Instruction: Generate impression based on findings.

Input: 30 year old male with a history of myocarditis with elevated troponin level. Referred for cardiovascular MRI to evaluate for possible occult ischemia, and myocarditis. MEDICATIONS: None First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 120 ml (normal range 142+/-34), the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9), the LVESV is 44 ml (normal range 47+/-19), the LV mass index is 56 g/m2, and the LV mass is 97 g. There are no regional wall motion abnormalities present. There is an atypical pattern of late gadolinium enhancement which spares the endocardium and involves the basal septum and the basal anterolateral and inferolateral walls. Additionally these segments showed evidence of increased signal on T2-imaging and on T1-weighted early gadolinium enhancement images. Together these findings support the diagnosis of acute/ subacute active myocarditis.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 62%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 52 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No evidence of prior myocardial infarction.3. Normal LV size and systolic function (LVEF 64%). There is evidence of acute/ subacute active myocarditis involving the basal septum and basal anterolateral and inferolateral walls.4. Normal RV size and systolic function (RVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Riley is a 46 year old female presenting with recent biopsy-proven intraductal papillary proliferation and focal ADH. There is scattered fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, limiting the sensitivity of this exam for the evaluation of subtle abnormalities.In the right medial breast, there is a segmental distribution of clumped non-mass-enhancment, spanning approximately 13.2 cm (AP) x 3.7 cm (transverse) x 5.4 cm (CC). The enhancement extends anteriorly up to the nipple base without demonstrable nipple involvement. This abnormality corresponds in appearance and distribution to the screen-detected abnormalities that were subsequently sampled under ultrasound guidance. The Hydromark clip is seen at the posterior-most extent of this enhancement. There is no additional abnormal enhancement seen elsewhere in the right breast or in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 13 cm span of abnormal segmentally-distributed clumped non-mass-enhancement of the right breast, corresponding to the mammographically detected abnormalities. Given the extensive span of this enhancement and the pathology results from recent biopsy, additional tissue sampling is recommended to exclude underlying malignancy. An US-guided vacuum assisted biopsy of a mid-depth and anterior-depth correlate can be performed if clinically desired. Alternatively, an excisional biopsy around the biopsy marker clip can be performed for additional tissue evaluation. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 18-year-old female status post rheumatoid cyst resection, annual evaluation Sequelae of frontal and left temporal craniotomy are again noted. A surgical cavity within the inferior left frontal lobe is stable in size and morphology. The degree and extent of T2 hyperintensity surrounding this cavity, likely representing gliosis, also remains stable. No suspicious enhancement is seen within or around the resection cavity.Elsewhere, no new areas of signal abnormality or pathologic enhancement are seen. No mass-effect or edema is detected. No abnormal fluid collections are seen. The ventricles are stable and normal in size.

Output: Stable postoperative findings with no evidence to suggest lesion recurrence.


Instruction: Generate impression based on findings.

Input: Newly diagnosed polycythemia vera with new numbness/tingling on the right side of her face. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a small developmental venous anomaly in the right posterior cingulate gyrus, Otherwise, there is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 49-year-old male with altered mental status and seizure. There is no evidence of intracranial hemorrhage, or mass. Multiple patchy hypodensities in a periventricular distribution are consistent with small vessel disease, age indeterminate.Additional small focal hypodensity at the right frontal lobe, image 14 represents a cortical stroke which is new when compared to the prior study but of uncertain chronicity. An additional finding of a small atrophic gyrus in the high left parietal convexity represents an old small cortical calcific stroke which was present on the previous CT scan of 4/07. MRI is recommended to further characterize these findings.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Subcortical stroke as described above of uncertain chronicity, new when compared to the previous study. MRI is recommended for further evaluation if clinically warranted.


Instruction: Generate impression based on findings.

