Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of brain, unspecifiedClinical question: MRI for pre-op planning for resection of right intraventricular tumorSigns and Symptoms: s/p craniotomy with EVD placement with residual tumor notedComments: There is redemonstration of an intraventricular mass present along the body of the right lateral ventricle. There is associated enlargement of the lateral ventricles which was also present on the prior exam as well as a fluid fluid level in the right lateral ventricle probably representing some blood products. A ventricular catheter courses through the right frontal lobe into the midline and subsequently extends to the third ventricle and has its tip in the third ventricle. The patient is status post removal of ventriculostomy tube previously coursing through the left frontal lobe. There is a tract of T2 high signal present where this catheter previously was present.There is redemonstration of subgaleal fluid present adjacent to bilateral frontal and parietal calvaria which appears to have increased in thickness when compared to the 11/17/2015 exam. It currently measures approximately 12 mm in thickness and previously measured approximately 9 mm in thickness. It is extent also appears to have increased AP dimension was previously around 96 mm and is now approximately 118 mm.The patient is status post right frontal craniotomy. There is a hyperintense T2 signal present within the right frontal lobe extending to the right lateral ventricle.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 mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A right-sided intraventricular mass is known to represent a central neurocytoma.2.There are postsurgical changes present with subgaleal fluid. The possibility of a CSF leak cannot be excluded on the basis of this exam.3.Abnormal signal in the right frontal lobe most likely represents postoperative change4.Ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Nonalcoholic fatty liver. ABDOMEN:LIVER, BILIARY TRACT: Although there is mild loss of signal intensity on out of phase imaging this is significantly improved from the prior study.The liver is normal in morphology and size, measuring 19.7 cm in the craniocaudal dimension.Stable segment 6 hemangioma measuring 3.5 x 2.9 cm (series 6/18). Additional segment 4A hemangioma is noted.No suspicious liver lesion or biliary ductal dilatation. The vessels are patent.SPLEEN: The spleen is normal in size morphology and signal intensity.PANCREAS: The pancreas is normal in morphology and enhancement. The main pancreatic duct is normal in caliber with normal ductal anatomy.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. Relatively mild fatty infiltration of the liver, significantly improved from the prior study.2. Stable hepatic hemangiomas.


Instruction: Generate impression based on findings.

Input: 54-year-old male with radiculopathy to the left fifth digit. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.There is no abnormal STIR signal to suggest acute marrow edema. The marrow signal appears unremarkable. The cerebellar tonsils are in normal position. The cervical medullary junction appears normal.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 mild left facet hypertrophy and mild left neural foraminal stenosis, unchanged. Redemonstration of central protrusion with indentation of the anterior thecal sac.At C4-5 small central, extrusion with anterior indentation of the thecal sac. Mild left facet hypertrophy and mild left neural foraminal stenosis.At C5-6 redemonstration of a broad-based central disc protrusion. Mild right greater than left facet hypertrophy with bilateral mild neural foraminal stenosis.At C6-7 there is a broad-based central disc protrusion with extension inferiorly 7 to 8 mm. Bilateral moderate neural foraminal stenosis.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.At T1-T2 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.C3/4: There is a small central broad-based protrusion with indentation of the anterior thecal sac.2.C4/5: Small central extrusion with anterior indentation of the thecal sac. Mild left neural foraminal stenosis.3.C5/6: Broad-based central disc protrusion with bilateral mild neural foraminal stenosis4.C6/7: Broad-based central disc protrusion with extension inferiorly 7 to 8 mm. Bilateral moderate neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 82 years, Female, vertigo and ataxia, stroke workup. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is mild global parenchymal volume loss, which is appropriate for age.Patchy foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic disease. There are a scattered foci of susceptibility effect consistent with chronic microhemorrhages involving the right thalamus, posterior left putamen, as well as the right anterior temporal subcortical white matter. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild opacification of the bilateral ethmoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct.2. Mild to moderate chronic small vessel ischemic disease.3. Few scattered foci of chronic microhemorrhage which may be related to chronic hypertension.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter as well as the pons. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are punctate foci of susceptibility effect in the right thalamus, consistent with hemosiderin deposition from chronic microhemorrhage. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the bilateral frontal, ethmoid, maxillary, and sphenoid sinuses.MRA BRAIN: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis. There is a 2 to 3 mm outpouching at the origin of the left posterior communicating artery.

Output: 1. Chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage or acute infarct. 2. Prominent infundibulum versus aneurysm at the left posterior communicating artery origin. 3. No evidence of significant stenosis affecting the Circle of Willis vessels.


Instruction: Generate impression based on findings.

Input: Snuffbox tenderness, recent wrist trauma, persistent pain/swelling. Question of scaphoid fracture. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear grossly intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears grossly intact.TENDONS: No significant abnormality noted. BONES: There is osteophyte and subchondral cyst formation at the basilar joint compatible with osteoarthritis. Foci of increased T2 signal within the lunate and triquetrum are compatible with cysts. No fracture is evident.ADDITIONAL

Output: 1. No scaphoid fracture is identified.2. Basilar joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: Reason: Rule out chronic scapholunate ligament tear History: Pain and popping LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact. No intra-articular gadolinium is identified within the radiocarpal joint.TRIANGULAR FIBROCARTILAGE COMPLEX: There is intermediate signal intensity within the articular disc of the triangular fibrocartilage complex indicating mild degeneration. The triangular fibrocartilage complex appears intact. No significant amount of fluid is identified within the distal radial ulnar joint.TENDONS: The flexor and extensor tendons appear intact. BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: No evidence of scapholunate or lunotriquetral ligament disruption.


Instruction: Generate impression based on findings.

Input: MRI Brain: There is redemonstration of hemorrhage within the left thalamus and throughout the ventricular system. The temporal horns are symmetrically prominent and proportional to the lateral ventricles. There is some additional small foci of susceptibility parenchymal abnormality including within the left parietal region and the lateral left basal ganglia which are nonspecific. There is no midline shift or herniation.MRA Head: The intracranial internal carotid arteries, middle cerebral arteries and right anterior cerebral artery are patent without significant stenosis. There is a hypoplastic left A1 segment. The proximal V4 segments are not well-visualized but is felt to be artifactual. Otherwise the vertebral arteries and basilar artery are patent without significant stenosis. There are fetal-type posterior cerebral arteries bilaterally which are developmental variants. No evidence of aneurysms or vascular malformations.

Output: 1.No significant interval change in the acute hemorrhage within the left thalamus and throughout the ventricular system.2.The temporal horns are symmetrically prominent and proportional to the lateral ventricles. However, continued close follow-up is suggested.3.Intracranial vasculature within normal limits and without flow-limiting stenosis, aneurysm or arterial vascular malformation.


Instruction: Generate impression based on findings.

Input: 47 year old with hypertension presenting for evaluation of atypical chest pain. MEDICATIONS: amlodipine, aspirin, atorvastatin, metoprolol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 211 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 56 g/m2, and the LV mass is 119 g. There are no regional wall motion abnormalities present. Native T1 times are normal 955 ms. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 200 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size. .Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThe aortic root is borderline in size (sinus of Valsalva 40 mm). The ascending thoracic aorta is dilated (46 mm 4 cm above the aortic valve plane). No obvious thoracic aortic dissection. 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 FindingsThe esophagus appears mildly dilated. A large subcarinal mass (probably lymph node) is noted (cross sectional diameter 2-2.5cm). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 64%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and systolic function (RVEF 55%).5. Dilated ascending thoracic aorta at 46 mm without evidence of obvious thoracic aorta dissection.6. Large subcarinal mass, probably lymph node.


Instruction: Generate impression based on findings.

Input: continued pain and swelling following a right subcondylar fracture two weeks ago There appears to be discontinuity of the medial epicondyle of the humerus with a small avulsed fracture fragment which is displaced distally by approximately 5-6 mm (image 12, series 801). There is also edema within the lateral epicondyle. There is increased T2 signal within the soft tissues of the elbow, more prominently along the medial aspect, compatible with edema/inflammatory changes. There is a small amount of fluid in the elbow joint adjacent to the olecranon fossa with some enhancement of the synovium. The visualized tendons are intact. There is a lesion within the visualized mid to distal biceps muscle which demonstrates intrinsic T1 signal on fat-saturated images, increased T2 signal, and some enhancement. The surrounding fascial planes appear intact.

