusion also are not as cpnspicuous. There is unchanged multilevel degenerative spondylosis with mild spinal canal stenosis at C4-5. The spinal cord displays normal signal. There is no evidence of intraspinal abscess. The vertebral column alignment is unchanged and there is degenerative endplate irregularity in the mid cervical spine. There is a left maxillary sinus retention cyst.

Output: 1. Overall continued decrease in the extent of the inflammatory process associated with the odontoid region osteomyelitis.2. Multilevel degenerative spondylosis of the cervical spine. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate source of headache History: headache, nocardia pneumonia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered periventricular and subcortical T2 hyperintensities without diffusion restriction or enhancement are nonspecific. A few scattered punctate foci of susceptibility are likely the result of chronic hypertension. Small left peripheral PICA territory focus of chronic ischemia is unchanged There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Mild bilateral mucosal thickening of the maxillary sinuses

Output: 1.Overall stable exam with a few scattered punctate foci of T2 hyperintensity which are nonspecific with differential including chronic small vessel ischemic disease, demyelinating disease, chronic migraine sequale and other inflammatory etiologies.2.Associated mild scattered foci of susceptibility are unchanged and likely the result of chronic hypertension.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate known metastatic lesions. Signs and symptoms: Headache and nausea/vomiting. Pre-and post-enhanced brain MRI:Examination demonstrate multiple nonhemorrhagic supratentorial and infratentorial metastatic lesions as was seen on prior exam.A large necrotic enhancing metastatic focus with extensive surrounding vasogenic edema is present in the cingulate gyrus of the right mid frontal lobe. It measures 19 x 24-mm thin cuts axial post enhanced images. There is resultant mass effect on the corpus callosum on the adjacent cortical sulci.Second largest supratentorial metastatic enhancing necrotic tumor is in the anterior tip of the right temporal lobe and measuring 21 times 19-mm in size. This finding also demonstrate extensive surrounding vasogenic edema length result of regional mass effect.Third largest supratentorial metastatic lesion is in the right basal ganglia measuring at 15 times 11-mm in transaxial dimension which also demonstrates central necrosis and surrounding vasogenic edema. Multiple additional small scattered metastatic lesions involving the cerebral hemispheres and including lesions at the level of ependymal lining of the ventricle.Mass effect on the right lateral ventricle the resultant significant collapse of the ventricle and deviation of midline to the left of approximately 7.5 mm at the level of the septum pellucidum is noted. The left lateral ventricle remains normal in size.Images through posterior fossa demonstrates a single tiny enhancing metastatic lesion in the inferior right cerebellum in paramedian location measuring approximately 6 mm in transaxial dimensions. No significant mass effect is associated with this finding.There is no evidence of leptomeningeal enhancement and no detectable calvarial abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.The signal intensity of paranasal sinuses and all mastoid air cells and middle ear cavities are within normal.

Output: 1.Multiple varying size necrotic, rim enhancing metastatic lesions in bilateral cerebral hemispheres with resultant approximately 7.5 mm deviation of midline to the left as detailed/measured above. Tiny right inferior cerebellar metastatic focus without appreciable mass effect.2.No detectable abnormal enhancement of the leptomeninges, calvarium, soft tissues of the scalp over the orbits.


Instruction: Generate impression based on findings.

Input: Aneurysm and cavernous malformation: headache, light flashes. MRI: There is a punctate focus of susceptibility effect in the left parietal lobe white matter with an adjacent developmental venous anomaly. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is a medially-directed outpouching from the right internal carotid artery adjacent to the opthalmic artery origin that measures up to 5 mm, with a 2 mm wide neck. There is no evidence of significant steno-occlusive lesions.

Output: 1. A punctate focus of susceptibility effect in the left parietal lobe white matter with an adjacent developmental venous anomaly likely represents a cavernous malformation. 2. A right opthalmic artery saccular aneurysm measures up to 5 mm.


Instruction: Generate impression based on findings.

Input: 47-year-old man with syncope. Evaluate for hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. There are prominent calcifications of the choroid plexus in the posterior horn of the right lateral ventricle and the body of the left lateral ventricle.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT with no findings of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 70-year-old woman with dense breasts and recently diagnosed triple negative right breast cancer presents for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Right breast: In the upper outer quadrant near the 11:00 position, there is a homogeneously enhancing lobulated mass with irregular borders consistent with the biopsy-proven malignancy. Clip artifact is seen along the lateral aspect of this mass. This mass measures approximately 1.5 x 1.8 x 2.3 cm (AP x TV x CC). No additional sites of abnormal enhancement is identified in the right breast.Left breast: No abnormal enhancement is seen in the left breast. Axilla: No abnormal lymph nodes are identified in either axillary region.

Output: Unifocal biopsy-proven right upper outer quadrant malignancy measuring 1.5 x 1.8 x 2.3 cm.No MRI evidence for malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with multiple sclerosis and paresthesias, assess for progression. Innumerable T2 hyperintense lesions are again seen in the periventricular white matter, brainstem and posterior fossa consistent with multiple sclerosis. On comparison with prior examinations, the majority of these lesions are stable or improved. For example, a prominent lesion in the medulla, and another at the level of the right facial colliculus, have distinctly decreased in size. Only one lesion in the right periventricular white matter (image 22 series 5) shows some equivocal evidence of increasing size.No evidence of mass effect is detected. No entirely new lesions are seen. The corpus callosum is thinned and there is likely some degree of mild central volume loss. The ventricular system is otherwise within normal limits. No abnormal collection or evidence of intracranial hemorrhage is seen.

