Instruction: Generate impression based on findings.

Input: 50-year-old female experiencing tingling in the right forearm Spinal alignment is anatomic. Vertebral body height, morphology and signal characteristics are within normal limits. The visualized spinal cord shows normal caliber and is free of any definite signal abnormality. A previously demonstrated apparent focus of T2 hyperintensity overlying the cord at the T2 level, seen only on the sagittal T2 sequence, is not present thus confirming it to be artifactual on the comparison exam. The visualized paraspinal contents are unremarkable.C2-3: Right facet hypertrophy. No significant spinal canal or foraminal stenosis. These findings are unchanged.C3-4: Right facet hypertrophy. Mild uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. These findings are unchanged.C4-5: Mild uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. These findings are unchanged.C5-6: Mild uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. These findings are unchanged.C6-7: Mild posterior disc-osteophyte complex formation and uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. These findings are unchanged.C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis. These findings are unchanged.There is no abnormal enhancement.

Output: 1.No significant spinal canal or foraminal stenosis.2.No abnormalities of the spinal cord are seen.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structuresClinical question: 3T Scanner, QSM, permeability, CCM ProtocolSigns and Symptoms: Genetically tested positive for CCMComments: CCM Protocol, QSM/Permeability, 3T Scanner | The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.On susceptibility imaging there is a small tubular structure coursing through the pons most likely representing a vein.

Output: There is no convincing evidence for cerebral cavernous malformation by MRI. MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Six-week follow-up, atlantooccipital dissociation Craniocervical alignment is within normal limits. Atlantoaxial interval is normal. Alignment of the remainder of the cervical spine is also maintained. There is no disruption involving the tectorial membrane or of the posterior longitudinal ligament inferiorly. Transverse ligament is also intact. Posterior ligamentous complex and anterior longitudinal ligaments also appear intact in the cervical spine.Previous seen collection (which was likely subdural) posterior to the cervical spine and posterior to the tentorial membrane has resolved. There is heterogeneity of the fat at the craniocervical junction ventral to the tectorial membrane (epidural space) without discrete residual hematoma. There is decrease in previously seen mild edema involving the lateral mass C1-C2 articulation. Mild joint fluid in the occipital condyle-C1 articulation is again seen and is nonspecific.No abnormal cord signal. No spinal canal or neural foraminal stenosis at any level in the cervical spine.

Output: Findings are compatible with relatively mild ligamentous injury without frank ligamentous disruption at the craniocervical junction. Compared to 8/2/2015, there has been evolution of the findings with resolution of associated blood products. Please see details above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Optic neuritis, unspecifiedOptic neuritis, unspecifiedClinical question: Optic neuritis protocolSigns and Symptoms: optic neuritis MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular white matter lesions many of which are perpendicularly oriented to the lateral ventricles. One in the right centrum semiovale enhances following contrast administration and measures approximately 26 x 15 mm coronal dimensions. There are several additional enhancing lesions present adjacent to the temporal horn of the left lateral ventricle within the white matter within the medial left temporal lobe. There is a ring-enhancing lesion present adjacent to the occipital horn of the right lateral ventricle. There is a couple small enhancing lesions present in the periventricular white matter adjacent to the trigones of the lateral ventricles bilaterally.Additional FLAIR hyperintense lesion is present in the right brainstem at the level of the pons and in the right cerebellar hemisphere inferiorly as well as the right cerebellum superiorly. These do not enhance following gadolinium administration.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions present within the brain parenchyma especially in the periventricular white matter but also present in the cerebellum and pons which are nonspecific but can be explained on the basis of demyelination other diagnostic considerations may include vasculitis and sarcoid.2.There are multiple enhancing lesions present in the periventricular white matter as well as in the left medial temporal lobe white matter the largest one being in the right centrum semiovale. One consideration is that these represent acute plaque formation if the patient has multiple sclerosis though they could also be a result of a granulomatous disorder as well. They are nonspecific3.No spinal cord lesion is identified and there is no convincing evidence for optic neuritis on the basis of MRI findings alone.


Instruction: Generate impression based on findings.

Input: Right knee instability MENISCI: There is no definite meniscal tear identified. A focal area of intermediate signal intensity is seen within the periphery of the posterior horn of the medial meniscus adjacent to the femoral articular cartilage. This is suspected to represent an interface with capsular structures rather than a true tear.ARTICULAR CARTILAGE AND BONE: There is a focal cleft of the articular cartilage of the lateral patellar facet which appears to extend through the majority of thickness of the cartilage. This is best appreciated on image 16 of series 3. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Focal cleft of the articular cartilage of the patella with mild edema of the superolateral corner of Hoffa's fat pad, the combination of which may indicate patellar instability. The Insall Salvati ratio is borderline abnormal however the TT to TG distance is normal. If a more accurate TT to TG distance is desired, CT can be obtained.


Instruction: Generate impression based on findings.

Input: Follow-up from previous MRI after whole body cooling: Perinatal depression in a full-term infant. There are small residual areas of T1 hyperintense foci of extra-axial hemorrhage along the bilateral occipital and cerebellar convexities, without mass effect. There is no evidence of acute infarct. There are small areas of high T2 and low T1 signal in the basal ganglia, left more than right. Otherwise, the previously demonstrated corresponding abnormal foci of high T1 signal in portions of the basal ganglia are no longer evident, with areas of T1 hyperintensity remaining in expected locations. The degree of myelination appears to be appropriate. 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 scalp fluid collection has resolved. The orbits are grossly unremarkable.

Output: 1. Decreased subacute extra-axial hemorrhages along the posterior cerebral and cerebellar hemispheres.2. Sequale of prior probable hypoxic ischemic injury in the basal ganglia, but no evidence of acute cerebral infarction.3. Resolved caput succedaneum.


Instruction: Generate impression based on findings.

Input: History of recurrent low grade astrocytoma s/p craniotomy and chemotherapy. There has been interval decrease in size of the predominantly enhancing lobular mass with peripheral cystic components centered in the hypothalamic region, now measuring up to 57 mm in the sagittal plane, previously 60 mm. There are punctate scattered foci of susceptibility effect in the tumor. The mass encases and displaces portions of the bilateral internal carotid, middle cerebral, and anterior cerebral arteries. There is persistent prominence of the lateral ventricles and partial effacement of the third ventricle. There is encephalomalacia in the anterolateral right frontal lobe, which may be related to right frontal craniotomy for tumor biopsy. There is no evidence of acute infarction.

Output: Interval decrease in size of the hypothalamic region astrocytoma.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber. There is redemonstration of a trace prominence of the central spinal canal from the C6-C7 level down to T1-2. There is no pathological enhancement.Previously seen mild spondylotic changes from C4-C5 through C6-C7 appear similar, except there is decreased conspicuity of the central annular fissure at C5-C6. There is up to moderate left foraminal narrowing at C5-C6, but unchanged.THORACIC SPINE

Output: 1.Interval postoperative changes relating to the bulking of exophytic intramedullary/intradural extramedullary predominant fat signal intensity mass centered at the T2 level, with residual fat components identified along the left lateral and dorsal midline cord, with slight interval increased visualization of surrounding CSF within the thecal sac.2.Interval significant increase somewhat nodular appearing enhancement within the cord adjacent to the areas of residual fat signal, likely relating to postoperative changes and granulation tissue formation. However, given the linear eccentric enhancement noted along the mass preoperatively, continued follow-up is recommended.3.Stable trace prominence of the central spinal canal within the cord just cranial to the level of the mass.


Instruction: Generate impression based on findings.

Input: New onset seizure, aphasia, right-sided weakness. Patient became combative during the scan, therefore, scan was prematurely aborted. There is no evidence of restricted diffusion lesion, therefore no evidence of acute ischemic lesion.T1 weighted sagittal scan shows no evidence of intracranial mass.Since other sequences of routine brain scan of MRI were not included on this scan, brain MRI needs to be rescheduled and rescanned.

Output: No evidence of acute ischemic infarct.Prematurely terminated exam due to patient combativeness, routine brain MRI scan is to be rescheduled and rescanned.