Output: 1. Avulsion fracture of the medial epicondyle with surrounding soft tissue inflammatory changes.2. T1 and T2 hyperintense lesion within the biceps muscle is non-specific. The differential includes strain/hemorrhage though facial planes appear relatively intact, an atypical hemangioma, or other soft tissue lesion. Follow up MRI is recommended to prove stability/resolution.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with history of Chiari with syrinx, presenting with worsening back pain. Assess for changes. The cerebellar tonsils descend 6 to 7 mm below the level of the foramen magnum. However they maintain a normal round contour and the CSF space at the foramen magnum is circumferentially patent. Robust biphasic CSF flow is seen both dorsally and ventrally through the foramen magnum.No evidence of abnormal signal or syrinx is seen in the cervical spinal cord. In the thoracic cord, very slight prominence of the central canal measuring no more than 1 mm in diameter is seen beginning at approximately T3 and continuing down to T11. The appearance is similar to prior. No abnormalities of the conus or cauda equina are seen. No intraspinal fatty material is detected.The cervical lordosis is mildly reversed similar to prior. Alignment in the remainder of the spine is unremarkable. The vertebral bodies demonstrate normal morphology and signal characteristics. No evidence of marrow edema is detected.At C5-6, disc osteophyte formation is seen with a focal right foraminal protrusion which seems to have increased in size since the prior examination. There is progressive moderate right foraminal narrowing. No significant generalized spinal canal stenosis is seen. The left foramen is patent.At C6-7, disc osteophyte formation is seen with a left foraminal disc protrusion. This appears relatively similar to the prior examination. There is a mild generalized spinal canal narrowing and moderate left foraminal narrowing. The right foramen is patent.Elsewhere in the spine, no significant disc disease, canal stenosis or foraminal narrowing is seen.

Output: 1. Findings are redemonstrated compatible with Chiari malformation. The cerebellar tonsils do, however, maintain a normal contour and the CSF space is circumferentially patent through the foramen magnum.2. Minimal prominence of the central spinal canal is seen in the thoracic region showing no significant change. This can reflect normal variation, though in the appropriate clinical context, can also represent minimal syrinx formation.3. At C5-6, there appears to be progression of a right foraminal disc protrusion with slightly worsened foraminal narrowing.4. At C6-7, a disc protrusion in the left foramen is similar to the prior exam.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no MRI findings of ligamentous injury.Incidental note is made of a mildly retroflexed odontoid tip.C2/3: UnremarkableC3/4: Mild left uncinate hypertrophy without resulting stenosis.C4/5: UnremarkableC5/6: Minimal disc bulge without significant associated mass effect or resulting stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: 1.There are no MRI findings of ligamentous injury.2.There are no disc herniation or stenoses.3.C3/4: Mild left uncinate hypertrophy without resulting stenosis.4.C5/6: Minimal disc bulge without significant associated mass effect or resulting stenosis.


Instruction: Generate impression based on findings.

Input: THORACIC SPINE: The vertebral column is within normal limits. There are several small posterior disc-osteophyte complexes throughout much of the thoracic spine, without significant spinal canal stenosis. The vertebral body and disc heights are maintained. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.LUMBAR SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is degenerative spondylosis in the lower lumbar spine. In particular, at L3-L4, there is diffuse disc bulge resulting in mild-to-moderate narrowing of the left neuroforamen, but no significant right neural foraminal or spinal canal narrowing. At L4-L5, there is a disc bulge with mild-to-moderate bilateral neural foraminal narrowing. At L5-S1, there is a disc bulge with a superimposed small left foraminal disc protrusion, resulting in moderate-to-severe left neural foraminal narrowing, mild right neural foramen stenosis, as well as slight spinal canal stenosis. The paraspinal soft tissues are unremarkable.

Output: 1. Degenerative spondylosis in the lower lumbar spine with up to moderate-to-severe left and moderate right neural foraminal stenosis at L5-S1, but no significant spinal canal stenosis. 2. Mild multilevel posterior disc-osteophyte complexes in the thoracic spine without evidence of significant spinal canal stenosis.3. No evidence of infiltrative marrow disease or spinal cord lesions.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracerebral hemorrhage, intraventricular [I61.5], Reason for Study: ^Reason: eval for new infarct History: worsening LUE weakness Brain MRIMultifocal scattered restricted diffusion lesions involving bilateral frontal lobe and corpus callosum splenium (right ACA and MCA territory as well as left ACA territory) as well as right cerebellar hemisphere indicating acute ischemic infarct (vertebrobasilar artery territory).Acute intracranial hemorrhage involving right basal ganglia and intraventricular hemorrhage are seen with encephalomalacia on the right frontal lobe indicating chronic ischemic infarction (right MCA territory).Ventriculostomy tube is inserted through the right lateral ventricle frontal horn and the tip is located at or around right side foramen of Monro, comparing to prior CT scan, there is no significant interval change of ventricle size. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the right MCA from the distal right ICA as well as fine arterial signal intensities on the distal left ICA at or around the origin of the left ACA A1 segment. The vertebrobasilar artery system appears to be normal.Constellation of above findings indicate possible Moyamoya phenomenon

Output: 1. Acute ICH at the right basal ganglia with acute IVH on bilateral lateral ventricles.2. Acute ischemic infarctions involving bilateral frontal lobes (bilateral ACA and right MCA territory), corpus callosum splenium and right cerebellar hemisphere (vertebrobasilar system territory).3. Chronic ischemic infarction at the right frontal lobe (right MCA territory).4. Ventriculostomy tube inserted through the right frontal burr hole, unchanged since prior CT scan.5. Non visualization of the right ACA A1 segment and MCA with multiple small arterial signal intensities on the left ICA bifurcation indicate Moyamoya phenomenon (disease).


Instruction: Generate impression based on findings.

Input: Alcoholic cirrhosis status post TACE RFA. Evaluate for HCC. History of biopsy-proven well-differentiated hepatocellular carcinoma 3/31/2016. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic fibronodular liver morphology. Segment 6/7 ablation cavity measures approximately 5.6 x 2.5 cm with intrinsic T1 weighted signal hyperintensity. No evidence of marginal recurrent or residual disease.Segment 3 1.0 x 0.9 cm lesion (series 1 101/167) which demonstrates mild arterial enhancement but no definite washout. It is associated with mild T2-weighted hyperintensity. The lesion is slightly more discrete when compared to the prior study.Several punctate intrinsically T1 weighted hyperintense foci are unchanged.No additional suspicious arterially enhancing lesion or lesion demonstrating washout on delayed phase imaging. On delayed phase imaging there are several punctate circumscribed hypointense foci which become more conspicuous which is likely related to the background fibrosis.No intra or extrahepatic biliary ductal dilatation.Cholelithiasis within a normally distended gallbladder. No evidence of gallbladder inflammation.Hepatic vasculature appears patent.Trace perihepatic ascites. Recannulation of the periumbilical vein.SPLEEN: Normal splenic size with numerous Gamna-Gandy bodies. Trace perisplenic fluid.PANCREAS: No pancreatic ductal dilatation. No focal lesion.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: New vague T2-weighted signal hyperintensity of a mid thoracic vertebral body only seen on the coronal images, correlate with the recent nuclear medicine bone scan.Heterogeneous subcutaneous fat and periumbilical region compatible with recent hernia repair.OTHER: No significant abnormality noted.

Output: 1.Post ablation changes of segment 6/7 without evidence of marginal recurrent or residual disease.2.Arterially enhancing 1.0 cm segment 3 lesion without washout does not meet strict imaging criteria for HCC. Continued short interval follow-up is recommended.3.Cirrhotic fibronodular liver morphology with trace ascites and recannulated periumbilical vein.


Instruction: Generate impression based on findings.