Output: Innumerable white matter lesions are redemonstrated compatible with multiple sclerosis. Overall, these lesions are stable or reduced in size. Only one lesion in the right periventricular white matter shows some evidence of increased size, but even this is equivocal.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], f/u progression, paresthesias. There is redemonstration of several foci of T2/FLAIR hyperintensity involving the supratentorial and infratentorial white matter. There appears to be a single new lesion adjacent to the atrium of the left lateral ventricle (series 401, image 50). Otherwise, no significant interval change is appreciated accounting for differences in technique. No midline shift or mass effect is appreciated. No intra-axial or extra-axial fluid collections are visualized.

Output: Minimal progression of demyelinating disease with a single new demyelinating plaque adjacent to the atrium of the left lateral ventricle.


Instruction: Generate impression based on findings.

Input: Newly diagnosed base of tongue squamous cell carcinoma: evaluate for T stage of primary: right ear/tongue pain. There is an enhancing mass centered in the right tongue base that measures up to 30 mm. The tumor also extends into the glossotonsillar sulcus and posterior lateral oral tongue and floor of mouth. However, the masseter and parapharyngeal spaces are intact. There is also sheet-like high T2 signal and enhancement along the left lateral oral tongue. There is necrotic appearing right level 2 and 3 lymphadenopathy. For example, a right level 2A lymph node measures 14 x 22 mm in axial section, a more inferior right level 2B lymph node measures 9 x 11 mm in axial section, and a right level 3 lymph node measures 6 x 10 mm in axial section. There is no definite significant lymphadenopathy in the left neck, at least based on size criteria. The salivary glands and thyroid appear unremarkable. There is mild degenerative lower cervical spondylosis. There appears to be atherosclerotic plaque at the bilateral carotid bifurcations. The orbits and imaged intracranial structures are grossly unremarkable.

Output: 1. A mass centered in the right tongue base that measures up to 30 mm. 2. Multiple necrotic appearing right level 2 and 3 lymphadenopathy is compatible with metastatic disease. 3. Sheet-like high T2 signal and enhancement along the left lateral oral tongue is nonspecific, but may be inflammatory versus less likely neoplastic.


Instruction: Generate impression based on findings.

Input: 43 year old with highly suspicious mass with extensive suspicious calcifications in the right breast presents for MR evaluation. There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.There are multiple cysts in both breasts.An irregularly shaped, rim enhancing mass is present at anterior 11 o'clock position in the right breast, measuring 29 x 22 x 35 mm (AP x LR x CC). This lesion is highly suggestive for malignancy.There are several round enhancing foci and masses surrounding the large rim enhancing mass, likely satellites. Overall measurement of the main mass with possible satellites is 40 x 33 x 43 mm.In addition, there is segmental non mass enhancement extending upper outer and lower outer quadrants in the right breast, measuring 68 x 49 x 130 mm.In the right axilla, there is an abnormal lymph node with thickened cortex, measuring 13 mm. In the left breast, there are multiple enhancing foci, which are likely parenchymal enhancement. There are a few small enhancing masses (less than 1 cm) in the left breast. Those masses are all similar in shape and show sow benign type kinetic pattern. The largest enhancing mass is located anterior 12 o'clock position, measuring 6 x 9 x 7 mm.No abnormal lymph nodes are identified in left axillary region.

Output: 1. Highly suspicious mass in the right 11 o'clock with possible satellites and suspicious non mass enhancement distributing segmentally in the right upper outer and lower outer quadrant.2. Suspicious right axillary lymph node3. Benign appearing masses in the left breast4. No abnormal lymph nodes in left axillary regionFollowing procedures were performed after this MRI.1. Ultrasound guided biopsy for the suspicious mass at 11 o'clock position in the right breast and abnormal right axillary lymph node2. Stereotactic core needle biopsy for the right breast calcifications which correspond to the non mass enhancing lesion3. MR directed ultrasound and ultrasound guided biopsy for the left 12 o'clock mass BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 42-year-old female with a history of right adrenal mass ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a wedge-shaped hypodense area within the left lobe liver likely representing focal fatty infiltration. MRI of the liver may be obtained for further evaluation.3.1 x 2.1 cm hypodense mass in the left lobe liver image number 55, series number 10 highly suspicious for metastatic disease.SPLEEN: Nonspecific 1.2-cm hypodense lesion in the spleen on image number 34, series number 10. Metastatic disease cannot be excluded.PANCREAS: No significant abnormality notedADRENAL GLANDS: There is an 18 by 16.5 by 22-cm mass superior to the right kidney. The mass indents and possibly invades the liver, IVC and the right kidney. This mass likely represents an adrenocortical carcinoma arising from the right adrenal gland. Left adrenal glands unremarkable.KIDNEYS, URETERS: Left kidney is unremarkable. Right suprarenal mass likely representing adrenocortical carcinoma inmates the right kidney. Venous collaterals posterior and lateral to the right kidney.RETROPERITONEUM, LYMPH NODES: IVC filter is in place. Retroperitoneal adenopathy. An index retrocaval lymph node measures 1.9 by 1.4 cm on image number 72, series number 10.IVC is invaded by the large mass. Major retroperitoneal vessels are displaced laterally and anteriorly by the mass.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Right suprarenal mass concerning for adrenocortical l carcinoma. The mass invades the IVC, right kidney and possibly liver.Left lobe lesion in the liver highly suspicious for metastatic disease. Focal fatty infiltration in the liver likely secondary to invasion of the IVC.Metastatic adenopathy.Nonspecific hypodense lesion in the spleen. Metastatic disease cannot be excluded.