Instruction: Generate impression based on findings.

Input: Recent biopsy of a low grade glioma involving the brainstem, with new right 6th nerve palsy and dysphagia. There are postoperative findings related to right transfrontal biopsy of the medullary lesion. There is a small amount of susceptibility effect along the biopsy track, which traverses the lateral margin of the right red nucleus and the posterior right pons, in the region of the abducens nucleus and the root of the abducens nerve, as well as the medulla, in the region of the right hypoglossal nucleus. There is no evidence of acute infarct. There is a small amount of pneumoventricle, but the ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The paranasal sinuses and orbits are unremarkable.

Output: Postoperative findings related to right transfrontal biopsy of the medullary glioma. There is a small amount of susceptibility effect along the biopsy track, which traverses the posterior right pons, in the region of the abducens nucleus and the root of the abducens nerve, as well as the medulla, in the region of the right hypoglossal nucleus.


Instruction: Generate impression based on findings.

Input: Elevated bilirubin, assess possible biliary reconstruction, stent status, progression of metastases ABDOMEN: Exam limited by motion artifact.LIVER, BILIARY TRACT: Hepatic metastases increasing in number and overall in size, most notably at the dome. Reference IVb lesion measures 5.7 x 4.5 cm (series 401, image 25), previously 5.2 x 3.8 cm. Reference porta hepatis lesion measures 3.8 x 2.5 cm (series 401, image 25), previously 3.5 x 2.6 cm. The porta hepatis lesions appears to invade / obstruct the main portal vein, unchanged (series 1401, image 49). The intrahepatic branches of the portal vein are not visualized. Common bile duct stent is present with decompression of the extrahepatic ducts. Persistent moderate intrahepatic biliary ductal dilation. Trace ascites.SPLEEN: No significant abnormality noted.PANCREAS: Slight increase in main pancreatic duct caliber. ADRENAL GLANDS: Unchanged left adrenal nodule measures 1.7 x 0.9 cm (series 401, image 24).KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right sided ostomy. No evidence of bowel obstruction.BONES, SOFT TISSUES: Degenerative changes affect the spine.

Output: 1.Innumerable hepatic metastases increasing in number and overall in size. 2.Persistent moderate intrahepatic biliary dilation secondary to obstructive metastasis superior to the CBD stent.3.Portal vein invasion / obstruction, unchanged.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, history of lung cancer with brain metastases, follow-up examination. Ill-defined T2 hyperintensity within the bilateral periventricular white matter is unchanged. No mass effect or edema is seen. No pathologic parenchymal enhancement is detected. No evidence to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. A subcentimeter nonspecific focus of enhancement within the left occipital bone is unchanged.

Output: Treatment effects are seen with no evidence of any active intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: 16-year-old male with right shoulder dislocation presents with pain and instability. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. No intra-articular gadolinium is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is linear branching signal abnormality traversing the posterior superior glenoid labrum at the 11 o'clock position, indicating a tear.BICEPS TENDON: The tendon of the long head of the biceps appears intact ADDITIONAL

Output: Posterior superior glenoid labral tear.


Instruction: Generate impression based on findings.

Input: 34 year old female patient with history of right breast mastectomy for invasive ductal carcinoma status post chemoradiation and hormone therapy. She was recently seen in the diagnostic mammography clinic secondary to bloody nipple discharge, at which time a 4 mm hypoechoic lesion was detected posterior to the left nipple on breast ultrasound, for which breast MRI was recommended for further evaluation. There is scattered fibroglandular tissue in the left breast.Moderate parenchymal enhancement is noted in the left breast.There are post surgical changes related to right mastectomy and flap reconstruction, with findings consistent with fat necrosis along the inferior medial aspect of the flap.LEFT BREAST:Fluid is present within dilated subareolar ducts, most prominently at the 12:00 position, which measures approximately 2.8 cm in extent. There is no associated abnormal enhancement or enhancing mass lesion corresponding to the lesion seen on the breast ultrasound examination dated 1/22/2016.Again seen is an approximately 8 mm round septated enhancing mass at the 3:00 position in the left breast, consistent with a fibroadenoma, which is unchanged from the 2014 MRI examination.No abnormal axillary lymph nodes are identified in either axillary region.

Output: Fluid-containing dilated subareolar ducts, most prominently at the 12:00 position, but without associated abnormal enhancement or mass. Ultrasound-guided biopsy of the lesion seen on the prior breast ultrasound is recommended for further evaluation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: New onset complex partial seizure with 2/2 generalization. History of dementia and HTN. There is mild scattered cerebral white matter T2 hyperintensity in the cerebral white matter. There is a punctate hippocampal remnant cyst in the left side. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The is mild cerebral volume loss, which is most pronounced in the bilateral medial temporal lobes. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a nonspecific subcentimeter probable cystic lesion in the right upper eyelid laterally. The orbits, skull, paranasal sinuses, and scalp soft tissues are otherwise grossly unremarkable.

Output: Mild scattered cerebral white matter T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease, and mild cerebral volume loss that is most pronounced in the medial temporal lobes, which may indicate early Alzheimer disease. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarction.The images are being moved to a new order with the correct exam description and this order will be credited.


Instruction: Generate impression based on findings.

Input: 55 year old male with recently diagnosed renal amyloid. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 85 ml/m2 (normal range: 74+/-15), the LVEDV is 179 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 117 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is normal gadolinium kinetics. There is patchy late gadolinium enhancement in the basal interior, inferolateral, and lateral walls in addition to the mid lateral wall. This pattern of late gadolinium enhancement is atypical for myocardial infarction and could be suggestive of an underlying fibrosing, infiltrative, or inflammatory process including amyloid. Myocardial native T1 time is elevated at 1178 ms which could be consistent with underlying diffuse fibrosis.Left AtriumThe left atrium is mildly dilated. There is an aneurysmal inter-atrial septumRight VentricleThe right ventricle is normal in size with normal systolic function The overall RV ejection fraction is 60%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 195 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 77 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (37 mm) in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%. There are no regional wall motion abnormalities present. 2. There is patchy late gadolinium enhancement in the basal interior, inferolateral, and lateral walls in addition to the mid lateral wall. This pattern of late gadolinium enhancement is atypical for myocardial infarction and could be suggestive of an underlying fibrosing, infiltrative, or inflammatory process including amyloid. Myocardial native T1 time is elevated at 1178 ms which could be consistent with underlying diffuse fibrosis.3. The right ventricle is normal in size with normal systolic function The overall RV ejection fraction is 60%.4. Bilateral atrial enlargement. There is an aneurysmal inter-atrial septum5. The constellation of findings taken together are highly suggestive of cardiac amyloid.


Instruction: Generate impression based on findings.

Input: Suspicious cerebellar tonsils on a prior MRI. The cerebellar tonsils are not low-lying. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a subcentimeter Thornwaldt cyst.

Output: No evidence of Chiari type 1 malformation.


Instruction: Generate impression based on findings.

Input: 47-year-old female with left knee pain, evaluate for a medial meniscal tear. MENISCI: There is a complex tear of the medial meniscus including a radial tear which begins along the free edge of the posterior horn and extends though the junction of the posterior horn and body. It is difficult to determine whether the peripheral-most fibers are intact or spared. There is additional signal abnormality within the body and posterior horn of the medial meniscus, indicating a combination of intrasubstance degeneration and horizontal tearing. There is also medial extrusion of the body of the medial meniscus. The meniscofemoral coronary ligament is not well-visualized and may be torn. The meniscotibial coronary ligament appears thickened likely reflecting degeneration. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is near-full-thickness to full-thickness loss of cartilage along the weightbearing surface of the medial femoral condyle between the meniscal horns. There also appears to be thinning of the articular cartilage along the far medial aspect of the medial tibial plateau, with mild edema-type signal in the underlying bone. The articular cartilage of the lateral and patellofemoral compartments is intact.LIGAMENTS: There is edema along the superficial band of the medial collateral ligament. This could represent a sprain in the correct clinical context, but we suspect that is secondary to the aforementioned medial compartment pathology. The lateral collateral ligament complex intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tear of the medial meniscus as described above including a near-complete to complete radial component.2. Medial compartment articular cartilage degeneration.3. Large joint effusion and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: Left trigeminal neuralgia Please note that MRI of the complete brain was not obtained as this was done per an IAC protocol as requested.There is a mass occupying the sella, right cavernous sinus and large portion of the clivus consistent with patient's known macroadenoma. There is no significant change in size and extent of the lesion, with the bulk of the lesion measuring 2.0 x 1.5 cm (1101/1), previously 2.0 x 1.6 cm on remeasurement. Additional reference measurements cannot be made as the coronal postcontrast sequences do not include the entire extent of the tumor. No mass effect of the tumor on either the left Meckel's cave or cavernous sinus. No abnormal enhancement along the left trigeminal nerve.Enhancement of the pituitary stalk and deviation to the left aspect of the sella is unchanged. Unchanged downward tenting of the chiasm consistent with postsurgical change. Flow voids are intact. No evidence of diffusion restriction to suggest acute infarct. Orbits and skull are grossly unremarkable. Mild mucosal thickening of the ethmoid sinuses.