Input: Reason: possible TFCC tear History: wrist pain. LIGAMENTS: Given the limitations of a non-arthrographic study, we see no abnormality of the intrinsic ligaments of the wrist. TRIANGULAR FIBROCARTILAGE COMPLEX: The articular disc of the triangular fibrocartilage complex appears intact.TENDONS: The tendons are within normal limits. BONES: The bones appear normal.ADDITIONAL

Output: Normal appearing wrist with no significant findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 69 year old female with retropharyngeal abscess. Please evaluate for spread to mediastinum. Images through the skull base and including cavernous sinuses remain within normal limits. Mastoid air cells and paranasal sinuses are also well pneumatized and unremarkable. Images through the soft tissues of the neck demonstrate edematous changes of the retropharyngeal space however no definitive evidence of an abscess is detected. Extensive post therapy changes are identified. Soft tissue prominence at the base of tongue is believed to be artifactual and secondary to placement of endotracheal tube. No definitive evidence of mass is identified. There are no old films available for comparison. No evidence of any abnormal enhancing nodes is detected.Increased soft tissue density with cavity formation is noted in the prevertebral space at the level of the larynx and extends inferiorly to at least to the level of the aortic arch in the mediastinum. The quality of images are very poor and further evaluation with an MRI is recommended. At the level of larynx this cavity contains air and may indicate patient's known abscess. At C6 and C7 within intervertebral disk a small amount of air collection may represent vacuum phenomenon however this is immediately at the level of abscess and although the bony density of the spine is not suggestive of osteomyelitis this possibility cannot be entirely ruled out and further investigation with MRI is recommended. This finding is best appreciated on axial images 63 and 64. The largest transverse diameter of this abscess cavity at the level of C5 -- C6 intervertebral disk space measures 33.2-mm (axial image 64 of 88). The cranial cephalad axis of the abscess measures approximately 82 mm. A component of this lesion within the mediastinum appears more solid and contains male multiple linear areas of increased density which may be vascular. This raises the possibility of a neoplastic process. This finding causes anterior displacement of the trachea and is best appreciated on axial image 76 to 88. The finding at this level on this examination is inseparable from the esophagus.Extensive apical scarring of bilateral lungs is noted. Significant amount of pleural effusion on the left and to lesser degree on the right is noted.

Output: 1.Prevertebral abscess extending from the level of the larynx to approximately the level of aortic arch in the mediastinum.2.The intra mediastinum component of this finding is more solid with no air collection and demonstrates multiple vasculature which may indicate presence of the mass in addition to more superiorly located abscess.3.On this examination possibility of osteomyelitis specifically at C6 and C7 cannot be rule out due to apparent continuity of air within the disk space and air within the abscess.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign intracranial hypertension Arnold-Chiari syndrome without spina bifida or hydrocephalus. Other disorders of meninges, not elsewhere classifiedClinical question: Chiari malformation, 4th ventricle stent, pseudomeningocele, please do with CSF flow studySigns and Symptoms: headaches, neck pain MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post suboccipital craniotomy and resection of the posterior arch of C1. There is a fluid collection present behind the C1 arch measuring approximately 33 x 12 mm axial dimensions which are stable compared to the prior exam. There is redemonstration of stent coursing through the foramen Magendie and into the fourth ventricle with tip at the top of the fourth ventricle. It is unchanged in positionCSF flow study indicates biphasic flow without any convincing evidence for obstruction at the level of the foramen magnum. Flow is also identified through the shunt tubing.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is no evidence for syrinx.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.Status post surgery for Chiari malformation with shunt placement. There is no evidence for obstruction to CSF flow. The postoperative findings including a small fluid collection overlying the dura are stable.2.There is no evidence for ventriculomegaly or syrinx.


Instruction: Generate impression based on findings.

Input: Family history of breast cancer in her mother, maternal aunt, and maternal grandmother. Personal history of benign left breast MR biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Cysts are again noted bilaterally. No abnormal enhancement is seen in either breast. Scattered enhancing foci in the left breast are stable.No abnormal axillary lymph nodes are identified in either axillary region. Mildly prominent symmetric lymph nodes are stable and not suspicious.

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


Instruction: Generate impression based on findings.

Input: 39-year-old female with heavy bleeding. Evaluate size and number of uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus measures 11.4 cm in AP, 8.6 cm in transverse, and 10.1 cm in craniocaudal diameter. There is a 5.3 x 5.1 x 3.3 cm submucosal fibroid causing a contour deformity of the endometrium (axial series 5 image 23, sagittal series 7 image 21, coronal series 6 image 25). Smaller anterior and posterior intramural fibroids are also noted. There are multiple subcentimeter nabothian cysts. Normal bilateral ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mildly enlarged uterus containing multiple fibroids, the largest of which is submucosal in location measuring 5.3 x 5.1 x 3.3 cm.5.3 x 5.1 x 3.3 cm submucosal fibroid


Instruction: Generate impression based on findings.

Input: Restaging olfactory neuroblastoma Face: Again seen are post-operative findings related to right medial maxillectomy and right anterior and posterior ethmoidectomy. There is no significant change in the enhancement within the right frontoethmoid treatment bed with small areas of low T2 signal. There is persistent mucosal thickening in the right maxillary sinus, slightly decreased in the interval. There is no new or enlarging mass. No new enhancement or mass involving the orbits. There is leftward nasal septal deviation. There is a subcentimeter Thornwaldt or nasopharyngeal retention cyst. There is a nonspecific 10 mm right level 2 lymph node which is not significantly changed since at least CT dated 10/30/2015 and favored to be reactive. Additional small scattered cervical lymph nodes are also nonspecific. No significant cervical lymphadenopathy by size criteria. Evidence of right thyroid lobectomy also noted.Brain: There is no evidence of intracranial extension of tumor. There is an unchanged prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable and there is no evidence of acute infection or 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.

Output: 1. No significant change in findings related to right sinonasal surgery with stable enhancement and focus of T2 hypointensity in the right superior anterior ethmoid surgical bed. These findings are nonspecific with possibility of posttreatment change versus stable small residual tumor. PET may be useful for further evaluation.2. No evidence of intracranial tumor.


Instruction: Generate impression based on findings.

Input: Reason: anterior vaginal mass History: enlarging anterior vaginal mass, postpartum 3 weeks, suspect urethral diverticulum. PELVIS:UTERUS, ADNEXA: Postpartum uterus anteverted and anteflexed in position. The right ovary measures 1.8 x 4.4 cm. The left ovary measures 2.3 x 3.2 cm. Both ovaries demonstrate normal follicles. No adnexal masses are identified.BLADDER: The bladder appears normal. There is mild circumferential thickening of the urethra with mildly increased mucosal enhancement suggestive of urethritis. No suspicious urethral masses are identified. There is no evidence of urethral diverticulum.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: Findings suggestive of urethritis without evidence of urethral mass or diverticulum.


Instruction: Generate impression based on findings.

Input: 80-year-old female with history of bilateral lumpectomies April 2015, on hormonal therapy. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), with postsurgical changes of bilateral lumpectomies. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. There is a small round benign morphology mass in the central left breast which appears slightly prominent but has also been seen on prior mammogram and MRI examinations, and may represent a proteinaceous cyst. A subcentimeter partially calcified oil cyst is noted in the left retroareolar region.

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


Instruction: Generate impression based on findings.