Instruction: Generate impression based on findings.

Input: Male, 66 years old, with multiple myeloma status post autologous stem cell transplant two years ago. Cervical:A well-circumscribed area of relatively T1 and T2 hyperintense signal is seen within the right aspect of the C4 vertebral body. This lesion correlates to a lucency on prior CT. Elsewhere, the cervical marrow signal is generally heterogeneous, but no definite additional focal lesions are seen.There are trace retrolistheses of C4 on C5 and C5 and C6. Spinal alignment is otherwise unremarkable. Slight loss of the C5 and C6 vertebral body height is noted. The visualized spinal cord demonstrates normal signal intensity and morphology.C2-3: Facet arthropathy. No significant spinal canal or foraminal stenosis. C3-4: Facet arthropathy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe left foraminal narrowing. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Severe left and moderate right foraminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation with mild spinal canal stenosis. Moderate bilateral foraminal narrowing. C6-7: Facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing.C7-T1: No significant spinal canal stenosis or foraminal narrowing.Thoracic:Mildly heterogeneous marrow signal is seen. However, no discrete or focal lesions are detected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. The spinal cord demonstrates normal signal intensity and morphology throughout. No epidural lesions are suspected. The intervertebral discs are preserved with no areas of significant canal or foraminal stenosis.Lumbar:Mildly heterogeneous marrow signal is seen. However, no discrete focal lesions are detected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural lesions are suspected. A focal cyst-like lesion with surrounding edema is partially visualized in the right sacral ala.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet arthropathy. Bulging disc. Mild spinal canal narrowing. No significant foraminal narrowing. L3-4: Facet arthropathy. Minimal bulging disc. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Mild bulging disc. Mild spinal canal narrowing. Severe right and moderate left foraminal narrowing. L5-S1: Facet arthropathy. Mild disc bulging. No spinal canal stenosis. Moderate bilateral foraminal narrowing.

Output: No definite evidence of any active myelomatous lesions are seen. A fairly geographic lesion within the C4 vertebral body correlates to a lucent lesion noted on prior CT. The internal signal characteristics suggest at least partially fatty consistency which could indicate a hemangioma or perhaps a chronic, treated myelomatous lesion.A focal cystlike lesion with edema in the right sacral ala, partially visualized on this exam, could represent the sequela of recent bone marrow aspiration.


Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer with single right occipital met status post resection and SRS: surveillance MRI. There are postoperative findings related to right occipital craniotomy. There is continued slight decrease in dural thickening along the and posterior falx cerebri and parenchymal enhancement within the right paramedian occipital lobe resection cavity. There is persistent confluent T2 hyperintensity along the margins of this resection cavity. No new abnormal intracranial enhancement is identified. There is an unchanged background of nonspecific cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute cerebral infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants.

Output: Slight interval evolution of treatment findings in the right occipital region without evidence of new intracranial metastases.


Instruction: Generate impression based on findings.

Input: 37 years Female (DOB:3/28/1978)Reason: Eval suprasellar mass. Please add pituitary cuts. History: suprasellar mass lesion,.PROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS MRI brain:There is a 44 x 29 mm coronal dimension and 42 x 35 mm sagittal dimension the mass involving the third ventricle and bulging inferiorly into the suprasellar cistern which insinuates itself into the third ventricle and subsequently abuts the inferior aspect of the body of the left lateral ventricle. There is associated distortion of the adjacent left thalamus and associated displacement of the internal cerebral veins superiorly. It appears to displace the optic chiasm inferiorly into the pituitary fossa. This is peripherally enhancing and somewhat septated. The signal intensity differs from spinal fluid and is lower than CSF in signal on T2 imaging and higher than CSF in signal intensity on T1 imaging.The lateral ventricles aren't dilated.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.Fiducial markers are in place.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline but displaced inferiorly by a the third ventricular mass. No intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: 1.A cystic mass in the third ventricle is present which bulges into the suprasellar cistern. This could represent a neoplasm such as a astrocytic astrocytoma2.There is ventriculomegaly present.3.Exam was performed the purpose of stereotactic guidance. 4.Exam is mildly compromised due to patient motion.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with history of lung cancer with metastases to brain status post RT. Signs and symptoms: Doing well but no new disease evaluation compared to prior scans. Pre-and post-enhanced head CT:Examination demonstrates further decrease in the size of a single small metastatic focus in the dorsal aspect of the right cerebellum. It measures approximately 4 x 6-mm in size compared to prior measurements of 11 x 11.There is no detectable surrounding vasogenic edema.Unremarkable pre-and post enhanced head CT otherwise and in particular no evidence of any new additional metastatic lesions of brain parenchymal or leptomeninges.Calvarium is intact.Limited images through the orbits are unremarkable.Paranasal sinuses and mastoid air cells are unremarkable.

Output: Further decrease in the size of a single right posterior cerebellar metastatic focus to 4 x 6-mm in size compared to prior measurements of 11 x 11. No evidence of any new findings.


Instruction: Generate impression based on findings.