Input: 64 year old female with a history of sarcoidosis, hypertension, hyperlipidemia, diabetes, ASD s/p closure in the 1970s. Referred for vasodilator stress cardiovascular MR due to new wall motion abnormality noted on recent echocardiogram.MEDICATIONS: Metformin, Amlodipine, Simvastatin, Metoprolol, Aspirin. First Pass PerfusionDuring hyperemia, non-transmural perfusion defects were noted in the basal inferolateral wall and the apical inferior, anterior, and lateral walls. The overall ischemia score is a total of 4 out of 32. Approximately 12% of the myocardium is ischemic. Viability/ Myocardial ScarThere was no prior myocardial infarction noted and the entire myocardium is viable. There is, however, a small amount of "atypical" late gadolinium enhancement in the apical anterior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. When compared to the prior study, the amount of late gadolinium enhancement is less. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 134 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 49 g/m2, and the LV mass is 94 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 166 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 86 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation. The posterior leaflet is somewhat tethered.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated, measuring 33mm in diameter. Right pulmonary artery measures 24 mm, Left pulmonary artery measures 22 mm.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a shelf of calcium along the apical anterior wall, which was also previously present.Extracardiac FindingsSternal wires are 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. There is a moderate burden of mild ischemia involving the left circumflex and distal left anterior descending artery territories.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 58%) with evidence of a small amount of atypical (non-myocardial infarction pattern) late gadolinium enhancement involving the apical anterior wall. The burden of late enhancement is less than on the prior study.4. Normal RV size with mildly reduced systolic function (RVEF 48%), which is slightly lower than on the prior study.5. Mild dilation of the main pulmonary arteries.6. Moderate mitral regurgitation. 7. Small area of pericardial calcification along LV apex.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old female with right knee pain and recurrent falls. MENISCI: There is intrasubstance degeneration within the body of the lateral meniscus, but we see no definite tear. Additionally, there is perhaps fraying of the undersurface of the posterior horn of the medial meniscus, but we see no discrete tear. ARTICULAR CARTILAGE AND BONE: There is mild to moderate diffuse degeneration of the articular cartilage of the patella. There is a small, focal full thickness defect along the articular cartilage of the medial femoral condyle, best seen on coronal image 14 of series 9. There is a subcentimeter, amorphous, and somewhat lobulated focus of abnormal signal intensity within the anterior aspect of the medial tibial plateau that may represent a small vascular malformation or cartilaginous rest, but this is of questionable significance.LIGAMENTS: The cruciate, lateral, and medial ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. There is minimal edema anterior to the patella and patellar tendon, which is not necessarily of clinical significance. ADDITIONAL

Output: Mild to moderate diffuse degeneration of the articular cartilage of the patella, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Contrast remained confined to the radiocarpal joint. No contrast entered the radioulnar joint to indicate a triangular fibrocartilage complex tear. Please refer to subsequent MRI report for further information.There is a deformity of the base of the fifth metacarpal indicating a healing fracture.Exposure time: 2:47 minutes.

Output: Successful intra-articular injection of dilute gadolinium for subsequent MRI examination. We see no findings to suggest a triangular fibrocartilage tear.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: pleae do dr javed MS protocol compare to priro History: falls, gait disorder Previously seen C2 level (just below the foramen magnum) spinal cord left side T2 high signal intensity lesion is more conspicuous than before. However, the lesion was not seen on sagittal FLAIR or T1-weighted images. The lesion also does not show any evidence of contrast enhancement. The signal characteristics are unchanged since prior scan.There is no other abnormal signal intensity lesion on cervical spinal cord.There is normal cervical lordosis. C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: Central focal protrusion of disc which abuts thecal sac results mild to moderate spinal canal stenosis. Slightly progressed disc protrusion since prior scan, otherwise unremarkable. C4-C5: Diffuse bulging of disc with mild to moderate spinal canal stenosis, unchanged since prior scan. C5-C6: Central focal protrusion of disc which abuts thecal sac, unchanged since piror scan. C6-C7: Mild neural foraminal narrowing on the left side, unchanged since prior scan. C7-T1: Moderate to severe bilateral neuroforaminal stenosis, unchanged since prior scan.

Output: 1. Spinal cord lesion consistent with demyelinating disease at the level of C2 is again seen, unchanged since prior scan.2. No other spinal cord lesion is seen.3. Grossly no significant interval change of degenerative lesions of cervical spina as described above.