Input: 82-year-old male with CHF, COPD presents with shortness of breath. Recently off Coumadin with elevated d-dimer. PULMONARY ARTERIES: Technically adequate pulmonary embolus examination without evidence of pulmonary embolus.LUNGS AND PLEURA: Multiple punctate calcifications consistent with prior granulomatous disease. Emphysema affects the upper lobes bilaterally. Mild atelectasis at the lung bases bilaterally.MEDIASTINUM AND HILA: Heart size within normal limits. Pacemaker leads terminate in normal position. No pericardial effusion. Atherosclerotic disease affects the visualized aorta. No mediastinal lymphadenopathy.Within the posterolateral aspect of the trachea in a non-dependent position is a 9 mm soft tissue density which is adherent to the right aspect of the tracheal wall, best seen on image 60/115, coronal series. The soft tissue density may represent adherent mucous or debris however further evaluation with bronchoscopy, if clinically warranted, may be considered as an underlying mass cannot be entirely excluded. Emergency room physician Dr. Melinda Graber was notified of results of these findings at 10 a.m.CHEST WALL: Multiple small axillary lymph nodes are not pathologic by size criteria. Minimal gynecomastia may be due to medication or may be physiologic. Pacemaker seen within the subcutaneous tissues of the left chest wall.UPPER ABDOMEN: Multiple punctate calcifications throughout the liver and spleen spleen consistent with prior granulomatous disease. Focal hyperdensity measuring approximately 4 mm adjacent to the right renal hila likely represents vascular calcification. No evidence of hydronephrosis. A nonspecific small adrenal nodule measuring approximately 24 Hounsfield units could be secondary to adenoma. Dedicated adrenal MRI may be considered for further evaluation.

Output: 1. No evidence of pulmonary embolus.2. Tracheal soft tissue density may represent adherent mucous or debris, however, further evaluation with bronchoscopy, may be considered as an underlying mass cannot be entirely excluded. Emergency room physician Dr. Melinda Graber was notified of results of these findings at 10 a.m.


Instruction: Generate impression based on findings.

Input: Knee pain. Evaluate for chondromalacia. MENISCI: No significant abnormality noted. No fluid-filled tear is seen.ARTICULAR CARTILAGE AND BONE: There is a focus of near-full-thickness to full-thickness cartilage loss at the lateral aspect of the medial patellar facet, without underlying bone marrow reactive changes. The cartilage of the tibiofemoral compartments appears normal.LIGAMENTS: No significant abnormality noted. The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Cartilage loss at the medial patellar facets bilaterally, left greater than right, as described above.


Instruction: Generate impression based on findings.

Input: Male 58 years old with prostate cancer scheduled for surgery. Evaluate for nerve sparing approach and extraprostatic disease. Biopsy showed adenocarcinoma in the right medial base, right mid medial and lateral, right apex medial and lateral, left mid medial and lateral and left apex medial and lateral. PELVIS:PROSTATE:Prostate Size: 4.7 x 2.5 x 3.9 cmPeripheral Zone: There are multiple small foci of hypointensity on T2 and ADC images. A 3 mm focus in the right mid gland and a 4 mm focus in the left mid gland (series 801, image 20) also demonstrate early contrast enhancement suspicious for adenocarcinoma.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Bone marrow signal intensity is within normal limits for the patient's age.OTHER: Note is made of a utricle cyst.

Output: Small foci of signal abnormality suspicious for prostate adenocarcinoma particularly in the right and left mid gland. No evidence of extracapsular extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of pituitary adenoma. Dedicated images of the sella demonstrate enhancing tissue within the right and left posterior aspect of the sella and abutting the right cavernous sinus. Enhancing tissue in the posterior sella measures 6x7 mm (sagittal post gad series 901, image 8/17). There is CSF signal involving the left anterior aspect of the sella with tiny nodule, noted on coronal T2 weighted image 6/15. No findings to suggest tumor within the cavernous sinuses or in the suprasellar cistern. Optic chiasm appears unremarkable. Minimal rightward midline shift of the infundibulum. Compared to comparison study from 11/9/2013, appearance of the sella is unchanged.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. There is mild global parenchymal volume loss with slight prominence of the ventricular system. No findings to suggest hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Minimal mucosal thickening involving the maxillary and ethmoid sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Subcentimeter enhancing tissue within the left posterior aspect of the sella is compatible with residual adenoma while enhancing tissue within the right aspect of the sella likely representing at least predominantly normal pituitary gland tissue. Cystic lesion within the left anterior aspect of the sella may represent a cystic component of the adenoma versus unrelated Rathke cleft cyst. There is no change in appearance of the sella between 11/2014 and 11/2013, and comparison with prior studies would be helpful. No significant mass effect or suprasellar extension.2. Images of the brain demonstrate no evidence of infarct or intracranial mass effect.3. Mild chronic small vessel ischemic disease.4. Global parenchymal volume loss, which appears advanced for patient's stated age.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with lung adenocarcinoma. Assess for brain metastases. No pathologic intracranial enhancement is seen. No edema or mass effect is detected. There are numerous foci of T2 hyperintensity scattered through the cerebral white matter which are non-specific. No intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: 1.No evidence of intracranial metastases.2.Scattered non-specific foci of white matter signal abnormality may reflect chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 23 years old, with seizures. No restricted diffusion is seen. No evidence of focal parenchymal signal abnormality, edema or mass effect is detected. The pattern of intracranial enhancement is within normal limits. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology. The mesial temporal structures are symmetric and unremarkable.

Output: 1.No acute intracranial abnormality.2.No specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: T10 vertebral body lesion. Possible metastatic disease. Head and neck cancer. 49-year-old male. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: T10 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Clinical question: 28 day old male HSV in CSF. Drain involvement? Signs and symptoms: HSV in CSF. Non-enhanced CT of brain:There are small foci of increased density along the medial aspect of right anterior temporal tip. The larger of these findings measures approximate the 4-mm times 4-mm on coronal reformatted image 17 an approximately 5 mm in transverse axis on axial post infusion imaging 8. The smaller lesions measure approximately 3 mm on axial image 7. I cannot be certain whether these represent subtle enhancement which which could represent a meningeal enhancement or may represent minimal parenchymal hemorrhage. In either case considering patient's clinical history a follow-up exam with an MRI is recommended. There is paucity of cortical sulci and the ventricular system remains small the patient's stated age of 27 days although no definitive edema is detected the findings may represent subtle underlying diffuse parenchymal edema. There is no evidence of midline shift. Images through posterior fossa are essentially unremarkable.Above findings were discussed at the time of interpretation with Dr.Gui.

Output: Small foci of increased density in the right anterior temporal lobe which may represent minimal enhancement or small amount of parenchymal hemorrhage. Paucity of cortical sulci and the small lateral ventricles may also represent subtle underlying parenchymal edema. Further follow-up with a dedicated MRI examination is recommended.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a heterogeneous T2/FLAIR hyperintense lesion within the cerebellar vermis, with areas of intrinsic T1 shortening and several foci of susceptibility artifact corresponding to previously noted calcifications as well as minimal patchy enhancement. Mild mass effect on the posterior wall of the fourth ventricle is again noted, without associated hydrocephalus. The mass is best delineated on the T2-weighted images. It currently measures 2.4 cm transverse x 3.0 cm AP on 401/9, likely without significant interval change when compared to more remote exams provided differences in technique and angulation.Low-lying cerebellar tonsils again extend 7 mm below the foramen magnum without peg-like appearance. There is moderate crowding. No evidence of diffusion restriction or midline shift. No new pathological enhancement is identified. There is no extra-axial fluid collection. Normal flow voids are identified in the major intracranial vessels. There is mild mucosal thickening in the maxillary sinuses.

Output: 1. No significant interval change in heterogeneous midline cerebellar vermian lesion with foci of calcification and enhancement with unchanged differential.2. Stable low lying but rounded cerebellar tonsils, possibly relating to the mass effect from the cerebellar vermian lesion. Please correlate clinically


Instruction: Generate impression based on findings.

Input: MRI brain The ventricles and sulci are within normal limits. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes, unchanged from prior. There is stable chronic lacunar infarct in the left external capsule. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild scattered opacification of the paranasal sinuses, minimally improved.MR thoracic spine: The thoracic spine is in normal alignment, with slightly exaggerated normal thoracic kyphosis. The vertebral heights are well-maintained. There is developmental ventral narrowing of the intervertebral disc between T4-T5 and fusion of the vertebrae posteriorly. There is mild disc desiccation and narrowing scattered along the mid to lower thoracic spine. There is mildly diffuse heterogeneous marrow signal which is nonspecific, with minimal endplate degenerative changes in the thoracic spine. There is a rounded T1 and T2 hypointense lesion in the T9 vertebral body, which likely represents an atypical hemangioma. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is a subcentimeter perineural cyst at right T8 level. There is mild thickening of the ligamentum flavum and facet arthropathy at the T12-L1 level. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. No evidence of acute intracranial ischemia, edema or mass effect.2. Moderate chronic small vessel ischemic disease and chronic lacunar infarct in the left external capsule, unchanged.3. Mild degenerative changes in the thoracic spine, otherwise unremarkable MRI. There is developmental partial fusion of T4-T5.