Output: Pituitary macroadenoma which involves the right cavernous sinus is unchanged. MRI IAC demonstrates no abnormal enhancement or mass effect along the course of the left trigeminal nerve to explain patient's symptoms.


Instruction: Generate impression based on findings.

Input: Evaluate for MS lesions, history of ptosis and right hyperreflexia There is a 7mm FLAIR hyperintensity of the left parieto-occipital junction white matter adjacent to the cortex. There are nonspecific mild punctate FLAIR hyperintensity of the left frontal, left occipital, and right occipital lobe white matter. No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.

Output: 1.There is a 7mm FLAIR hyperintensity of the left parieto-occipital junction white matter adjacent to the cortex. 2.There are nonspecific mild punctate FLAIR hyperintensities of the left frontal, left occipital, and right occipital lobe white matter. 3.The above findings are nonspecific with a differential which would include demyelination, vasculitis, and sequelae of prior inflammation or injury.


Instruction: Generate impression based on findings.

Input: There is massive pan-ventricular dilatation without MRI evidence of transependymal CSF resorption. There are no parenchymal masses or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. 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.

Output: There is massive pan-ventricular dilatation without MRI evidence of transependymal CSF resorption. There is no associated abnormal enhancement or susceptibility abnormality.


Instruction: Generate impression based on findings.

Input: 10-year-old female with elevated inflammatory markers, elevated white count, and right hip pain. Bone marrow signal is within normal limits. No acute fracture or malalignment is evident. There is low T1 and low T2 signal along the right mid sacroiliac joint representing sclerosis. There is no specific evidence of sacroiliitis. There is a trace amount of fluid within the left hip joint which is likely physiologic. No right hip joint effusion. The muscles are normal in appearance without abnormal signal. No evidence of loculated fluid collection or soft tissue calcification. There is subtle increased T2 signal along the left aspect of the coccyx in the ischioanal fossa fat.The visualized intra-abdominal contents are within normal limits. The ovaries are seen bilaterally and appear normal in appearance. There is a trace amount of free fluid is noted within the dependent portion of the pelvis.

Output: 1.Subtle increased T2 signal along the left aspect of the coccyx in the ischioanal fossa fat favored to be inflammatory in etiology although this is equivocal.2.Right mid sacroiliac joint sclerosis. 3.No right hip joint effusion.


Instruction: Generate impression based on findings.

Input: Male 56 years old Reason: cancer surveillance - rectal carcinoma. s/p transanal endoscopic microsurgical History: rectal carcinoma Overall image quality: Good, but patient refused intravenous contrast, which limits evaluation.PELVIS:PROSTATE/SEMINAL VESICLES: Diffuse low T2 signal in the peripheral zone of the prostate is nonspecific, please correlate with PSA levels.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: NoneLymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor: There is asymmetric thickening of rectosigmoid colon, this may be in part due to residual fecal material or underdistention, but given the lack of contrast cannot be characterized further. There is no abnormal diffusion signal at this region or mesorectal lymph node.Size: 2.7 x 1.8 x 3.5 cm (image 601/series 38)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Rectosigmoid region(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 4 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 9 cmCircumference of the rectum involved: 50%Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Not invaded.MRI T-stage: T2 - Tumor invades submucosal and/or tumor invades muscularis propriaNo extension outside the serosa and no encroachment on the mesorectal fascia.BONES/SOFT TISSUES: No significant abnormality noted.OTHER: Focal fat herniation through the right levator muscle.

Output: This is a limited study due to lack of IV contrast as patient refused further imaging.1.Asymmetric thickening of the rectosigmoid colon could represent neoplasm as characterized above, but given lack of contrast please correlate with direct visualization.2.Nonspecific diffuse T2 hypointensity in the peripheral zone of the prostate, please correlate with PSA levels.


Instruction: Generate impression based on findings.

Input: Headache and seizures. There are postoperative findings related to right temporal craniotomy. There is unchanged encephalomalacia in the right temporal lobe. There are also unchanged scattered foci of cerebral white matter T2 hyperintensity. The hippocampi appears to be intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is mild fusiform bulbous enlargement of the azygous anterior cerebral artery. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Postoperative findings with extensive right temporal lobe encephalomalacia and mild scattered probable chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Brain MRI: There is susceptibility artifact related to braces which limits evaluation of the frontal lobes on multiple sequences. Again seen are postsurgical changes of Chiari I decompression with preserved CSF spaces ventrally and dorsally at the neoforamen magnum, much improved since preoperative study from 5/1/2014. Cerebellar tonsils extend to the level of the upper aspect of the odontoid process. The dorsal aspect of the cerebellum more superiorly abuts the craniectomy margin as seen before. There is biphasic CSF flow ventrally and dorsally at the foramen magnum, mildly diminished posteriorly, but much improved since preoperative study from 5/1/2014.Remainder of the brain is essentially unremarkable. Prominent dural calcifications are incidentally noted. Partially empty sella is seen which can be normal variant and unchanged. Ventricles and sulci are within normal limits and unchanged. The basal cisterns remain patent. There is no midline shift or mass effect. Minimal nonspecific punctate foci of T2/FLAIR hyperintensity are seen in the frontal white matter. No diffusion abnormality. No extra-axial fluid collection. Normal flow-voids are demonstrated in the major intracranial vascular structures. Cervical MRI: There is no abnormal cord signal or evidence of syrinx. Vertebral body heights and alignment are maintained. Minimal degenerative changes are seen. There is no spinal canal or neural foraminal stenosis at any level. Bone marrow signal is benign. Paraspinous soft tissues tissues are unremarkable.Thoracic MRI: No abnormal cord signal or evidence of syrinx. Vertebral body heights and alignment in the thoracic spine are maintained. Minimal degenerative changes are seen including small left paracentral disc protrusion at the T2-T3 level as seen before, trace disc bulges more inferiorly, as well as mild degenerative changes involving the costovertebral, costotransverse, and facet joints. There is no significant spinal canal stenosis or neural foraminal stenosis at any level. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.

Output: 1. Postoperative changes related to Chiari decompression are again seen. There is biphasic CSF flow ventrally and dorsally at the foramen magnum, mildly diminished posteriorly, but much improved since preoperative study from 5/1/2014.2. No cord signal abnormality or evidence of syrinx in the spinal cord.


Instruction: Generate impression based on findings.

Input: 78-year-old female with low back pain in the sagittal distribution. Multilevel spondylosis and disc bulges with anterolisthesis of L4 on L5. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Bone marrow signal is benign. The conus terminates at the distal L1 level.Individual levels as below:T12-L1: Mild disc bulge with no significant compromise to spinal canal or neural foramina.L1-2: Mild disc bulge with no significant compromise to spinal canal or neural foramina.L2-3: There is facet hypertrophy and ligamentum flavum hypertrophy. A disc bulge is present. These cause a mild spinal canal narrowing and mild left neural foraminal stenosis. L3-4: There is facet hypertrophy and ligamentum flavum hypertrophy. A disc bulge is present. These cause a moderate canal stenosis but no neural foraminal narrowing.L4-5: There is 8 mm of anterolisthesis and a disc bulge. There is facet hypertrophy and ligamentum flavum hypertrophy. A disc bulge is present. These cause a severe spinal canal stenosis with severe left and moderate right neural foraminal stenosis. L5-S1: A disc bulge is present without spinal canal stenosis. There is bilateral mild neural foraminal stenosis.Incidentally noted right renal cyst. A structure is seen to the right of descending aorta that is demonstrated on prior exams and is favored to represent a benign vascular or lymphoid structure.