Instruction: Generate impression based on findings.

Input: 47 years, Female, follow-up post surgery and SRS for brain metastasis. Examination is motion degraded despite repeating multiple sequences. Compared to 4/6/2016, there has been evolution of postsurgical changes related to recent resection of left cerebellar lesion. Again seen is a heterogeneously enhancing tissue surrounding the resection cavity which appears stable to minimally more prominent, with more prominent interval increase in fluid filling the resection cavity which extends to the cerebellar surface. Extent of T2 hyperintensity related to vasogenic edema in the left cerebellar hemisphere extending into the left middle cerebellar peduncle and left dorsolateral pons is not significantly changed. Mass effect including mild effacement of the fourth ventricle is also not significantly changed. Partial effacement of the left ambient cistern is also similar to prior. No midline shift. No hydrocephalus. No uncal herniation.There has been slight enlargement of the enhancing right parietal lesion which measures 16 x 19 x 16 mm, previously 13 x 13 x 13 mm. There is surrounding vasogenic edema which is also slightly increased in the interval. Again noted is herniation of the left posterior aspect of the left cerebellar hemisphere at the previous craniotomy defect.There is a 7 x 7 mm enhancing right cerebellar lesion which has not been well seen on recent studies but demonstrates enlargement, measuring 5 x 5 mm on MRI dated 4/3/2016. There is a fluid collection involving the suboccipital soft tissues measuring approximately 2.6 x 5.8 cm in the axial plane which demonstrates increased peripheral enhancement, while the overall size of collection is similar to prior. Bilateral staphylomas are again noted.

Output: 1. There is been interval evolution of postsurgical changes related to resection of recent left cerebellar mass. Again noted are areas of irregular peripheral enhancement in the resection bed which remain suspicious for residual tumor although there is likely a component of radiation necrosis. Although the amount of this enhancing tissue is not increased, there is increased fluid within the surgical cavity and along the surgical tract which may reflect evolving postsurgical changes, but would suggest continued close follow-up evaluation.2. Enhancing right parietal and right cerebellar lesions demonstrate slight interval enlargement compared to 4/6/2016 and more prominent increase in size when compared to prior study from 3/3/2016. There is also mild increase in vasogenic edema surrounding the right parietal lesion. No new lesions are appreciated within the limits of motion degraded study.3. Fluid collection in the left suboccipital soft tissues is grossly similar in size to prior and compatible with a pseudomeningocele. There is increase in surrounding enhancement which may represent evolution of postsurgical change/granulation tissue. Superimposed infection however cannot be excluded.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with decreased alertness, not following commands, appears encephalopathic. Image quality is significantly reduced by motion artifact. Given this limitation, no strict diffusion is seen. Periventricular T2 hyperintensity is unchanged. Susceptibility effect and volume loss of the right basal ganglia are unchanged. No areas of edema or mass effect are seen. No large acute intracranial hemorrhage or abnormal extra axial fluid collection is observed. The ventricles and sulci are prominent compatible with parenchymal volume loss, but the ventricular system is stable in size and morphology.

Output: Again, the examination is motion degraded, but despite this limitation, no significant interval change is seen when compared to the prior study. Findings are noted suggestive of chronic ischemic injury to the right basal ganglia and chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Left leg radiculopathy: pain and numbness. There are apparent postoperative findings related to left hemilaminotomy at L4-5. There is disc space narrowing and 4 mm of L4 on L5 anterolisthesis. There is also a disc bulge and facet hypertrophy at L4-5 with moderate to severe left and mild right neural foraminal stenosis, as well as moderate spinal canal stenosis. There is mild disc bulging at L5-S1 without significant spinal canal or neural foraminal stenosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at L4-5 with moderate to severe left and mild right neural foraminal stenosis, as well as moderate spinal canal stenosis and mild anterolisthesis of L4 on L5.


Instruction: Generate impression based on findings.