Instruction: Generate impression based on findings.

Input: History of C5 fracture. Neck pain. There is reversal of cervical lordosis. Chronic wedging deformity of C5 and C6 vertebrae is present. There is extensive degenerative disease of the cervical spine. At C2 - C3 intervertebral level, there are facet arthropathic changes. At C3 - C4 intervertebral level, there are facet and uncovertebral joint arthropathic changes. There is disk protrusion causing spinal canal stenosis. At C4 - C5 intervertebral level, there is disc-osteophyte complex, causing spinal canal stenosis. There are degenerative changes of the uncovertebral joints and facet joints, causing bilateral neural frontal narrowing which is greater on the left. At the C5 - C6 intervertebral level, there is posterior disc-osteophyte complex, causing spinal canal stenosis. There is facet and uncovertebral joint degenerative disease, causing bilateral neuroforaminal narrowing, greater on the right. At the C6-C7 intervertebral level, there is posterior disc-osteophyte complex, causing spinal canal stenosis. There is facet and uncovertebral joint degenerative disease, causing bilateral neuroforaminal narrowing.The thyroid glands appear enlarged, with nodularity and calcifications.

Output: 1. Degenerative disease of the cervical spine as described above. Please also refer to MRI of the cervical spine findings for further correlation.2. Enlarged thyroid glands, with nodules and calcifications. This may represent goiter, but malignancy is difficult to be excluded. Please also correlate with thyroid imaging study and other clinical parameters.


Instruction: Generate impression based on findings.

Input: 15-year-old female with history of right shoulder pain and instability. ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is unremarkable. There is no fluid within the subacromial or subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a complete tear of the anterior/inferior glenoid labrum from the 3 to 6 o'clock position compatible with a soft tissue Bankart lesion. Amorphous intermediate signal abnormality inferior to the glenoid likely represents degenerating torn labrum. While there is blunting of the anterior glenoid, there is no cortical discontinuity to suggest a bony Bankart lesion. There is a tiny focus of full-thickness articular cartilage loss along the anterior/inferior glenoid. A 7 mm oval low signal intensity loose body located posteriorly in the joint likely represents the aforementioned articular cartilage fragment. Additionally, there is a small cortical depression along the posterolateral aspect of the superior humeral head compatible with a mild Hill-Sachs deformity.BICEPS TENDON: The biceps tendon is unremarkable. ADDITIONAL

Output: 1.Complete tear of the anterior/inferior glenoid labrum compatible with soft tissue Bankart lesion as well as a mild Hill-Sachs deformity.2.Loose body located posteriorly in the joint likely represents an avulsed fragment of glenoid articular cartilage.


Instruction: Generate impression based on findings.

Input: Male, 13 years old, with imbalance. Evaluate for demyelination. Multiple patches of T2 hyperintensity are seen within the spinal cord including at the C2-3, C6, C7 and T4 levels. Lesions at C2-3 and C7 show mild enhancement with questionable enhancement at T4. The lesions result in no significant spinal cord expansion. Elsewhere, cord signal intensity, morphology and pattern of enhancement are within normal limits.Anomalous vertebral development is seen at C3-4 with a small C3-4 disk space and mild wasp-waisting of the vertebral bodies, as well as fusion of the right sided C3-4 facet joints and the spinous processes.Vertebral body morphology is otherwise unremarkable. There is a mild reversal of the normal cervical lordosis centered at C3-4. Elsewhere spinal alignment is smooth and anatomic. Marrow signal characteristics are within normal limits. No pathologic marrow enhancement is seen.The spinal canal and neural foramina are widely patent throughout.

Output: 1. Multiple spinal cord lesions are demonstrated which would be compatible with a diagnosis of demyelinating disease. At least two of these lesions show evidence of enhancement.2. Abnormal vertebral body morphology at C3-4 which may represent a Klippel-Feil spectrum anomaly.


Instruction: Generate impression based on findings.

Input: 16 year-old female with right hip pain. Evaluate for labral tear. ACETABULAR LABRUM: There is mild blunting of the acetabular labrum, which may be postsurgical in etiology given the history of labral repair.ARTICULAR CARTILAGE AND BONE: Mild CAM deformity again noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Focal nodular thickening of the synovium near the insertion of the iliopsoas appears slightly decreased from the previous exam. This finding is nonspecific, though may represent focal synovitis, possibly from iliopsoas impingement.2.Small CAM deformity again noted.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. No intracranial hemorrhage or diffusion weighted abnormalities. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. There is a solitary focus of white matter punctate T2 hyperintensity in the left anterior peri-insular white matter (series 6, image 15). Given the solitary nature of this lesion, it is likely of no clinical significance. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: No cerebellar ectopia to suggest Chiari malformation.


Instruction: Generate impression based on findings.

Input: Left sided facial swelling. Assess for infection. Brain MRI:There is no acute infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. There is no mass or abnormal intracranial contrast enhancement. There is no extra-axial fluid collection. The major intracranial vascular flow voids are preserved.Mastoid air cells are clear. A well-circumscribed T2-hyperintense, contrast-enhancing lesion, measuring up to 1.5 cm, involving the right parietal bone may represent an incidental hemangioma.Orbits MRI:There is thickening and infiltrative T2-hyperintense signal involving the left cheek area extending medially to the left nasal side wall without drainable fluid collection. There is no or very minimal involvement of the left preseptal/preorbital tissue. The orbits are unremarkable accounting for the chronic right inferior orbital blowout fracture with associated fat herniation and apparent tethering of the inferior rectus muscle.Moderate mucosal thickening in the inferior aspect of the left maxillary sinus has not changed since previous CT scan. This is associated with inflammatory changes involving the left premaxillary and retromaxillary fat along with periosteal contrast enhancement which correlates with periosteitis on the previous CT scan. Adjacent periodontal disease involving teeth #15 and 16 is better assessed on the CT scan. The mild mucosal thickening and opacification in the ethmoid sinuses is unchanged. Cranial MRV:The dural venous sinuses are patent as well as the internal cerebral veins. There is also no cortical vein thrombosis. There is no definite thrombosis of the cavernous sinuses, which are fairly symmetric.

Output: 1.Left facial soft tissue inflammatory/infectious changes without drainable fluid collection are probably related to underlying left chronic maxillary sinusitis, which in turn is probably odontogenic given the adjacent periodontal disease (teeth #16 and 15), which is better assessed on the CT scan.2.Chronic right orbital floor blowout fracture. No other post septal orbital abnormality.3.No dural venous thrombosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Neck and back pain. Signs and symptoms: Neck and back pain. Nonenhanced cervical spine MRI:There is normal anatomical alignment of vertebral column however the mild straightening of the cervical lordosis which could be positional.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord.There is no significant degenerative changes of cervical spine.There is no evidence of spinal stenosis or neural foraminal compromise at any level.Nonenhanced thoracic MRI:There is normal anatomical alignment of the vertebral column and with normal signal intensity on all MRI sequences.No significant degenerative changes of thoracic spine is detected.No evidence of spinal canal compromise or stenosis at any level.Mild facet and ligamentum flavum hypertrophic changes results in mild neural foraminal compromise bilaterally at T8-T9 and left neural foraminal at T7-T8 levels. There is normal signal intensity and caliber of thoracic cord.Unremarkable paraspinal soft tissues.Nonenhanced lumbosacral spine:The alignment of the vertebral column is anatomical.The signal intensity of the vertebral column is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild disc desiccation and a tiny central shallow disc protrusion (axial T2 series 25 image 25) resulting in slight indentation of thecal sac without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc desiccation, mild bilateral facet and ligamentum flavum hypertrophy, mild bilateral facet effusion, midline shallow disc protrusion (axial T2 series 25 image 31) resulting in mild flattening deformity of the thecal sac however without spinal stenosis or neural foraminal compromise.L5-S1 demonstrate mild disc desiccation and mild facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. No paraspinal soft tissue abnormalities. There is mild bilateral facet effusion.