Output: 1. Multilevel degenerative spondylosis and disc bulges. These result in spinal canal stenosis and neural foraminal stenoses that is worst at the L4-L5 level.2. Anterolisthesis measuring 8 mm of L4 on L5.


Instruction: Generate impression based on findings.

Input: Male, 81 years old, with lower extremity weakness and incontinence. Assess for cord compression. Chronic spinal canal narrowing and cord impingement is seen in the cervical region due to multilevel spondylosis. Elsewhere, no acute cord compression is seen. Mild to moderate narrowing of the spinal canal is demonstrated in the lumbar region due to disc degeneration but otherwise no significant canal compromise is noted. Vertebral body heights are preserved. Alignment is grossly anatomic. The thyroid appears to be enlarged and heterogeneous.

Output: 1.No evidence of acute cord compression is seen.2.Multilevel disc degeneration, spinal canal stenosis and cord impingement in the cervical spine will be better assessed on dedicated cervical spine imaging.3.An enlarged heterogeneous thyroid gland is seen which can be evaluated non-emergently with a dedicated ultrasound examination if clinically warranted.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage of the medial compartment. Otherwise no significant abnormality noted.LIGAMENTS: The anterior cruciate ligament is ruptured. The posterior cruciate ligament and remaining ligamentous structures of the knee are intact. No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Ruptured ACL. The remaining ligamentous and tendinous structures of the knee are otherwise intact.2. Normal lateral and medial menisci.3. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Seizures. Evaluate for abscess status post cavernous malformation resection. There are postoperative changes of a left posterior temporal craniotomy for cavernous malformation resection. There is high T1 signal surrounding resection cavity and susceptibility effect indicating postoperative edema and blood blood products. There is minimal rim of peripheral enhancement along the edge of the resection cavity as well as enhancement of the adjacent dura which is nonspecific and likely related to the postsurgical changes. Peripheral restricted diffusion along the resection cavity could be from the sequela of cytotoxic edema or blood products themselves. No central restricted diffusion to suggest purulent material within the cavity. The size of the surgical cavity and edema are grossly similar to minimally larger from prior CT allowing for differences in technique. There are no abnormalities elsewhere in the brain. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Mild scalp soft tissue thickening and minimal extra-axial fluid in the left parietal region is also related to postoperative changes. The major cerebral flow voids are intact. A mucous retention cyst or polyp is present in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Evolving postoperative changes related to resection of left posterior temporal cavernous malformation. There is no specific evidence of intracranial infection, with blood products along the resection cavity, mild surrounding edema, and enhancement which may represent evolving postsurgical changes. If there is high suspicion of intracranial infection, follow-up imaging may be obtained.


Instruction: Generate impression based on findings.

Input: Ms. Mohammed is a 53-year-old female enrolled in the research breast cancer screening study for high-risk individuals. Family history of breast cancer in mother and three maternal aunts. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. However, there is mild enhancement seen in the skin of the medial right breast, which appears to be grossly similar in appearance when compared to prior MRI from 2015 and perhaps even 2010. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) No MRI evidence for malignancy in either breast. (2) Mild enhancement in the skin of the medial right breast, appearing stable when compared to prior examination. Recommend correlation with physical examination findings to ensure concordance with the image findings.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 74 years Male (DOB:12/16/1941)Reason: eval radiculopathy History: significant worsening of bilateral finger paresthesias, history of C6 radiculopathy on EMG in 2006 and C6-7 disc bulge on MRI in 2006PROVIDER/ATTENDING NAME: KAMALA GULLAPALLI COTTS KAMALA GULLAPALLI COTTS The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation present.There is T2 hyperintense lesions present within the spinal cord without mass effect. One is centered along the right hemicord centrally at the C3 vertebral level. Another is located in the central portion of the left hemicord at the C3-4 vertebral level. These are associated with subtle focal volume loss. These were also present on the MRI from 1/14/2006.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is left-sided facet hypertrophy at this level. The facet hypertrophy has progressed since 2006.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a left paramedian disc protrusion present this level. There is left-sided facet hypertrophy present at this level. The facet hypertrophy has progressed since 2006.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are endplate osteophytes present this level associated with a central disc protrusion which has mildly progressed 2006.At C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes at this level associated with disc material and only mild encroachment of the left-sided exiting nerve roots. This has minimally progressed since the previous exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The left vertebral artery flow void appears to be intact. The right vertebral artery flow-void is absent. This appearance is unchanged since an MRI of the brain from 11/23/2005 and an MRI of the cervical spine from 1/14/2006.

Output: 1.A couple lesions centered within the gray matter of the spinal cord at C2 and C3 subtle volume loss suggests that these may represent small foci of myelomalacia. These have not changed substantially since 2006.2.There are degenerative changes present cervical spine with mild encroachment of left-sided exiting nerve roots at C6-7. This has not significantly progressed since the previous exam from 2006.3.The right vertebral artery appears occluded. This has been the case since 2005. It is conceivable that this can suggest ischemia as an explanation for the patient's upper cervical cord lesions .


Instruction: Generate impression based on findings.

Input: 59 years Male (DOB:10/1/1956)Reason: staging for newly diagnosed lung cancer History: lung cancerPROVIDER/ATTENDING NAME: EVERETT E. VOKES EVERETT E. VOKES The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular punctateNormal 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.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for brain metastases


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: assess for structural lesion History: memory difficulties There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Small developmental venous anomaly is seen on the left parietotemporal lobe white matter (trigone area).The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. Developmental venous anomaly on the left posterior parietotemporal area white matter.


Instruction: Generate impression based on findings.

Input: 30 year-old female with history of the C1/2 abnormality. Cervalgia.IMAGE ACQUISITIONS: Non-infused CT of the cervical spine. There is deformity and abnormal rotation at the level of the atlantoaxial joint suggesting subluxation. Additionally, there is irregular lucency within the dens. However, no associated bone marrow signal abnormality was seen on the recent MRI and there is no soft tissue swelling in this region. More likely, the dens finding represents a chronic nonhealing fracture then an acute abnormality. Additional degenerative changes at this level including subchondral cyst formation.

Output: 1. Lucency in the dens without associated findings to suggest acute fracture. More likely the findings represent chronic nonhealing fracture.2. Rotational deformity at the atlantoaxial joint suggests subluxation. Flexion and extension radiographs could be considered to assess stability.


Instruction: Generate impression based on findings.

Input: Male 35 years old Reason: pain History: pain in right knee MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: No findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: please dom Dr Javed MS protocol, compare to priorSigns and Symptoms: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular and subcortical white matter lesions within the brain parenchyma which were also present on the prior exam from May 4, 2015.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus which was also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are small foci of T2 signal hyperintensity within the cervical spinal cord centrally and anteriorly at the C3 vertebral body level measuring approximately 3 mm in size along the right posterior lateral aspect of the spinal cord at the T3-4 disc space level, along the left lateral aspect of the spinal cord at the C45 disc space level measuring 3 mm and along the right posterior lateral aspect of the spinal cord at the C6-7 disc space level measuring 2 x 3 mm.. There is an additional lesion present at the T7 T1 level along the right posterior lateral aspect of the spinal cord. None of these are associated with contrast enhancement. Compared to the prior exam 5/13/2015 these lesions are stable.No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. This has not changed substantially since the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There is a left lateral recess disc protrusion present at this level which was also present on the prior exam and encroaches on the left-sided exiting nerve roots at the left lateral recess..At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions present in the cervical spinal cord which appears stable when compared to prior exam.2.There are multiple lesions present within the brain parenchyma which appears stable compared to the prior exam.3.There are degenerative changes present in the cervical spine associated with left lateral recess disc protrusion at C5-6 which encroaches on the left-sided exiting nerve root and is stable since the prior exam.