Input: A 59 years old male with non-ischemic cardiomyopathy, severe systolic dysfunction, diabetes mellitus, hypertension, colon cancer with chemotherapy. Diagnosed on 12/2014 with a right atrial clot associated to a catheter that was removed and then the clot was not seen in the following echocardiography. Now referred to MRI for further evaluation including etiology of the myocardial dysfunction. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 146 ml/m2 (normal range: 74+/-15), the LVEDV is 377 ml (normal range 142+/-34), the LV end systolic volume index is 108 ml/m2 (normal range 25+/-9), the LVESV is 276 ml (normal range 47+/-19), the LV mass index is 97 g/m2 (normal range 85+/-15), and the LV mass is 249 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is a mid-wall stripe late gadolinium enhancement in the interventricular septum which is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing process. The pattern is most commonly described in patients with dilated cardiomyopathy. Right VentricleThe right ventricle is severely dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 322 ml (normal range 142+/-31), the RV end systolic volume index is 87 ml/m2 (normal range 31+/-9), and the RVESV is 223 ml (normal range 54+/-17).AtriumThe left atrium is severely dilated. The right atrium is moderately dilated.No interatrial shunt was noted. There is a mass in the right atrial appendage, which is not particularly mobile and most likely represent residual calcified thrombus, based on the patients clinical history and MRI findings. Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. There is a diastolic mitral regurgitation noted.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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 ascending aorta is mildly dilated (46mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated in size (41mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsMild bilateral pleural effusion was noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severe systolic dysfunction, LVEF 27%. There is a mid-wall stripe of late gadolinium enhancement involvement the interventricular septum. The finding is atypical for prior myocardial infarction and suggests the presence of underlying fibrosis as might be seen in dilated cardiomyopathy.2. The right ventricle is severely dilated with moderate to severe systolic dysfunction, RVEF 31%.3. There is a mass in the right atrial appendage, which is not particularly mobile and most likely represent residual calcified thrombus, based on the patients clinical history and MRI findings. 4. The left atrium is severely dilated. The right atrium is moderately dilated. No interatrial shunt was noted. 5. There is mild to moderate aortic regurgitation.6. There is mild mitral regurgitation.7. The ascending aorta is mildly dilated8. The main pulmonary artery is severely dilated in size (41mm).9. Mild bilateral pleural effusion was noted.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils are low lying, extending up to approximately 8 mm inferior to the foramen magnum. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is possible linear signal abnormality along the imaged portions of the upper cervical spinal cord.

Output: 1. No evidence of acute or chronic infarct.2. Low-lying cerebellar tonsils compatible with Chiari 1 malformation. 3. Possible linear signal abnormality along the imaged portions of the upper cervical spinal cord may represent artifact versus less likely syrinx, given that the prior spine MRI from 2010 did not show this abnormality. Nevertheless, a repeat MRI may be useful if the development of a syrinx is a clinical consideration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Initial staging of recently diagnosed lung cancer. There are punctate foci of susceptibility effect in the posterior left Heschl gyrus region and right frontal corona radiata. Otherwise, there is no evidence of intracranial tumors. There is no evidence of intracranial hemorrhage or acute infarct. There is mild cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution. The third and lateral ventricles are prominent, perhaps disproportionately with respect to the sulci and there is a prominent jet of cerebrospinal fluid in the third ventricle. There are also prominent cerebrospinal fluid spaces posterior to the cerebellum and a small left middle cranial fossa arachnoid cyst. 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. There is a right lens implant. There is fluid in the right mastoid air cells.

Output: 1. Punctate foci of susceptibility effect in the posterior left Heschl gyrus region and right frontal corona radiata may represent a chronic microhemorrhages or perhaps an atypical metastases. Otherwise, no evidence of intracranial tumors.2. Findings suggestive of possible normal pressure hydrocephalus.3. Mild cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: syrinx spine, yearly follow up History: yearly follow up. Untethered 2/2009. There are again extensive multi-level segmentation anomalies involving virtually the entire spine and rotatory scoliosis with thoracic curve to the left. There is a stable low-lying conus, which is again at the L3 vertebral level. No prone imaging was performed. There is a persistent syrinx most conspicuous in the lower thoracic cord, which measures 6 x 8 mm in greatest axial dimensions. There is also a stable thickened filum measuring up to 3 x 4 mm along the distal thecal sac, although discontinuous, consistent with prior untethering surgery.There is no significant spinal canal stenosis. Marrow signal is unremarkable. Sagittal alignment is unremarkable.

Output: 1. Stable syrinx most prominent in the lower thoracic cord.2. Low-lying conus medullaris remains at L3 level. Prone imaging not available. 3. Extensive multi-level segmentation anomalies and scoliosis.


Instruction: Generate impression based on findings.