Output: 1.Nonenhanced cervical MRI is unremarkable.2.Nonenhanced MRI of thoracic spine demonstrate mild bilateral neural foraminal compromise at T8-T9 and left neural foraminal T7-T8 levels and unremarkable exam otherwise.3.Nonenhanced MRI of the lumbar spine demonstrate small central disc protrusions at L3-L4 and L4-L5 levels with mild indentation of the thecal sac however without spinal stenosis or neural foraminal compromise. Mild bilateral facet effusion at L4-L5 and L5-S1 and unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 55 years, Male, Reason: evaluate renal lesion, rule out renal recurrence History: hx of prostate cancer, renal cell carcinoma sp partial nephrectomy. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter cyst in the left hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes in the left upper pole. There are multiple bilateral renal cysts, some of which are hyperintense on T1 weighted images including a left mid pole cyst measuring 2.1 cm (10/16), which likely represent hemorrhagic/pronation is contents. No enhancing tissue to suggest local recurrenceRETROPERITONEUM, LYMPH NODES: Enlarged right para-aortic lesion measuring 2.0 x 1.5 cm (7/24).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the lumbar spine with hardware from lower lumbar spinal fusion.OTHER: No significant abnormality noted.

Output: 1.No evidence of local recurrence.2.Enlarged retroperitoneal lesion. Differential includes a primary retroperitoneal mass, including a pheochromocytoma, versus an enlarged malignant lymph node.3.Bilateral hemorrhagic renal cysts.


Instruction: Generate impression based on findings.

Input: 57 years Female (DOB:1/25/1959)Reason: preop planning for tumor resection History: loss of smellPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI There is a 40 mm x 40 mm axial dimension extra-axial mass located in the anterior cranial fossa at the midline which involves the cribriform plate. It has a stellate pattern of flow voids centrally within it. There is a small amount of the associated T2 signal hyperintensity in the adjacent orbital gyri bilaterally.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Mass in the anterior cranial fossa is most likely a meningioma. Examination was performed for the purpose of stereotactic guidance.


Instruction: Generate impression based on findings.

Input: 66-year-old man with increasing PSA. PELVIS:PROSTATE:Prostate Size: 42 x 34 mm.Peripheral Zone: There is an area of T2 hypointensity, diffusion restriction, and avid enhancement seen in the anterior right paramedian prostate apex (series 801, image 13; series 43, image 264; series 1401, image 1366). This area measures approximately 17 x 13 mm in maximal cross-sectional dimension.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality or involvement of the seminal vesicles noted.Extracapsular Extension: The capsule at the 10:00 position of the right prostatic apex (series 1401, image 1367) appears to be involved.BLADDER: The bladder is markedly distended. Please note that the patient attempted to void prior to examination.LYMPH NODES: Inguinal lymph nodes are noted, likely reactive. No suspicious lymphadenopathy identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the right paramedian prostatic apex suspicious for prostate carcinoma with extraprostatic extension.2. Markedly distended bladder post-void without significant central zone hypertrophy.


Instruction: Generate impression based on findings.

Input: Ms. Chen is a 57 year old female presenting for further evaluation of a suspected area of architectural distortion in the right central breast. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Specifically, there is no abnormal enhancement seen at the site of suspected mammographic abnormality in the right central breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Patient may resume annual screening mammography, due next in May 2017.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with history of IgA MGUS and questionable cervical myeloma lesion on exam from 2/13. An area of signal abnormality seen on the prior examination within the C3 vertebral body has changed in the interval, becoming less STIR hyperintense and more T1 hyperintense compatible with fatty evolution. Elsewhere, scattered endplate irregularity is seen, likely degenerative in nature, with associated endplate marrow signal alteration. No additional or new areas of concerning marrow replacement or edema are seen.Although image quality on some sequences is degraded by motion artifact, no definite areas of spinal cord signal abnormality are detected.C2-3: Unremarkable. C3-4: Small posterior disk osteophyte. Ventral thecal sac effacement. No significant generalized canal stenosis. No significant neuroforaminal narrowing. No changes. C4-5: Minimal posterior disk osteophyte. No significant spinal canal or foraminal stenosis. No changes.C5-6: Minimal posterior disk osteophyte. No significant spinal canal or foraminal stenosis. No changes.C6-7: Minimal posterior disk osteophyte. No significant spinal canal or foraminal stenosis. No changes.C7-T1: Unremarkable. Mucosal thickening seen within the right maxillary sinus.

Output: Previously identified signal abnormality within the C3 vertebral body has become less edematous and more fatty in signal quality. This may simply represent the evolution of endplate degenerative disease, or possibly a healed/healing lesion related to MGUS. In either case, the interval changes suggest evolution to a less active and more chronic state.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:10/3/1946)Reason: 70 yo F with brain metastases from melanoma, diagnosed in 11/2016 status post combined BRAF/MEK inhibitor therapy, referred for consideration of SRS, eval sizes of lesions History: nonePROVIDER/ATTENDING NAME: SEAN PITRODA STEVEN J. CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an 11 mm enhancing lesion present within the left frontal lobe along the anterior aspect of the left middle frontal gyrus. It has a heterogeneous appearance on T2 and FLAIR imaging. Some punctate foci of susceptibility effect are present within the lesion. This previously measured 17 mm.Additional enhancing lesions with a similar MR characteristics are also present in the left middle frontal gyrus posteriorly measuring 7 mm and previously measuring 10 mm, in the left occipital lobe laterally measuring 7 mm and previously measuring 10 mm, along the left posterior temporal lobe measuring 4 mm and previously measuring 11 mm, along the left posterior temporal lobe measuring 3 mm and previously measuring 5 mm, along the right anterior temporal lobe measuring 7 mm and previously measuring 11 mm, along the left cerebellar hemisphere medially measuring 4 mm and previously measuring 8 mm. In compared to the prior exam it appears little smaller. Along the right cerebellar hemisphere previously measuring 2 mm and currently measuring 2 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: There are multiple lesions scattered throughout the brain parenchyma which are compatible with metastatic disease which has regressed compared to the previous exam. Similar signal characteristics and height at these are hemorrhagic type metastatic lesions. This consistent with the diagnosis of melanoma.


Instruction: Generate impression based on findings.

Input: A 57 year old male with history of lymphoplasmacytic lymphoma and known gastrointestinal amyloidosis. A recent echocardiography showed normal left ventricular function with hypertrophy up to 15mm in the septum. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 61 ml (normal range 47+/-19). There is concentric hypertrophy with a maximum of 15 mm at the basal infero-septum at end diastole. There is late gadolinium enhancement in a diffuse pattern with multiple areas of prominent enhancement. In the clinical context of this patient, these findings suggest the presence of cardiac amyloid. Native T1 mapping also suggests abnormal myocardial signal consistent with amyloid.No intracavitary thrombus.No iron overload.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with low-normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 165 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 83 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 dilated (34 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Probable catheter in SVC.PericardiumThere is a small pericardial effusion.Extracardiac FindingsNo lymphadenopathy was noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 59%.2. There is concentric hypertrophy.3. There is late gadolinium enhancement in a diffuse pattern with multiple areas of prominent enhancement. In the clinical context of this patient, these findings suggest the presence of cardiac amyloid. 4. Native T1 mapping also suggests abnormal myocardial signal consistent with amyloid.5. The right ventricle is normal in size with low-normal systolic function, the RVEF is 50%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 35-year-old man with history of ulcerative colitis and PSC, please evaluate for progression of disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is slightly nodular in contour.The previously seen T2 hyperintense, progressively peripherally enhancing lesion in segment 4A (series 15, image 62) measures 21 x 20 mm, previously 26 mm. Additionally, there is an enhancing geographic focus in the subcapsular segment 8 (series 1701, image 59) with a small vessel leading towards it.There is narrowing of the distal hepatic duct along with mild, irregular intrahepatic biliary duct dilatation without new stricture or focal lesion.SPLEEN: There is mild splenomegaly. The spleen is otherwise normal.PANCREAS: The pancreas is normal and there is no pancreatic duct dilatation. ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change from the prior examination with biliary strictures and mild dilatation.2.Slight decrease in size of segment 4 hemangioma.3.Subcapsular segment 8 lesion, likely a small vascular shunt.