Input: Again seen are postoperative findings related to prior left occipital lobe GBM resection with mild interval evolution including slight decrease in size of the resection cavity. Adjacent blood products also demonstrate slight evolution. There is overall no significant change in extent of the FLAIR signal abnormality in the left occipital lobe which extends into the left periatrial region as well as the left posterior temporal lobe. Previous seen heterogeneous enhancement surrounding the resection cavity including small rounded nodules demonstrate minimal change in configuration and enhancement pattern but without clear evidence of interval progression. Small areas of increased central nonenhancement are noted. Enhancement extending to the ependymal surface of the left lateral ventricle is again seen.There is no new mass effect, midline shift, or herniation. No evidence of acute infarct or new hemorrhage. No hydrocephalus.

Output: Compared to 4/10/2016, there is no clear evidence of interval tumor progression. Subtle differences described above may be related to radiation and evolution of postsurgical change.


Instruction: Generate impression based on findings.

Input: 71 years, Female, worsening dementia and thalamic mass. Examination is limited to 3-D T2 sequence for operative planning. Again demonstrated is expansile T2 signal abnormality centered within the medial aspects of the bilateral thalami extending into the midbrain as well as laterally into the lateral aspect of the thalamus on the right. Additional signal abnormality involving the splenium of the corpus callosum on the right is also noted. Subtle T2 hyperintensity along the right paramedian frontal lobe along the cingulate gyrus is also noted. Chronic appearing T2 signal abnormality involving the left medial temporal lobe has remained unchanged across multiple prior studies. No midline shift or herniation. No hydrocephalus.

Output: Note examination is limited to 3-D T2 sequence for operative planning. Infiltrative mass centered on the thalami is incompletely evaluated but remains highly suspicious for neoplasm such as glioma or lymphoma. Patient will return for repeat study with sedation including postcontrast sequences for further evaluation.


Instruction: Generate impression based on findings.

Input: Scoliosis is better demonstrated on prior x-ray. There is diffuse heterogeneous marrow throughout the thoracic and lumbar spines without significant correlative abnormality on sagittal STIR imaging.Thoracic spine:The vertebral body heights and disc spaces are maintained. A benign hemangioma is present within the T6 vertebral body. Discogenic reactive endplate changes are noted at sporadic levels. The spinal cord is without focal atrophy, edema, or myelomalacia. Incompletely characterized T2 hyperintense foci are present within bilateral thyroid lobes which correlates with previously demonstrated bilateral thyroid nodules.C7/T1: Posterior osteophyte disc complex, slight ligamentum flavum thickening, with bilateral neural foraminal encroachment.T1/2: Posterior osteophyte disc complex and slight ligamentum flavum thickening. There is bilateral neural foraminal encroachment.T2/3: Posterior osteophyte disc complex and slight ligamentum flavum thickening. There is bilateral neural foraminal encroachment.T3/4: Posterior osteophyte disc complex without cord encroachment or stenosis. T4/5: No significant disc bulge or cord encroachment. T5/6: No significant disc bulge or cord encroachment. Ligamentum flavum thickening partially efface the posterior CSF space without significant resulting stenosis.T6/7: No significant disc bulge or cord encroachment. T7/8: No significant disc bulge or cord encroachment. Ligamentum flavum thickening partially efface the posterior CSF space without significant resulting stenosis.T8/9: Posterior osteophyte disc complex and slight ligamentum flavum thickening. There is bilateral neural foraminal encroachment.T9/10: No significant disc bulge or cord encroachment.T10/11: Posterior osteophyte disc complex and ligamentum flavum thickening. There is bilateral neural foraminal encroachment.T11/12: Trace anterolisthesis T11 on T12, posterior osteophyte disc complex and ligamentu flavum thickening. There is mild central stenosis and bilateral neural foraminal encroachment.T12/L1: Small left paracentral disc protrusion, superimposed disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is borderline central stenosis.Lumbar spine:There are no fractures. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: Asymmetric bulge to the left, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild left lateral recess stenosis.L2/3: Asymmetric bulge to the left, likely flavum thickening, mild to moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild central, mild bilateral lateral recess, moderate left neural foraminal, and mild right neural foraminal stenosis.L3/4: Diffuse annular disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild central, mild bilateral lateral recess, and mild to moderate bilateral neural foraminal stenosis.L4/5: Trace anterolisthesis L4 on L5, diffuse annular disc bulge, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is mild bilateral lateral recess and mild to moderate bilateral neural foraminal stenosis.L5/S1: Mild disc bulge and minimal bilateral facet hypertrophy without stenosis.