Input: Patient with unilateral left bloody nipple discharge and breast lump. Family history of cancer. Moderate parenchymal enhancement is noted bilaterally. There are symmetric scattered glandular elements bilaterally.In the left central breast 4 cm behind the nipple, there is an irregularly shaped, homogeneously enhancing mass measuring 2.2 cm AP x 1.5 cm CC x 1.3 cm TV.In the left central breast 6 cm behind the nipple, there is a focus of enhancement measuring 0.7 cm AP x 0.8 cm CC x 0.8 cm TV. In the right central breast 4 cm behind the nipple, there is non-mass enhancement measuring 1.2 cm AP x 0.8 cm CC x 1.0 cm TV. Artifact is noted in the superficial left retroareolar region from a prior-placed biopsy clip. The previously seen fibroadenoma in this region is not evident on MRI. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Three areas of suspicious enhancement bilaterally, most prominently as an irregularly shaped left central breast mass, suspicious for malignancy. MRI-guided ultrasound examination of all 3 regions is recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Signs and Symptoms: brain lesionComments: Pre op MRI. Surgery today. Please page resident to place fiducials. 6876 | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a ring-enhancing lesion in the left inferior parietal lobule measuring 8 mm , ring-enhancing nodule in the right inferior temporal gyrus measuring 8 x 4 mm and 7 x 6 mm enhancing nodule located along the isthmus of the cingulate gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions are present along the internal capsules and 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple ring-enhancing lesions present within the brain parenchyma. Differential considerations include metastases as well as abscesses.2.Periventricular and subcortical white matter as well as the brainstem changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Examination was performed the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: 56-year-old female with pain. ROTATOR CUFF: There is thickening and increased signal intensity of the supraspinatus indicating mild to moderate tendinosis. There is also more focal increased signal intensity within the distal fibers of the tendon, at its insertion, indicating a small insertional tear that appears to involve the majority of the tendon thickness including the bursal surface, but spares the articular surface fibers at their insertion. There is minimal tendon retraction. Slightly more proximally, the articular surface fibers of the tendon are indistinct, suggesting fraying or focal degenerative tearing. The supraspinatus muscle appears intact. There is minimal interstitial tearing along the myotendinous junction of the infraspinatus. There is mild tendinosis of the infraspinatus tendon. The infraspinatus muscle appears normal. The teres minor muscle and tendon appear normal. There is minimal tendinosis of the subscapularis distally, but no tear is evident. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial/subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. No joint effusion is evident. There is minimal increased signal intensity within the superior labrum which may reflect degeneration, but we see no fluid-filled labral tear, given the limitations of a non arthrogram study.BICEPS TENDON: Give the limitations of a non arthrogram study, the tendon of the long head of the biceps appears normal.

Output: 1. Tendinosis and partial-thickness tearing of the supraspinatus involving both the bursal and undersurface fibers as described above. Other rotator cuff findings as described above.2. Mild osteoarthritis of the acromioclavicular joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, status post right L5-S1 microdiscectomy. Assess for L5-S1 herniation. Spinal alignment is anatomic. Vertebral body height and morphology are normal. Edematous degenerative endplate signal alteration has progressed at L5-S1. In addition, several scattered foci of fatty marrow replacement are again seen similar to prior. No pathologic marrow enhancement is seen.The visualized spinal cord, conus and cauda equina are unremarkable except as discussed below. No pathologic intracanalicular enhancement is seen.Mild loss of disc height and T2 signal at L3-4 and L4-5 is stable to slightly progressed. Loss of disc height has progressed at L5-S1. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy. Mild bulging disc with a central annular fissure. No significant spinal canal or neuroforaminal stenosis. No interval changes. L4-5: Moderate facet hypertrophy which may have progressed slightly. Mild bulging disc with a progressive annular fissure. No significant spinal canal or neuroforaminal stenosis. L5-S1: Postoperative findings are seen consistent with a right posterior approach for microdiscectomy. Since the prior examination, a large central/right paracentral disc protrusion has recurred, measuring at least 21 x 11 mm in the axial plane. This results in a severe spinal canal stenosis with crowding and impingement of the cauda equina nerve roots. The neural foramina themselves are not significantly narrowed. Moderate to severe facet arthropathy and ligamentum flavum thickening are unchanged.

Output: Recurrent disc herniation at L5-S1 with significant spinal canal stenosis and nerve root impingement.


Instruction: Generate impression based on findings.

Input: Ataxia that has gotten significantly worse with some dragging of the right foot and persistent strabismus. There is marked diffuse cerebellar volume loss, which has significantly progressed since 2008. Linear T2 hyperintensity in the left lateral midbrain is likely artifactual. The brainstem and supratentorial brain otherwise appear to be unremarkable. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The supratentorial ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Marked diffuse cerebellar volume loss, which has significantly progressed since 2008. Differential considerations include inherited cerebellar ataxia, mitochondrial disorders, ataxia telangectasia, for example. Perhaps MR spectroscopy can offer additional insights.


Instruction: Generate impression based on findings.

Input: 62 year old woman with anomalous left main coronary artery referred to evaluate for ischemia and viability to determine potential benefit of surgery. First Pass PerfusionDuring hyperemia and during resting conditions, nearly circumferential perfusion defects are noted in the basal and mid ventricular slices. Although this finding would typically represent a dark rim artifact, given the patient's known anomalous left main coronary artery, subtle global hypokinesis, and evidence of small myocardial infarction, the possibility that it represents mild resting and hyperemic ischemia can not be excluded. Viability/ Myocardial ScarThere is a non-transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal anterolateral wall. This segment has an intermediate probability of viability. The remainder of the entire myocardium is viableLeft VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is mild global hypokinesis with slightly worse hypokinesis of the basal anterolateral wall. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), the LVEDV is 153 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 35 g/m2, and the LV mass is 60 g. 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 64 ml/m2 (normal range 69+/-14), the RVEDV is 112 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 50 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. Tortuous thoracic descending aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia and during resting conditions, nearly circumferential perfusion defects are noted in the basal and mid ventricular slices. Although this finding would typically represent a dark rim artifact, given the patient's known anomalous left main coronary artery, subtle global hypokinesis, and evidence of small myocardial infarction, the possibility that it represents mild resting and hyperemic ischemia can not be excluded. 2. There is a non-transmural myocardial infarction (i.e. late gadolinium enhancement) involving the basal anterolateral wall. This segment has an intermediate probability of viability. The remainder of the entire myocardium is viable3. The left ventricle is normal in size with mildly reduced systolic function (LVEF 48%). There is mild global hypokinesis with slightly worse hypokinesis of the basal anterolateral wall. 4. Normal RV size and systolic function (RVEF 55%).