Instruction: Generate impression based on findings.

Input: 45-year-old woman with history of slurred speech and lower extremity spasticity. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. There is no intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. A few, punctate foci of susceptibility artifact are noted in the subcortical cerebral white matter, likely small foci of hemosiderin deposition or mineralization. There is no abnormal parenchymal or meningeal enhancement. The major flow-voids are preserved. The sella and orbits are grossly within normal limits. The paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. CERVICAL SPINE

Output: 1.No intracranial findings to explain the patient's symptoms.2.Multilevel cervical degenerative disease, progressed from the prior examination. There is spinal canal stenosis and mild cord impingement at C4/C5 without evidence of edema or acute inflammation.3.Numerous borderline enlarged bilateral cervical lymph nodes. Correlation with clinical and laboratory findings is suggested.


Instruction: Generate impression based on findings.

Input: Male, 9 years old, with posterior pituitary proteinaceous cyst, follow-up examination. Redemonstrated is an oval hypoenhancing structure situated between the anterior and posterior pituitary glands. This lesion measures up to 6 mm in length and shows no significant interval change in size or morphology.The pituitary gland is otherwise within normal limits. The pituitary stalk sits at midline and demonstrates normal enhancement. No lesions of the suprasellar cistern or optic chiasm are demonstrated.

Output: Stable pituitary lesion most likely representing a pars intermedia cyst.


Instruction: Generate impression based on findings.

Input: Male 71 years old with history of terminal ileal enteritis, gas/bloating, and lower abdominal pain. Assess for small bowel wall thickening, mass lesion. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are a few bilateral subcentimeter renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Status post appendectomy. Sigmoid colon diverticulosis without evidence of diverticulitis.There is no evidence of acute or chronic small bowel or colon inflammation. No stricture or fistula is identified.BONES, SOFT TISSUES: Status post fusion of L2-L5.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Status post fusion of L2-L5.OTHER: No significant abnormality noted.

Output: No bowel wall thickening or evidence of acute or chronic inflammation.


Instruction: Generate impression based on findings.

Input: Evaluate for residual lesion s/p skull lesion resection. There are postoperative findings related to recent resection of a left parietal skull lesion and cranioplasty, without evidence of residual lesion. There is trace extra-axial fluid in the surgical bed and mild diffuse dural enhancement and overlying scalp swelling and fluid. There are also subcentimeter foci of vasogenic edema in the brain parenchyma superficially deep to the surgical site. There is no evidence of intracranial mass lesions, midline shift, or territorial cerebral infarction. The ventricles are normal in size and configuration. The cerebellar tonsils are slightly low-lying, but display rounded morphologies.

Output: Postoperative findings related to recent resection of a left parietal skull lesion, without evidence of residual lesion.


Instruction: Generate impression based on findings.

Input: Reason: To evaluate for any strucural lesion. (Seizure 2 protocol) History: seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the right sphenoid sinus and scattered mucosal thickening elsewhere. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for an intracranial mass lesion or other source of the patient's seizures.


Instruction: Generate impression based on findings.

Input: Male; 76 years old. Reason: 76 yo M with history of pancreatic side branch IPMNs History: rule out growth of IPMNs ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No biliary ductal dilatation. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Stable multi-lobulated, septated T2 hyperintense lesion in the uncinate process which appears to communicate with the pancreatic duct and measures up to 4 x 1.6 cm, unchanged (series 5/51). No significant enhancement.Stable lobulated T2 hyperintense lesion at the anterior aspect of the pancreatic neck which appears to communicate with the pancreatic duct and measures up to 1.3 x 0.9 cm, unchanged (series 5/32). No significant enhancement.Mild dilation of the main pancreatic duct including focally in the pancreatic head measuring up to 8 mm (series 8/24), not significantly changed since prior studies dating back to 4/19/13.The above findings are most compatible with combined-type IPMN.Subcentimeter pancreatic body side branch-type IPMN is unchanged (series 5/44). No significant enhancement.ADRENAL GLANDS: Small left adrenal nodule, unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable combined-type and side branch-type IPMNs.


Instruction: Generate impression based on findings.

Input: Reason: cognitive decline History: episodic memory decline The lateral ventricles are large. There is no sulcal effacement present however the sulci are relatively thin.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 demonstrates a mucus retention cysts in the maxillary sinuses and some scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.Findings suggest mild ventriculomegaly. The possibility of normal pressure hydrocephalus cannot be excluded. Please correlate with the patient's clinical symptoms


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with medically intractable epilepsy. Presurgical evaluation. Sensorimotor cortical activation of the hand and face maps as expected along the pre- and post-central gyri. Reliable sensorimotor cortical activation of the foot could not be achieved despite repeat attempts. Passive visual simulation elicits primary visual cortical activation along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation and sentence completion paradigms. Language is left dominant. Broca's area, which is visualized on both paradigms, maps to the pars opercularis of the left inferior frontal gyrus. Wernicke's area, which is visualized on the sentence completion paradigm, maps along the posterior aspect of the left superior temporal sulcus.

Output: The sensorimotor cortex for hand and face is well delineated. Sensorimotor cortex for the foot could not be reliably visualized.The primary visual cortex is identified as expected along the bilateral calcarine sulci.Language is left dominant. Broca's and Wernicke's areas are identified in their customary locations.


Instruction: Generate impression based on findings.

Input: 40 years, Female, Reason: assess pancreas History: abdominal pain and elevated lipase. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: 0.9-cm (13/44) segment 8 hyperenhancing lesion which is bright on T2 likely represents a flash filling hemangioma.SPLEEN: Mild splenomegaly. Subcentimeter hyperenhancing lesion the spleen likely represents a hemangioma.PANCREAS: Nonspecific cystic foci involving the head of the pancreas, 7 mm (7/46) and tail, 6 mm (7/69) which do not appear to indicate but the pancreatic duct. Normal enhancement throughout the pancreas. There is normal ductal morphology without evidence of divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nonspecific subcentimeter cysts within the pancreas. Follow-up is recommended.2.Small hemangiomas in the liver and spleen.


Instruction: Generate impression based on findings.

Input: Nasolacrimal duct cyst versus epidermal cyst: 1cm nodule on left nasal side wall. There is a well-defined ovoid T2 hyperintense and T1 hypointense non-enhancing lesion in the subcutaneous tissues of the left nasolabial fold that measures up to 9 mm. The lesion does not involve the nasolacrimal duct and the underlying bone is intact. There is a right tympanomastoid effusion. There is a small retention cyst in the left maxillary sinus. There appears to be a small right temporomandibular joint effusion and mild anterior subluxation of the mandibular condyle. The salivary glands are unremarkable. There is a defect in the left orbital floor with protrusion of orbital fat and mild deformity of the left inferior rectus muscle, likely secondary to prior trauma. The imaged intracranial structures are unremarkable.

Output: 1. A well-defined cystic lesion in the subcutaneous tissues of the left nasolabial fold that measures up to 9 mm likely represents an epidermal inclusion cyst. 2. Right tympanomastoid effusion.3. Small right temporomandibular joint effusion and mild anterior subluxation of the mandibular condyle, which may indicate temporomandibular joint dysfunction.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post Omaaya placement. Signs and symptoms: Same Nonenhanced head CT:Interval placement of a right frontal Omaaya placement.The tip of the shunt catheter is in the dilated right frontal horn. Minimal expected post operative air in the ventricle and the subarachnoid space is present.There is no definitive decrease in the size of the ventricles since prior MRI exam.Extensive post operative changes of a left anterior temporal lobectomy and residual encephalomalacia is noted.

Output: 1. Expected pot op changes of right frontal ventricular catheter with the tip in the right frontal horn.2. No change in the size of dilated supra tentorial ventricles.3. Stable exam otherwise.


Instruction: Generate impression based on findings.