Instruction: Generate impression based on findings.

Input: Examination is somewhat limited by lack of intravenous contrast. Redemonstrated is diffuse destruction and replacement of the L1-2 disc space with T2 hyperintense signal with destruction of the adjacent endplates and significant collapse of the L1 greater than L2 vertebral body. There is slight interval decrease in the extent of abnormal STIR hyperintensity. The degree of moderate retropulsion appears similar at the L1 level with unchanged moderate spinal canal stenosis and bilateral foraminal stenosis. No other worrisome marrow signal is appreciated. There is persistent diffuse edema, with poor definition of the bilateral psoas muscles, the right greater than left iliacus muscles, as well as the paravertebral muscles, which may represent a component of atrophy superimposed upon edema. There is interval decrease in size of the previously seen loculated collections within the psoas muscles.The lumbar spine is otherwise in stable alignment. The vertebral body and disc heights are otherwise unchanged. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The previously described degenerative changes appear similar. Small amount of focal epidural fat is again incidentally noted along the right lateral aspect of the thecal sac at the L3-4 level. Partially imaged are bilateral renal atrophy with innumerable microcysts.

Output: 1. Expected evolution of L1-L2 discitis/osteomyelitis with slightly decreased associated marrow edema. Stable extent of collapse of the L1 greater than L2 vertebral bodies with persistent moderate spinal canal and bilateral foraminal stenosis.2. Interval decrease in size of fluid collections within the psoas muscles, with persistent edema and possible superimposed atrophy/degeneration of the psoas muscles, iliacus muscles and dorsal paraspinal muscles.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified kidney, except renal pelvis [C64.9], Reason for Study: ^Reason: s/p nephrectomy for RCC. R flank pain, L thigh numbness, ?periportal LN on OSH scans on PACS. Abd AND Lumbar MRI together please History: R flank pain, s/p For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is about 17.8mm x 15.4mm sized lesion on the L3 vertebral body which shows low signal intensity on T1 and high signal intensity on T2 with intense enhancement on Gad infusion.The lesion shows lamellated appearance on T1 and T2 weighted images indicating central soft tissue layer, surrounding sclerotic bone area and bone marrow edema which show enhancement. In addition, there is evidence of focal endplate defect which is associated with the lesion. Constellation of these findings are suggestive of acute Schmorl's node, however, single vertebral body metastasis cannot be completely excluded. Since bone scan may not differentiate two diagnostic possibilities, follow up imaging about 1-2 months with MRI with and without contrast is recommended. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance except L3 vertebral body. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level.The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Acute Schmorl's node, L3 vertebral body inferior end plate. Vertebral body metastatic lesion cannot be completely excluded considering the patient's history. Follow up MRI with and without contrast enhancement is recommended.2. Diffuse bulging of disc at the level of L34 and L45 as described above. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Abnormal PET scan Note that the examination is limited by motion artifact and lack of intravenous contrast; the exam was performed with the shoulder coil and does not include the chest wall in its entirety.There is diffuse edema within the pectoralis major muscle that extends anteromedially beyond the field-of-view. Edema also extends along the anterior margin of the coracobrachialis and short head of the biceps muscle as well as along the anterior margin of the deltoid although to a lesser degree. Edema is also present within the soft tissues anterior to the coracoid process and adjacent to the distal clavicle. This edema is nonspecific in nature; however there is no focal fluid collection to suggest the presence of abscess.ROTATOR CUFF: There is thickening and intermediate signal of the supraspinatus tendon indicating moderate tendinosis. There is poor definition of the undersurface fibers suggesting fraying with a more focal area of increased signal abnormality at the insertion on the greater tuberosity suspicious for an insertional tear; the bursal surface fibers appear intact. Tendinosis also extends posteriorly to involve the anterior fibers of the infraspinatus. There is moderate to severe fatty atrophy of the supraspinatus muscle with relatively mild atrophy of the infraspinatus muscle and teres minor. The teres minor tendon is intact. There is undersurface tearing of the subscapularis at its insertion on the lesser tuberosity with associated mild fatty atrophy of the muscle.SUPRASPINATUS OUTLET: There is severe osteoarthritis of the acromioclavicular joint but no fluid is present within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is moderate osteoarthritis the glenohumeral joint with degenerative tearing of the glenoid labrum.BICEPS TENDON: Evaluation of the long head of the biceps tendon is limited by motion artifact and the lack of intra-articular contrast. Portions of the tendon are not well seen within the rotator interval which is suspicious for tearing.ADDITIONAL

Output: 1. Nonspecific edema of the left pectoralis major muscle and anterior soft tissues of the shoulder joint, the extent of which extends off of the field of view of this study. There is no discrete fluid collection to suggest abscess. If further evaluation is clinically warranted, MRI of the chest wall with and without contrast can be considered.2. Osteoarthritis of the shoulder with rotator cuff tendinosis/tearing and other findings as described above.


Instruction: Generate impression based on findings.

Input: There is a 3 mm lesion in the left medial frontal lobe subcortical white matter which has a hypointense rim on T2-weighted images with corresponding susceptibility artifact. There is no significant enhancement of this lesion. There is an adjacent developmental venous anomaly within the medial and inferior left frontal lobe. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. High-resolution images of the sella demonstrate a partially empty sella with the residual pituitary gland flattened along the bottom of the sella. The pituitary gland enhances heterogeneously without a discrete hypointense focus to confirm a pituitary adenoma. There are no suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally.

Output: 1. Partially empty sella with heterogeneously enhancing flattened pituitary gland without a discrete focus to confirm a pituitary adenoma.2. Medial left frontal lobe lesion with imaging features compatible with a cavernous malformation and associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: 67 yo with cardiac arrest Left VentricleThe overall LV ejection fraction is 56%, the LV end diastolic volume index is 79 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19). Moderate concentric LVH. There are no regional wall motion abnormalities present. Most of the delayed enhancement images are not interpretable. However the AP4C image is good. This clearly shows a mid wall stripe of delayed enhancement in the basal IVS and a focal midwall area of enhancement in the basal lateral wall. All other cardiac segments could not be evaluated. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal . The overall RV ejection fraction is 60%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 147 ml (normal range 142+/-31), the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9), and the RVESV is 59 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is dilated. SOV 39mm; pAscAo 38; dAscAo 34 mm; pDescAo 33mm; dDescAo 29 mm. 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 mildly dilated.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. Normal LV EF with moderate concentric hypertrophy. 2. No LV regional wall motion abnormalities.3. Limited delayed enhancement examination, but there is delayed enhancement in the basal septum and lateral wall4. Enhancement pattern is midwall and inconsistent with prior MI. 5. Normal RV size and function without wall motion abnormalities.6. Mildly dilated aorta.


Instruction: Generate impression based on findings.

Input: History of cervical cancer s/p hysterectomy b/l SPO with lymph node dissection (negative), Pathologic Staging (pTNM [FIGO]): pT1b1N0MX (FIGO Ib1) Primary Tumor (pT) pT1b1 [IB1]. Evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable asymmetrically markedly atrophic right kidney. Moderate left hydroureteronephrosis, unchanged. Mild right sided hydronephroureter. Mild ureteral thickening, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral breast prostheses.PELVIS:UTERUS, ADNEXA: Status post hysterectomy stable lobulated right lateral pelvic wall T2 hyperintense collection encasing the right ureter measuring 2.6 x 2.0 cm (series 6/19), may reflect a post-surgical seroma/lymphocele related to prior lymph node dissection. No enhancing soft tissue in the surgical bed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination with no evidence of local recurrence or metastatic disease.2.Stable left greater than right hydroureteronephrosis and non-specific non-enhancing right lateral pelvic wall T2-hyperintense collection involving the right ureter, likely post-operative from lymph node dissection.3.Chronic right renal atrophy.