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cord. Signs and symptoms: Urinary frequency, urgency and incontinence. Nonenhanced lumbar MRI:There is normal anatomical development, alignment and signal intensity of the vertebral column.No spinal stenosis or neural foraminal compromise is detected.There is normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina.There is normal termination of cord at L1-L2 level.There is forward movement of the conus and proximal cauda equina on prone sagittal T2-weighted images compared to supine sagittal series.Unremarkable. Spinal soft tissues other than a small single locule cyst in the posterior-superior lateral aspect of the left kidney measuring at 15 x 17 mm in transaxial dimensions.

Output: 1.Unremarkable nonenhanced lumbar MRI and without evidence of the cord.2.Incidental note is made of a 15 x 17 mm superficial left renal cyst.


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with urinary incontinence and weakness. Thoracic:Exaggerated kyphosis in the mid to lower thoracic spine likely reflects endplate irregularities and slight anterior wedging from T6 through T11. Sagittal alignment is otherwise unremarkable.Otherwise, vertebral body morphology is unremarkable. Vague enhancement seen within the T11 vertebral body. Elsewhere, vertebral body signal characteristics are unremarkable.The dorsal epidural fat is prominent throughout much of the thoracic spine, but most notably from T4 through T9. This results in a generalized narrowing of the thecal sac. There is complete effacement of the CSF space and potentially some mass effect upon the spinal cord in this region. Contributing to this appearance is severe facet hypertrophy and ligamentum flavum thickening bilaterally at T4-5, on the right at T5-6, and bilaterally at T6-7. Significant foraminal narrowing is seen on the left at T4-5-7, and on the right at T4-5, T5-6 and T6-7.No convincing evidence of any spinal cord signal abnormality is seen. No pathologic intracanalicular enhancement is seen.Lumbar:Spinal alignment is anatomic. Allowing for degenerative irregularity and signal change at L5-S1, vertebral body morphology and marrow signal characteristics are unremarkable. The L5 and S1 endplates are enhancing which is likely degenerative in nature. No other pathologic marrow enhancement is seen.The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed by level below.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc. Mild generalized spinal canal narrowing. Mild right foraminal narrowing. L4-5: Advanced facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Mild bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc with a large superimposed central disc extrusion which projects inferiorly and extends nearly to the S1 to disc bulge. Extrusion causes a severe narrowing of the central spinal canal and likely impingement of the multiple sacral nerve roots. Moderate bilateral foraminal narrowing.

Output: 1.Prominence of the dorsal epidural fat is seen in the thoracic region, most conspicuously between T4 and T9. This, along with posterior element hypertrophy, causes a significant narrowing of the thecal sac with complete effacement of the CSF. The spinal cord itself may be slightly compressed by this process though there is no evidence of cord edema. Prominent epidural fat is often an incidental finding, though on occasion it can produce symptomatology.2.Exaggerated kyphosis in the mid to lower thoracic spine in association with endplate irregularity and mild anterior wedging from T6 through T11 may reflect Scheuermann's disease.3.A large inferiorly directed central disc extrusion at L5-S1 is seen, resulting in significant encroachment upon the central spinal canal and likely impingement of multiple sacral nerve roots.4.Enhancement within the T11 vertebral body is seen, a nonspecific finding which may represent a slightly atypical presentation of hemangioma.


Instruction: Generate impression based on findings.

Input: Male, 69 years old. Pain. Evaluate for rotator cuff tear. Several sequences are limited by patient motion artifact. Multiple foci of signal void are noted in the soft tissues above the humeral head presumably representing metallic susceptibility artifact from prior surgery.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon with approximately 1 cm of proximal retraction. The tear involves the majority of the supraspinatus tendon, although a small portion of the tendon posteriorly appears to extend to the greater tuberosity. The remainder of the supraspinatus tendon appears thinned, likely reflecting chronic attritional tearing. There is mild fatty atrophy along the myotendinous junction. Otherwise, the supraspinatus muscle appears normal. Mild tendinosis affects the infraspinatus tendon, but we see no full-thickness tear. There is mild fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon are intact. There is increased signal intensity in the subscapularis tendon distally indicating moderate to severe tendinosis and interstitial tearing with propagation of tearing along the myotendinous junction and formation of a small intramuscular cyst. Small cysts are seen in the underlying lesser tuberosity. The subscapularis muscle appears intact. The coracohumeral interval is approximately 7 mm, raising the possibility of subcoracoid impingement.SUPRASPINATUS OUTLET: There is widening of the acromioclavicular joint presumably reflecting prior surgery. There is fluid in the subacromial/subdeltoid bursa, likely reflecting the patient's rotator cuff tear. The coracoacromial ligament appears slightly thickened.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is perhaps mild osteoarthritis of the glenohumeral joint. Intermediate signal intensity within the superior labrum suggests degeneration, but we see no fluid-filled labral tear. There is a small glenohumeral joint effusion with fluid concentrating in the subscapular recess.BICEPS TENDON: Although the tendon of the long head of the biceps is visualized within the bicipital groove, it is not visualized in the rotator interval, which may reflect rupture or prior tenotomy.

Output: 1.Full-thickness near-complete tear of the supraspinatus tendon with additional rotator cuff tendinopathy as described above.2.Surgical changes of acromioclavicular joint resection as above.3.Degeneration of the superior labrum with nonvisualization of the intra-articular biceps tendon, presumably reflecting rupture or prior tenotomy.