Input: Male 59 years old Reason: eval for internal derangement History: knee effusion. MENISCI: The body of the medial meniscus appears attenuated compared to that of the lateral meniscus. This may reflect chronic attritional fraying or possibly prior meniscectomy, but we see no discrete meniscal tear.There is a tiny focus of increased signal intensity along the free edge of the body of the lateral meniscus, best seen on the sagittal images, suggestive of a small radial tear of questionable clinical significance. There is globular intrasubstance signal within the anterior and posterior horn suggestive of intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is near-full-thickness to full-thickness degeneration of the articular cartilage of the anterior aspect of the medial tibial plateau. There is signal abnormality in the underlying subchondral marrow that may be degenerative in etiology or reflect prior orthopedic intervention, such as microfracture. There is also near-full-thickness to full-thickness degeneration of the articular cartilage of the medial femoral condyle, just above the posterior horn of the medial meniscus.There is a near-full-thickness to full-thickness degeneration of the articular cartilage of the femoral trochlea, particularly centrally and along the medial facet, with underlying intra-articular osteophytes and subchondral cysts. There is also near-full-thickness degeneration of the articular cartilage of the patella along the medial facet.The articular cartilage of the lateral compartment is relatively intact. There is edema type signal along the posterior aspect of the lateral femoral condyle that is nonspecific and may represent a bone contusion or be degenerative in etiology. There are small tricompartmental osteophytes.LIGAMENTS: Anterior cruciate ligament is intact. There is a prominent meniscofemoral ligament extending from the posterior horn of the medial meniscus to the medial aspect of the lateral femoral condyle, but we see no discrete posterior cruciate ligament; we are uncertain if this reflects prior trauma or a peculiar anatomic variant. The medial collateral ligament appears intact. There is a small ossicle between the medial collateral ligament and underlying medial femoral condyle that is surrounded by low signal intensity that may represent scarring from prior injury. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degenerative arthritic changes as described above, predominantly affecting the medial and patellofemoral compartments.2.Findings suggestive of a tiny radial tear of the body of the lateral meniscus. Attenuation of the body of the medial meniscus may reflect chronic attritional fraying or prior partial meniscectomy, but we see no findings to suggest an unstable meniscal tear.3.Nonvisualization of the PCL may reflect prior injury or, perhaps, a peculiar anatomic variant.4.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 56 years old. Severe pain and swelling. Sjogren's. MENISCI: There is partial extrusion of the body of the medial meniscus with globular internal signal abnormality which is not definitely extend to an articular surface. There is apical blunting/finding loss of the anterior horn of the lateral meniscus. ARTICULAR CARTILAGE AND BONE: There is mild diffuse cartilage thinning of the patella, with a focal full-thickness defect along the lateral patellar facet with mild underlying marrow signal abnormality as well as a partial-thickness defect near the apex. There is a large area of full thickness cartilage loss involving the medial femoral condyle and medial tibial plateau with bone marrow reactive changes predominantly affecting the femoral condyle and to a lesser degree the tibial plateau. The lateral tibiofemoral articulation shows mild to moderate diffuse cartilage thinning without focal defect or underlying marrow signal abnormality.LIGAMENTS: Cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Full-thickness cartilage loss involving the medial tibiofemoral articulation with bone marrow reactive changes predominantly affecting the medial femoral condyle. Associated partial extrusion of the body of the medial meniscus without definite tear.2.Focal patellar full-thickness cartilage defects and associated marrow reactive changes as above.3.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Ms. Araujo is a 39-year-old patient with a family history of breast cancer in her sister diagnosed at age of 29. She presents for MRI screening evaluation. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Moderate to marked background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.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.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. There is mildly heterogeneous diffuse bone marrow signal. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There are mild disc osteophyte complexes throughout the cervical spine and mild facet arthropathy at C5-C6 and C6-C7. There is mild spinal canal stenosis at C6-C7. There is no significant neural foraminal stenosis.THORACIC SPINE

Output: 1. No evidence of fracture, subluxation, spinal cord compression, or abnormal spinal cord signal.2. Heterogeneous marrow signal in the cervical spine is nonspecific, but assessment for multiple myeloma is limited by the lack of contrast.3. Multilevel mild degenerative spondylotic changes in the cervical and lumbar spine.4. Subcentimeter perineural cyst at the right L3-4 neural foramen with inferior displacement of the exiting L3 nerve root and bilateral Tarlov cysts at the S2 level with expanded foramina.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 85-year-old male with right ankle pain, edema on MRI. Evaluate for neoplasm versus unusual insufficiency fracture There is diffuse soft tissue swelling. There is periosteal reaction along the medial malleolus and distal tibial diaphysis that is more prominent on current study than the prior study. We see no discrete fracture line, however there is slight increase in sclerosis along the anterior aspect of the distal tibial epiphysis that corresponds to the suspected insufficiency fracture seen on prior MRI.

Output: Increase in periosteal reaction along the medial tibia and focal sclerosis along the anterior tibial epiphysis may represent an unusual insufficiency fracture as suggested on prior MRI.


Instruction: Generate impression based on findings.

Input: MRI for preoperative planning of a sphenoid sinus mucocele/fluid filled lesion to sinus near artery with boney erosion. There is a globular T2 hyperintense and T1 hypointense lesion with thin peripheral mucosal enhancement that completely occupies the left sphenoid sinus and measures up to 25 mm. The walls of the left sphenoid sinus are diffusely thinned. The other paranasal sinuses and intracranial structures are unremarkable.

Output: Findings suggestive of left sphenoid sinus mucocele formation.


Instruction: Generate impression based on findings.

Input: 39 year-old female with multiple sclerosis diagnosed in 2005. MRI BRAIN: There is a new left pontine lesion with low T1 signal and a newly apparent patchy T2 hyperintense lesion in the right middle cerebellar hemisphere. Otherwise, there has been no significant interval change of the T2 hyperintense cerebral white matter and small medial left cerebellar hemisphere lesions, which are predominantly distributed in the periventricular regions. Many of the lesions demonstrate T1 hypointensity, but there is no evidence of associated enhancement. The ventricles are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. There is mild persistent scattered paranasal sinus mucosal thickening. The skull and extracranial soft tissues are unchanged. MRI CERVICAL SPINE: There is redemonstration of scattered abnormal T2 signal in multiple reasons of the cord throughout the cervical and thoracic spine cord. No enhancing lesions are identified. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. There is mild disc desiccation signal throughout the cervical spine and mild disc height loss at C5-6. The vertebral bone marrow is unremarkable. A posterior disc osteophyte complex with central disc protrusion is demonstrated at C5-C6 with mild flattening of the ventral spinal cord. There is no significant neural foraminal stenosis is evident.

Output: 1. Newly apparent infratentorial demyelinating lesions. The supratentorial demyelinating lesions otherwise appear to be similar as on the prior exam, accounting for differences in technique. 2. The demyelinating lesions in the cervical and thoracic spinal cord do not appear significantly changed, given differences in technique.3. Interval central disc protrusion at C5-C6 that mildly indents the spinal cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Elevated PSA. No pathology available.October of 2015 was found to have a PSA of 36 ng/mL. In November it was repeated and found to be 41 ng/mL. In September of 2015, he underwent a transrectal ultrasound-guided biopsy which showed no evidence of cancer. Hesubsequently underwent an MRI on November 25, 2015, which suggested an abnormality measuring approximately 2 cm at the right base and mid portion of his prostate within the transition zone and extending anteriorly into the periprostatic space. An MR-guided biopsy at that point suggested 16 mm ofGleason 8 cancer at the right mid, 5 mm of Gleason 8 cancer at the right apex, 5 mm of Gleason 8 cancer at the left mid. PELVIS:PROSTATE:Prostate Size: 3.9 x 5.3 x 4.6 cmPeripheral Zone: The peripheral zone is relatively T2 weighted hyperintense with several band like linear regions of hypointensity. There is also nearly diffuse T1-weighted hyperintensity of the peripheral zone, findings compatible with blood product, and limiting evaluation. Bandlike focal thickening in the right lateral apex measuring 1.0 x 0.6 cm (series 301/53) demonstrating low T2 weighted signal intensity, likely related to blood product. Ill-defined region of low ADC and T2-weighted signal in the left mid-gland (series 403/184 and series 601, image 15) may represent a site of disease.No additional discrete abnormality. Central Gland: Centered in the right mid gland is 2.1 x 2.0 x 2.1 cm T2-weighted mildly hypointense poorly defined lesion (series 801 /14) with associated restricted diffusion (series 403/264). The lesion demonstrates avid relatively early enhancement (series 1 401/2 337).Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The mass centered in the right mid gland transitional zone appears to extend anteriorly where it obscures the right anterolateral prostatic margin suspicious for extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant 2.1 cm lesion in the mid-portion of the right mid-gland with suspected right anterolateral extraprostatic extension.