Output: There is diffuse heterogeneous marrow throughout the thoracic and lumbar spines without significant correlative abnormality on sagittal STIR imaging.Thoracic spine:1.There is diffuse heterogeneous marrow throughout the thoracic and lumbar spines without significant correlative abnormality on sagittal STIR imaging. This appearance is benign yet indicates a diffuse marrow process. The differential diagnosis would most likely include anemia many causes or chronic smoking.2.Diffuse multilevel thoracic spondylotic changes without significant resulting stenoses as described in detail on a level by level basis above.3.L1/2: Mild left lateral recess stenosis.4.L2/3: Mild central, mild bilateral lateral recess, moderate left neural foraminal, and mild right neural foraminal stenosis.5.L3/4: Mild central, mild bilateral lateral recess, and mild to moderate bilateral neural foraminal stenosis.6.L4/5: Mild bilateral lateral recess and mild to moderate bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Aphasia [R47.01], Reason for Study: ^Reason: eval for stenosis History: aphasia Brain MRIMultifocal restricted diffusion lesions on the left hemisphere including left frontal lobe superior and middle frontal gyri, left insular cortex, and left frontal operculum indicating acute ischemic infarction. There is no evidence of hemorrhagic conversion. Underlying brain shows patchy FLAIR high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no evidence of arterial luminal stenosis, no arterial aneurysm on bilateral ICAs, MCAs, ACAs and vertebrobasilar system.Neck MRAMotion artifacts degraded examination quality.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate no evidence of significant (more than 50%) of luminal narrowing of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins appear to be normal but tortuous proximal bilateral vertebral arteries. There is no evidence of luminal stenosis in the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Multifocal left MCA territorial acute ischemic strokes without evidence of hemorrhagic conversion as described above.2. No evidence of significant arterial luminal stenosis on both intracranial and extracranial craniocervical arterial system.


Instruction: Generate impression based on findings.

Input: Aphasia [R47.01], Reason for Study: ^Reason: stroke History: slurred speech and left sided weakness Brain MRI:Motion artifact degraded image qualityNo evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. No evidence of intracranial arterial aneurysm, no significant (more than 50%) arterial luminal stenosis.


Instruction: Generate impression based on findings.

Input: History of testicular cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Mild splenomegaly measuring 15 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left periaortic lymph node measures 7 mm in short axis (series 401/8). No new or additional retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small hiatal hernia with small nonspecific gastroesophageal lymph nodes, unchanged dating back to 2013.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable left para-aortic lymph node.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with a pineal lesion noted on head CT, please evaluate further. A cystic pineal lesion is evident measuring up to 15 mm AP, 9 mm CC, and 12 mm TV. Incomplete and somewhat irregular enhancement of the rim of the lesion is seen, along with a central enhancing component which could represent a septation or perhaps a portion of the native pineal gland.The lesion appears to exert mild mass effect upon the underlying tectum of the midbrain. No significant parenchymal edema is seen though there may be very slight associated narrowing of the cerebral aqueduct.Brain parenchymal morphology is otherwise unremarkable. No significant edema or generalized mass effect is detected. No other enhancing lesions are observed. There are no findings to suggest intracranial hemorrhage. Ventricles are normal in size and morphology.

Output: The presence of a cystic pineal lesion is confirmed on this examination measuring up to 15 mm in maximum dimension. The lesion is slightly complex as there is partial irregular wall enhancement, along with an enhancing central component which could, however, represent a portion of the native pituitary gland. Statistically, this lesion most likely represents a benign pineal cyst, with a neoplastic etiology such as a pineocytoma considered less likely. A follow-up examination is recommended in 6-12 months to verify stability of the lesion.