Instruction: Generate impression based on findings.

Input: Female, 27 days old, currently 35 weeks corrected gestational age, not showing feeding cues, concerning for TORCH infection. No evidence of restricted diffusion, edema or mass effect is seen. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits. The degree of sulcation is relatively delayed for a corrected gestational age of 35 weeks, appearing more similar to that which is seen at 32 weeks gestation. However, the pattern of myelination is appropriate or even somewhat advanced for gestational age.The region of the pituitary gland is unremarkable. The corpus callosum is present and fully formed. The brainstem, cerebellar vermis and cerebellar hemispheres are all within normal limits.

Output: 1.No definite acute or focal abnormalities are seen.2.The degree of cerebral sulcation appears to be mildly delayed, correlating more closely to a 32 week gestation than a 35 week gestation. However, the pattern of myelination is appropriate or even somewhat advanced for age. The relevance of these findings is uncertain. A follow-up examination is suggested, preferably in no less than 3-6 month's time, to assess for subsequent development.


Instruction: Generate impression based on findings.

Input: 61-year-old male with destructive bony lesion L5/S1. Evaluate unknown primary malignancy. History of hemachromatosis and diabetes. The recent PET examination demonstrates no pathologic foci of increased radiotracer accumulation to indicate FDG avid tumor in the neck, chest, abdomen or pelvis. Specifically, the region of L5/S1 is negative on FDG-PET.On the recent PET scan examination show moderate to markedly increased metabolic activity throughout the entire colon suggesting a nonspecific infectious or inflammatory colitis.CHEST:LUNGS AND PLEURA: Mild left lower lobe volume loss and atelectatic changeMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There is hepatosplenomegaly. The liver measures 20 cm craniocaudally, and the spleen measures approximately 14 cm. The hepatic parenchyma is hypodense relative to the spleen suggesting fatty infiltration. There are small calcifications in the liver, probably due to old granulomatous disease. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cortical hypodensities compatible with simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the spineOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis, without evidence of diverticulitis. No specific abnormality was found in the colon to correspond with the area of increased uptake on the recent PET scan examination.BONES, SOFT TISSUES: Multilevel degenerative disk disease. Abnormal mass lesion infiltrates the spinal column at L5-S1, seen best at axial image 150/222. These findings are compatible with an aggressive process, such as infection or malignancy. No significant interval change since recent MRI and CT scans of the lumbosacral spine.OTHER: Prominent left varicocele at axial image 220/222.

Output: Hepatosplenomegaly. Probable fatty infiltration of the liver. No significant interval change in the L5-S1 aggressive process seen on recent CT and MRI examinations. No local neoplasm. Left varicocele. Findings are discordant with PET-CT exam regarding the colon, where no abnormality was found.


Instruction: Generate impression based on findings.

Input: 32-year-old female with biopsy-proven right intraductal papilloma, with bilateral bloody nipple discharge confirmed on physical exam. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact is identified at the site of a right retroareolar biopsy clip. There is no associated abnormal enhancement. Normal T1 hyperintensity is identified within bilateral retroareolar ducts, right greater than left. Within the right upper outer quadrant, there is a normal-appearing intramammary lymph node, confirmed on mammogram 5/5/2016. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No abnormality identified at site of right retroareolar biopsy clip. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: Male 69 years old Reason: has kidney and prostate cancer; evaluate 2.5 cm caudate lobe mass History: none ABDOMEN:LIVER, BILIARY TRACT: There is a 2.2 x 2.1-cm T2 hyperintense lesion within the caudate lobe. This demonstrates incomplete peripheral nodular enhancement with progressive fill-in and is most consistent with a hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large heterogeneously enhancing left lower pole renal mass with central non-enhancement suggestive of necrosis. This measures at least 8.9 x 12.7 cm (series 801, image 87). Tumor extends into the left renal vein. No tumor is identified within the IVC. The right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes. A reference left periaortic lymph node measures 2.0 x 1.4 cm (series 801, image 99).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Enhancing lesion within the L1 vertebral body suspicious for a metastatic deposit.

Output: 1.Caudate lobe lesion is most consistent with hemangioma.2.Large left renal necrotic mass consistent with renal cell carcinoma. There is left renal vein invasion and metastatic retroperitoneal lymphadenopathy.3.L1 vertebral body metastasis.


Instruction: Generate impression based on findings.

Input: Ms. Kaparos is a 44-year-old female presenting for high-risk screening MRI evaluation. Family history of breast cancer in mother, sister, and ovarian cancer in maternal grandmother. Patient has a CHEK 2 mutation. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with a hamartoma with meningothelial elements in the right frontoparietal scalp. Evaluate for underlying meningioma with extracranial extension. An area of subcutaneous thickening is seen in the high right parietal scalp which appears to be composed of both fatty and scarlike tissue. The lesion enhances on postcontrast images and demonstrates restricted diffusion. The bone immediately deep to the scalp lesion is mildly thickened with irregular margins and is somewhat heterogeneously low in signal intensity. There may be very mild marrow enhancement, best appreciated on sagittal T1 postcontrast images (image 9 series 12). The extracranial periosteum is slightly thickened and enhancing as well.No evidence of any intracranial mass or pathologic enhancement is seen including in the high right parietal area. No edema or mass effect is detected. A few scattered small foci of T2 hyperintensity in the cerebral hemispheres are nonspecific. No findings are seen to indicate intracranial hemorrhage or any abnormal extra-axial fluid. Ventricular size and morphology are within normal limits.