Instruction: Generate impression based on findings.

Input: 4-month-old male with persistent vomiting and macrocephaly. Increased head circumference in past one month. Please evaluate for hydrocephalus. There are bilateral extra-axial fluid collections in the frontal regions. There are no clearly visible bridging cerebral veins to indicate a subarachnoid location. Based on the current study, chronic subdural hematoma cannot be excluded. Recommend MRI for further evaluation of these fluid collections as clinically indicated.The ventricles and basal cisterns are slightly prominent but not clearly abnormal.The calvaria appears enlarged. The skull base is radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Bilateral extra-axial fluid collections. Chronic subdurals versus subdural hygroma. Recommend MRI to better evaluate as clinically indicated.


Instruction: Generate impression based on findings.

Input: Subcentimeter nodule in the right lobe of thyroid on MRI. Please evaluate. RIGHT LOBE MEASUREMENTS: 2.7 x 1.8 x 6.0 cmLEFT LOBE MEASUREMENTS: 2.6 x 1.6 x 5.6 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: 2 complex nodules. The superior nodule measures 1.4 x 1.3 x 2.1 cm and the second nodule at the equator measures 1.6 x 1.3 x 2.2 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: Complex isthmic nodule measures 1.4 x 0.6 x 1.1 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple complex thyroid nodules as described.


Instruction: Generate impression based on findings.

Input: Suspected neural foraminal stenosis bilaterally at C6-7-C8 level: bilateral arm numbness. There is an eccentric left disc extrusion or perhaps a sequestration associated with a small posterior disc osteophyte complex at the C6-7 level that results in marked impingement of the exiting left nerve roots and slight indentation of the left aspect of the spinal cord. There is mild right neural foraminal stenosis at C6-7. There are also posterior disc-osteophyte complexes at C4-5 and C5-6 levels, with mild spinal canal, moderate left C4-5 and C5-6 neural foraminal stenosis, and severe right C5-6 neural foraminal narrowing. There is mild right C7-T1 uncovertebral joint hypertrophy, but no significant spinal canal or neural foraminal stenosis. The C1 though C4 levels are unremarkable. There is no abnormal signal within the spinal cord. The vertebral column alignment is anatomic. The vertebral body heights are preserved. There is a hemangioma in the T2 vertebral body. The paraspinal soft tissues are unremarkable. However, there are multiple thyroid nodules.

Output: 1. An eccentric left disc extrusion or perhaps a sequestration associated with a small posterior disc osteophyte complex at the C6-7 level results in marked impingement of the exiting left nerve roots and slight indentation of the left aspect of the spinal cord. 2. Posterior disc-osteophyte complexes at C4-5 and C5-6 levels result in mild spinal canal, moderate left C4-5 and C5-6 neural foraminal stenosis, and severe right C5-6 neural foraminal narrowing. 3. Mild right C7-T1 uncovertebral joint hypertrophy, but no significant spinal canal or neural foraminal stenosis. 4. Multiple thyroid nodules.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, with history of Ehlers Danlos syndrome, status post multiple shoulder surgeries for ligamentous laxity, with chronic limitations of mobility of the right shoulder and upper extremity. Evaluate for a structural cause. Vertebral body alignment is anatomic. However, the spinolaminar line is slightly angulated at the C6-7 level, likely a developmental finding. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.The intervertebral discs are intact with no evidence of any significant bulging or herniation. The spinal canal and neural foramina remain patent.

Output: 1.No evidence of any significant vertebral body abnormality is seen. 2.The spinal canal and neural foramina are widely patent throughout the cervical spine. No abnormalities of the spinal cord are detected.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with history of lung cancer metastases to the brain status post radiosurgery. A lesion in the left inferior frontal lobe demonstrating minimal peripheral enhancement shows no significant interval change in size when compared to the prior examination. Likewise, a mildly rim-enhancing lesion in the left cerebellum shows no significant interval change in size.A punctate enhancing focus within the left intraparietal sulcus is less conspicuous than on the prior examination. Previously described punctate enhancing lesions within the right superior parietal lobule and along the right occipital cortex are no longer distinctly visualized.None of the above mentioned lesions cause any significant edema. No new lesions are identified. No generalized mass effect is detected. The ventricles remain normal in size and morphology.

Output: Lesions in the left inferior frontal lobe and left cerebellum show no significant interval change. A punctate lesion within the left intraparietal sulcus is less conspicuous than on the prior examination. Two other previously described punctate lesions are no longer distinctly visualized. No new lesions are seen.


Instruction: Generate impression based on findings.

Input: There is redemonstration of the infiltrating nonenhancing mass involving the hypothalamus extending into the optic chiasm, thicker on the left side. It measures 16 x 21 x 14 mm (1101/7, 1201/15) compared to 17 x 20 x 13 mm, and remains similar to baseline. There is redemonstration of focal thickening of the contiguous left prechiasmatic optic nerve likely also relating to tumor involvement.Dedicated images through the sella demonstrate a normal height of the pituitary gland. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. There is redemonstration of patchy areas of T2/FLAIR hyperintensity along the deep gray nuclei, cerebral peduncles, brainstem, cerebellum as well as within the left amygdala/medial temporal lobe, where there is also mild expansion without enhancement. There is slight interval fluctuation of these findings, with slight increased size of the rounded left cerebellar lesion (now measuring up to 12 mm, compared to previous 7 mm) as well as of the medial right basal ganglia lesion. Other areas including within the cerebellar white matter appear slightly less prominent. Faint linear susceptibility is again noted along the right precentral gyrus which may relate to a capillary telangiectasia. There is no diffusion abnormality. The ventricles and basal cisterns are within normal limits. There is no midline shift or herniation. There is no extra-axial fluid collection. The major cerebral flow voids are intact.

Output: 1.Continued stable appearance of presumed hypothalamic/optic glioma with mild extension to involve the left prechiasmatic optic nerve.2.Slight interval fluctuation of FASI as detailed above. No significant associated mass effect.3.Continued mild expansion with abnormal signal involving the left mesial temporal lobe. Continued follow-up is recommended to evaluate for possible primary neoplasm.4.Unremarkable MR appearance of the pituitary gland.


Instruction: Generate impression based on findings.

Input: 84-year-old male with multiple bilateral hypodense lesions in the kidneys ABDOMEN: Lack of IV contrast and motion limits evaluation examination. LIVER, BILIARY TRACT: Extensive metastatic lesions throughout the liver consistent with metastatic disease. The largest lesion is in the left lobe measuring 3.3 x 3.6 cm, segment 2/3. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left superior pole, heterogenous, predominantly T2 hypointense renal mass measuring 2.7 x 3.1 cm is suspicious for malignancy. T1 hyperintense, T2 hyperintense, partially exophytic lesion in the interpolar right kidney may represent a hemorrhagic or proteinaceous cyst. Minimally complex left interpolar renal cyst. RETROPERITONEUM, LYMPH NODES: Infrarenal aortic aneurysm is partially visualized, not significantly changed in AP diameter when measuring at similar levels. There is peripheral isointense signal around the aorta, incompletely assessed. BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Nodule in the right middle lobe is again noted. Basilar atelectasis.