Instruction: Generate impression based on findings.

Input: Right carotid sheath mass There is an intensely enhancing mass centered at the right carotid bifurcation with splaying of the right internal and external carotid arteries. Mass measures approximately 3 x 2.5 cm in the AP and transverse dimensions and approximately 4.5 cm in the craniocaudal dimension. Small flow-voids within the mass are evident. Scattered subcentimeter neck lymph nodes are seen which are not significant by size criteria. No other neck masses. Major neck vasculature flow-voids are preserved. Dominant left vertebral artery. Airway remains patent.Degenerative changes are seen in the cervical spine including small disc osteophyte complexes in the lower cervical spine, ossification of the posterior longitudinal ligament at the C7 level, better seen on CT, and bulky anterior flowing osteophytes throughout the cervical spine most consistent with DISH. No high-grade spinal canal stenosis.Suggestion of prior endoscopic sinus surgery with extensive opacification throughout the paranasal sinuses, particularly the left frontal, left maxillary, bilateral ethmoid, and sphenoid sinuses. Visualized brain parenchyma is grossly unremarkable for age.

Output: Hypervascular mass centered at the right carotid bifurcation with imaging features most consistent with a carotid body paraganglioma.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: Evaluate for mass, strokes History: altered mental status. Multiple scattered restricted diffusion lesions on the left occipital lobe without evidence of hemorrhagic transformation nor evident surrounding edema indicating subacute or early chronic ischemic stroke. The lesions are seen as subtle high signal intensity lesions on FLAIR images.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Multiple retention cysts on bilateral maxillary sinuses and opacifications on bilateral ethmoid sinuses, sphenoid sinus and frontal sinus.

Output: 1. Subacute or early chronic ischemic infarctions at the left occipital lobe, likely left PCA territory without evidence of associated hemorrhagic transformation nor surrounding edema.2. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: There is a soft tissue mass centered on the planum sphenoidale measuring 15 x 11 mm on series 4 image 10, and 19 mm on series 7 image 7. This mass abuts the optic chiasm and is isointense to brain on T1 weighted images and minimally hyperintense on T2/FLAIR images. Although difficult to visualize on prior CT, it is retrospectively present and similar in size. There is an apparent increased CSF signal in the mildly expanded sella representing either an empty sella or possibly a cystic mass within the sella. This is not well evaluated on this noncontrast exam which is not tailored to evaluate the sella or the skull base. There is mild prominence of the lateral and third ventricles as well as the sulci, and a relatively normal sized fourth ventricle, less disproportionate to sulci as compared to the prior exam. There is persistent moderate soft tissue crowding at the foramen magnum with a somewhat pointed morphology of the cerebellar tonsils extending up to 7 mm below the foramen magnum. There is focal prominence of extra-axial space posterior to the superior cerebellar tonsils representing new cisterna magna versus retrocerebellar cyst. There is no acute infarct, mass effect or midline shift.There is decreased abnormal T1 signal in the posterior superior aspect of the C4 vertebral body.

Output: 1.A 15 x 11 x 19 mm planum sphenoidale extraaxial mass which at least abuts the optic chiasm. Further evaluation with sella/skull base MRI without and with IV contrast is recommended (if not contraindicated). While this lesion presumably represents meningioma, given history of breast cancer, metastatic lesion is not entirely excluded although considered to be less likely.2.Prominent CSF signal in the lower aspect of the sella may represent partial empty sella or an inferior pituitary cystic mass. This can be further evaluated on follow-up MRI.3.No definite evidence of normal pressure hydrocephalus. Findings consistent with diffuse age-related volume loss.4.Findings consistent with Chiari I malformation.5.Decreased abnormal T1 signal in the posterior superior aspect of the C4 vertebral body may represent possible degenerative change although metastatic lesion cannot be excluded. Further evaluation with dedicated cervical spine imaging or bone scan is recommended.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified convulsionsClinical question: first time seizureSigns and Symptoms: HIV, first time seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. There is T2 and FLAIR heterogeneous signal hyperintensity in the basal ganglia bilaterally. There is no associated diffusion restriction.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: Bilateral basal ganglia lesions. The differential is fairly broad and includes lymphoma and infections (cryptococcus, toxoplasma and viral) as well as neurodegenerative/metabolic causes such as Wilson disease and Huntington disease . Although included in the differential, its distribution and appearance is not typical for hypoglycemic encephalopathy, ischemia, CJD and extrapontine myelinolysis.