Instruction: Generate impression based on findings.

Input: Right hepatic lobe lesion on ultrasound ABDOMEN:LIVER, BILIARY TRACT: Moderately T2 hyperintense segment 8 lesion demonstrates arterial enhancement and mild progressive enhancement measuring 1.8 x 1.4 cm (series 4, image 11), suggestive of an FNH. No adjacent biliary duct dilatation or capsular retraction seen. Intralesional signal dropout seen on opposed-phase imaging, consistent with intravoxel fat, may be seen with an HNF alpha1 mutated type of adenoma or an FNH. The former would typically have become isointense in the portal venous and delayed phases of postcontrast imaging, unlike in this case, where contrast retention was evident. T2 hyperintense lesion in segment 7 adjacent to the intrahepatic IVC measures 1.6 x 1.0 cm with peripheral nodular enhancement, appearance consistent with a hemangioma. Additional scattered subcentimeter T2 hyperintense foci are noted throughout the liver with characteristics consistent with cysts and flash filling hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Arterially enhancing segment 8 hepatic lesion with signal characteristics most consistent with FNH (focal nodular hyperplasia); adenoma is considered less likely. If followup imaging is pursued, 1-hour delay imaging following the administration of IV contrast would be helpful in improved differentiation and confirmation of an FNH. 2. Segment 7 hepatic lesion with signal characteristics consistent with a hemangioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: concern for cervical stenosis vs. radiculopathySigns and Symptoms: left sided numbness, weakness, and pain MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is some mild multilevel disc desiccation present.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. There is a small central disc protrusion present at this level.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. There is a small central disc protrusion present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Small disc protrusions are also present at T1-2 and T2-3 without any obvious compromise to the spinal canal or exiting nerve roots.

Output: 1.There are mild degenerative changes present in the cervical spine without significant compromise to spinal canal or neural foramina.2.There is no evidence for intracranial mass lesion or spinal cord lesion to explain the patient's symptoms of left-sided weakness, numbness and pain


Instruction: Generate impression based on findings.

Input: epidural fluid collection, follow up. Back pain. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Previously identified epidural or extradural fluid collection at the level of T12-L1 is again shown. The MR signal characteristics as well as size (20mm x 11mm) of the lesion do not show any significant interval change since prior exam. Therefore, the possibility of epidural hematoma might be relatively lower.Instead, since the content of the lesion well follows those of CSF, this lesion could be extradural CSF leakage or epidural arachnoid cyst. On axial T2 weighted images (series 1601, image 10/20), the left side of dural lining appears to be thinned out. Most frequent extradural CSF collection is related to prior trauma including lumbar puncture. Diagnosis could be made through CT myelography with delayed CT scan, although differentiation from arachnoid cyst is often difficult.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication with minimal to mild diffuse disc bulging, no change since prior exam. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. No change of T12-L1 extradural/epidural fluid collection since prior exam. Diagnostic possibility include extradural CSF leakage or arachnoid cyst, CT myelography with delayed scan is recommended for further investigation.2. Disc dessication with mild disc bulging, no change since prior exam.


Instruction: Generate impression based on findings.

Input: Skin ulceration Note that the patient was unable to complete the exam and the study was performed without intravenous contrast. Also note that the distal tip of the fibula was not entirely included on the axial sequences.Within the limits of this exam, there are no marrow signal abnormalities to suggest osteomyelitis. There is mild diffuse subcutaneous edema of the leg and although this becomes confluent along various portions of the leg, there are no specific findings to suggest abscess.There is fatty atrophy of the musculature of the leg most severely involving the posterior compartment. Edema type signal is noted within muscles of the anterolateral compartment which is nonspecific in nature and may reflect inflammation or subacute atrophy. Muscle atrophy and soft tissue edema also affects the right leg on the large field-of-view but again there are no marrow signal abnormalities to suggest osteomyelitis.

Output: Soft tissue inflammation of the leg without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Numerus tonic-clonic seizures. History suggestive of encephalitis. The brain shows normal signal characteristics and morphology. Specifically, the mesial temporal lobes are symmetric and without abnormal signal. There is no sign of malformation of cortical development. There is no intracranial hemorrhage. The major intracranial vascular flow voids are preserved. Following contrast injection, there is no abnormal brain or leptomeningeal contrast enhancement.There is minimal ethmoid mucosal thickening. Minimal secretions are present posteriorly in the left sphenoid sinus. These findings are nonspecific. The eye globes are mildly elongated anteroposteriorly, which can be associated with myopia. There is no destructive skull lesion.

Output: There is no brain abnormality to explain the seizures.


Instruction: Generate impression based on findings.

Input: Complex partial seizures with EEG showing left temporal lobe discharges. There is patient motion, most pronounced on the susceptibility-weighted and isotropic T1 imaging. There is no gross intracranial hemorrhage. There is no acute infarct. The ventricles, sulci and other CSF-containing spaces are normal in size. There is no sign of malformation of cortical development. The hippocampi show no definite volume loss, abnormal signal or loss of architecture accounting for slight rotation of the left hippocampus. Otherwise, there is no mass-effect, midline shift or brain herniation. The major intracranial vascular flow voids are preserved. There are dilated perivascular spaces inferior to the deep gray nuclei.There is no destructive skull lesion or gross scalp abnormality. The orbits are also unremarkable. There is trace ethmoid mucosal thickening.

Output: 1.No definite hippocampal volume loss, abnormal signal or architectural loss. Left hippocampal head is mildly rotated.2.Otherwise, the examination is unremarkable.


Instruction: Generate impression based on findings.

Input: Male 59 years old Reason: HCC screening, vascular patency History: s/p OLT, being evaluated for repeat OLT ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates a nodular contour and prominence of the hepatic fissures consistent with cirrhosis. There is no focal liver lesion.The arterial phase of imaging is limited. While the main hepatic artery appears grossly patent, they are suboptimally evaluated and could be definitively characterized with dedicated Doppler ultrasound. The portal veins and hepatic veins are patent.SPLEEN: Splenomegaly measuring 15.4 cm. T2 hyperintensity within the spleen likely represents a small cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Multiple enlarged portacaval, retroperitoneal and mesenteric lymph nodes. While regional lymphadenopathy is expected in the setting of cirrhosis, the location of some of these is somewhat atypical. Additionally, some of the nodes demonstrate a subtle increase in size compared to prior study 01/02/14. While these may be reactive, low-grade lymphoma is a differential consideration. Continued attention should be paid to these on follow-up imaging. A reference left retroperitoneal lymph node measures 2.0 x 1.6 cm (series 9, image 64), previously 1.7 x 1.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with portal hypertension. No focal liver lesion.2.Limited arterial phase imaging makes evaluation of the main hepatic artery difficult. While this appears grossly patent this could be definitively characterized with Doppler ultrasound. The portal veins and hepatic veins are patent.3.Multiple enlarged abdominal lymph nodes. While regional lymphadenopathy is expected in the setting of cirrhosis, the location of some of these is somewhat atypical. Low-grade lymphoma is a differential consideration and continued attention should be paid to these on follow-up imaging.


Instruction: Generate impression based on findings.

Input: Left cavernous sinus meningioma s/p SRS with subsequent mass change on imaging. There is interval decrease in size of the extra-axial mass centered along the left cavernous sinus, which now measures 11 x 26 mm, previously 14 x 38, resulting in decreased mass effect upon adjacent structures. In addition, the mass now demonstrates more homogenous enhancement. There is no evidence of acute intracranial hemorrhage or acute infarction. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The intracranial internal carotid artery flow voids appear to be intact. There is retention cyst formation in the bilateral maxillary sinuses. The skull and scalp soft tissues are unremarkable.

Output: Interval evolution of post-treatment findings with decrease in size of the mass centered along the left cavernous sinus.