Output: Lack of IV contrast and motion limits evaluation examination. 1.Left superior pole renal mass as detailed above suspicious for malignancy. Predominant T2 hypointensity suggests papillary subtype. 2.Innumerable liver masses compatible with metastases. 3.Infrarenal aortic aneurysm with peripheral isointense signal around the aorta may reflect a chronic dissection or peripheral thrombus, incompletely assessed. A dedicated CTA is recommended to evaluated the aorta. 4.Right middle lobe nodule, indeterminate and better seen on prior CT imaging.


Instruction: Generate impression based on findings.

Input: Prior MRI spine showing enhancement in pons: left sided decreased sensation, brisk reflexes in LE bilaterally. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered T2 hyperintensity in the cerebral white and pontine matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Scattered T2 hyperintensity in the cerebral white and pontine matter likely represents chronic small vessel ischemic disease. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 79 year old female with continued burning chest pain, prior abnormal stress. First Pass PerfusionDuring hyperemia, a perfusion defect is noted in the basal anteroseptum and the mid inferoseptum, anteroseptum, anterior, and anterolateral walls. Based on the atypical distribution of the perfusion defect, the differential diagnosis includes microvascular dysfunction and epicardial coronary disease. Left VentricleThe left ventricle is normal in size and global function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), the LVEDV is 100 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 48 g/m2, and the LV mass is 86 g. There are no regional wall motion abnormalities present. There is late gadolinium enhancement involving the basal inferior, inferoseptal, and anteroseptal walls. In the inferior wall it is in a mid-wall pattern; however, in the inferolateral and anterolateral walls it is subendocardial and involves ~50% of the wall thickness. Although this pattern is consistent with myocardial infarction, it may also represent an infiltrative process as the wall thickness is preserved.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 86 ml (normal range 110+/-24), the RV end systolic volume index is 16 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsHiatal hernia is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, a perfusion defect is noted in the basal anteroseptum and the mid inferoseptum, anteroseptum, anterior, and anterolateral walls. Based on the atypical distribution of the perfusion defect, the differential diagnosis includes microvascular dysfunction and epicardial coronary disease.2. There is late gadolinium enhancement involving the basal inferior, inferoseptal, and anteroseptal walls. In the inferior wall it is in a mid-wall pattern; however, in the inferolateral and anterolateral walls it is subendocardial and involves ~50% of the wall thickness. Although this pattern is consistent with myocardial infarction, it may also represent an infiltrative process as the wall thickness is preserved.3. Normal LV size and systolic function (LVEF 66%).4. Normal RV size and systolic function (RVEF 66%).5. Moderate tricuspid regurgitation.6. Hiatal hernia is noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Epilepsy: MRI for use during laser ablation. There is a transoccipital approach laser probe with a peripherally-enhancing ablation zone involving the right hippocampus and posterior amygdala. The ventricles are normal in size and configuration. There is no midline shift or herniation.

Output: Expected findings related to repeat right amydohippoampal laser ablation.


Instruction: Generate impression based on findings.

Input: Left salivary duct carcinoma ex pleomorphic adenoma status post chemotherapy and left deep lobe parotidectomy and neck dissection with pathology showing metastatic carcinoma in 4/19 lymph nodes. There are post-treatment findings in the neck, including left deep lobe parotidectomy and neck dissection. There is diffuse edema in the remaining portions of the left parotid gland, likely related to treatment effects, but no measurable tumor in the parotidectomy bed. The left submandibular gland also appears to be mildly edematous. The right-sided salivary glands are unremarkable. There is no residual significant cervical lymphadenopathy, including in the supraclavicular regions. The thyroid gland is unremarkable. The osseous structures are intact. There is mild ethmoid and left maxillary sinus mucosal thickening. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck without evidence of measurable residual left parotid tumor or significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Cerebral cyst, follow-up evaluation. Also bilateral leg and arm pain with hot/cold paresthesias, particularly involving the lower legs, no specific distribution. Brain MRI:There has been no significant change of a large extra-axial CSF signal intensity lesion overlying the left frontal, temporal and parietal lobes. It again measures 5.3 x13.4 cm in the transverse and oblique AP dimensions at the level of the foramen of Monroe, when measured in the same locations utilized previously. Overall, there is now less left hemispheric mass effect as best evidenced by slightly decreased left lateral ventricular effacement, and a decrease in left-to-right midline shift (measuring 1-2 mm, previously 5 mm). This is presumed secondary to an increase in overall calvarial vault growth and volume, combined with stable mass dimensions. There is outward convexity of the calvarium over this lesion similar to prior. There remains some superior displacement of the distal left MCA branches. There are no other acute new abnormalities including any additional intracranial mass or fluid collection. There is no diffusion abnormality. Mastoid air cells are clear. Complete spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The conus is normal in signal and morphology and terminates at L2. Upon prone imaging, the conus and cauda translate anteriorly. The visualized paraspinal contents are unremarkable. There are no segmentation anomalies.

Output: 1.There has been no significant change of a large extra-axial CSF signal intensity lesion overlying the left frontal, temporal and parietal lobes. Overall, there is now less left hemispheric mass effect as best evidenced by slightly decreased left lateral ventricular effacement, and a decrease in left-to-right midline shift (measuring 1-2 mm, previously 5 mm). This is presumed secondary to an increase in overall calvarial vault growth and volume, combined with stable mass dimensions.2.Negative complete spine MRI without cord signal abnormality, fatty filum, Chiari malformation, tethered cord, or segmentation anomaly.


Instruction: Generate impression based on findings.

Input: Reason: assess lines placement History: lines presentVIEW: Chest and abdomen AP (two views) on 5/31/16 time stamped at 10:21. The endotracheal tube tip has been retracted and is now at the level of the carina. There are small lung volumes. The left lung collapse has slightly improved with minimal aeration of the left lung base. There is significant soft tissue edema and abdominal distention. The umbilical venous catheter tip is at the level of the left hepatic vein. The umbilical artery catheter terminates at T8. The NG tube is in the stomach. There is an overall paucity of abdominal gas with peripherally displaced bowel gas, consistent with the abdominal mass identified on the MRI. A catheter seen within the urinary bladder.

Output: The endotracheal tube tip has been retracted and is now at the level of the carina.


Instruction: Generate impression based on findings.

Input: Evaluate for stability of hemangioma, left lower extremity weakness, pain, and radicular signs. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with T2/STIR hyperintense lesion with enhancement involving the L4 vertebral body, right greater than left, most compatible with a hemangioma. Lesion measures up to 3 cm in diameter similar to prior. Subcentimeter T1 hyperintense lesion involving the superior L1 vertebral body is also compatible with small hemangioma. The conus medullaris is normal in position. Individual levels as 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: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Unchanged enhancing L4 lesion most compatible with a hemangioma.2. No spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 75-year-old female with history of cholelithiasis and cervical cancer. Evaluate for obstructive jaundice and abdominal pain, especially in the right upper quadrant. ABDOMEN:LUNG BASES: Bibasilar atelectasis. Borderline cardiomegaly. Coronary artery calcification.LIVER, BILIARY TRACT: The liver is enlarged and measures 18.3 cm craniocaudally. Hydropic gallbladder is probably filled with sludge. The gallbladder measures more than 12 cm in length and the wall is mildly thickened and edematous. The common bile duct diameter is only 6 mm. No intrahepatic biliary duct dilatation. There are large periportal, hepatic hilar and celiac lymph nodes which have increased in size since the 2007 examination. Findings may be due to acute on chronic cholecystitis. Dedicated multiphase liver CT or MRI exam may be helpful in delineating a subtle neoplastic lesion, although this etiology is less likely. SPLEEN: The spleen is enlarged and measures 14.4 cm. Subcentimeter splenic hypodensities are stable. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus and adnexa are present. There are calcific densities in the vicinity of the cervix due to prior therapy. No associated lymphadenopathy.BLADDER: 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: Interval development of hydropic gallbladder containing sludge with enlargement of celiac, portal and hepatic hilar lymph nodes. Common bile duct and intrahepatic ducts are not dilated. Findings may be due to acute on chronic cholecystitis, but a small neoplasm cannot be excluded.