Output: An area of subcutaneous scalp thickening is seen in the high right parietal region likely indicating the site of the biopsied/excised lesion. The bone immediately deep to the lesion is thickened with irregular margins and perhaps minimal marrow enhancement. While these findings are by no means specific, they can be seen in the context of intraosseous meningioma, which could potentially account for the meningothelial elements on histology. If further evaluation is warranted, a CT examination can be considered to better evaluate the bony features. No evidence of any intracranial meningioma is seen.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: brain metastasis History: new onset seizures Brain MRIMultifocal various sized susceptibility artifacts on bilateral hemisphere which could represent chronic petechial hemorrhages or mineralization.Scattered T2/FLAIR high signal intensity lesions on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion.There is subtle T2/FLAIR high signal intensity seen within the proximal right post central sulcus (series 701, image 25). However, this lesion does not show any evidence of enhancement on post Gad images, nor shows any evidence of susceptibility artifacts. Thus, this is non specific. It could represent slow flow cortical vein or an artifact. However, local proteinaceous materials including small amount of subarachnoid blood products cannot be completely excluded.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.Bilateral (right worse than left) mastoid air cells show opacifications.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Non specific increased signal intensity on the proximal right post central sulcus on T2/FLAIR image.3. Multifocal bihemispheric chronic petechial hemorrhages or mineralizations.4. Non specific small vessel ischemic disease. 5. Normal brain MRA and Neck MRA.


Instruction: Generate impression based on findings.

Input: Brain parenchymal morphology is within normal limits. Right middle cranial fossa arachnoid cyst measuring approximately 3.1 x 2.0 cm with mild mass effect on the right anterior temporal lobe. There are minimal punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular (notably periatrial) and subcortical white matter. No edema is detected. Diffusion-weighted images are within normal limits. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. There is no pathological intracranial enhancement. The ventricles are normal in size and morphology. The pituitary gland is somewhat smaller than is typically seen.

Output: 1. No definite seizure foci are identified.2. Nonspecific white matter FLAIR intensity may reflect microvascular ischemic disease.3. Right middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 69-year-old male patient with history of elevated PSA. Evaluate for targetable lesions. PELVIS:PROSTATE:Prostate Size: 5.6 x 5.4 x 6.7 cm. Peripheral Zone: There is a 4 mm focus in the left base adjacent/contiguous to the transitional zone which demonstrates T2 hypointensity, ADC hypointensity, and early enhancement. Central Gland: The central gland is enlarged with BPH nodules. Seminal Vesicles: No significantly abnormality.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 4 mm lesion in the left base which likely represents an extension of BPH in the peripheral zone, however, a cancer cannot be excluded by MRI.


Instruction: Generate impression based on findings.

Input: Abdominal pain. History of pancreatic and common bile duct dilatation. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal suspicious hepatic lesion. Distended gallbladder without cholelithiasis or acute inflammation.There is intrahepatic and extra hepatic biliary ductal dilatation with the common bile duct distended up to 16 mm. It tapers abruptly within the pancreatic head. No filling defect is seen to suggest a gallstone.SPLEEN: No significant abnormality noted.PANCREAS: There is pancreatic ductal dilatation to the level of the pancreatic head with mild pancreatic parenchymal atrophy. There is a subtle hypoenhancing pancreatic head mass measuring approximately 2.2 x 2.1 cm (series 13/2051) at the level of the abrupt common bile duct and pancreatic duct caliber change. This region also shows mild restricted diffusion.No significant peripancreatic lymphadenopathy. The celiac axis and superior mesenteric artery are patent without suspected tumor involvement or encasement. The SMV, splenic vein and portal vein also appear uninvolved.Following secretin administration there is increased caliber of the pancreatic duct and increased secretions through the GI tract.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis or suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysmal dilatation measuring 2.2 cm in maximal AP dimension.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Common bile duct and pancreatic ductal dilatation to the level of pancreatic head with a suspected 2.2 cm pancreatic head mass. An EUS/ERCP is recommended for further evaluation. There is upstream biliary ductal, pancreatic ductal and gallbladder distention. No vascular involvement.


Instruction: Generate impression based on findings.

Input: T4bN0 left sinonasal squamous cell carcinoma status post treatment. There are postoperative findings related to sinonasal surgery. There is interval decrease in size of the enhancing tumor centered in the left anterior ethmoid cavity with protrusion into the medial left extraconal orbit, measuring 11 x 20 mm, previously 20 x 28 mm. There are persistent obstructed secretions and mucosal thickening in the left frontal sinus and frontoethmoid recess. There is also no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged, scattered, nonspecific, foci of non-enhancing T2 hyperintensity in the cerebral white matter. There are small areas of encephalomalacia in the right cerebellar hemisphere. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: Post-treatment findings in the sinonasal region with interval decrease in size of the tumor centered in the left anterior ethmoid cavity with protrusion into the medial left extraconal orbit.


Instruction: Generate impression based on findings.

Input: First time seizure. No findings to suggest seizure focus. No intracranial mass or mass-effect. No sulcation abnormality, heterotopic gray matter, or cortical dysplasia. Bilateral hippocampi are normal in size, signal characteristics, and demonstrate preserved internal architecture. No intracranial hemorrhage. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Low lying cerebellar tonsils which remain rounded with preserved adjacent subarachnoid spaces; no evidence of Chiari. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No findings to suggest seizure fossa. 2. Low-lying tonsils cerebellar tonsils incidentally noted without convincing evidence of Chiari 1.