Instruction: Generate impression based on findings.

Input: 53-year-old female with history of MR guided right breast biopsy in 2009 demonstrating FEA and PASH and ultrasound-guided left breast biopsy in May 2014 that showed a fibroadenoma. Strong family history of breast cancer in 3 sisters, mother and maternal grandmother, one sister was tested for BRCA. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Multiple subcentimeter T2 hyperintense cysts are noted throughout both breasts.A Hydromark clip is present at the 2 o'clock position of the left breast, posteriorly. Immediately adjacent to the clip is a 3 mm enhancing focus corresponding to the patient's known biopsy proven fibroadenoma. Multiple enhancing foci in both breasts are mostly unchanged. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Cervical pain (stenosis). Weakness. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and morphology. At C2-3, there is mild anterior indentation of the thecal sac by a disc-osteophyte complex that also mildly deforms the spinal cord, but without abnormal signal. The neural foramina are preserved at this level. At C3-4, a disc-osteophyte complex causes moderate anterior indentation of the thecal sac deforming the underlying spinal cord. The neural foramina are preserved at this level. At C4-5, a disc-osteophyte complex causes mild thecal sac indentation and minimal spinal cord deformity. Associated right-sided uncovertebral proliferative change causes mild narrowing of the neural foramen. At C5-6, there is slight indentation of the thecal sac by disc-osteophyte complex results in mild canal narrowing but no cord deformity. The neural foramina are preserved at this level. At C6-7, there is minimal anterior indentation of the thecal sac by disc-osteophyte complex. In addition, there is mild bilateral uncovertebral process hypertrophy, but no significant neural foraminal narrowing. At C7-T1, there is no significant spinal or foraminal narrowing. The vertebral artery flow voids appear to be intact. The paravertebral soft tissues are unremarkable.

Output: Relatively mild multilevel cervical degenerative spondylosis that is most pronounced at C3-C4 level, with mild-to-moderate spinal canal narrowing, but no spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: There is a relatively thick-walled, cystic lesion in the inferior aspect of left frontal horn without appreciable enhancement, appearing similar to the prior study. There is no associated mass effect or evidence of hydrocephalus. The ventricles and sulci are normal in size. The remainder of the brain is unremarkable without abnormal enhancement. No diffusion-weighted abnormalities are identified. There are no extra-axial fluid collections. The paranasal sinuses and mastoid air cells are clear.

Output: Thick-walled, cystic lesion in the left frontal horn, appearing similar to the prior study. Differentials include a chronic lesion related to prior infection such as neurocysticercosis. Given the relatively thick wall of the lesion, this would not be compatible with a simple neuroepithelial cyst. A low-grade neoplasm cannot be entirely excluded, such as a subependymoma, and recommend continued follow-up.


Instruction: Generate impression based on findings.

Input: Soft tissue mass right lower back, etiology unclear. Concern for increase in size and change in texture. ? Desmoid tumor. Please evaluate. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. T1 hyperintense lesion involving the L2 vertebral body is consistent with a small hemangioma. The conus medullaris is normal in position.There is mild generalized facet arthropathy throughout the lumbar spine. Additional details regarding degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No significant spinal canal or neural foraminal stenosis. L5-S1: There is a central/right paracentral disc protrusion which partially effaces the lateral recesses, particularly on the right where there is contact of the right S1 nerve root. No significant central spinal canal stenosis. There is mild bilateral neural foraminal stenosis.In the right upper lumbar superficial musculature at the L1-L2 level, there is a lesion measuring 1.1 x 3.7 cm in the AP and transverse dimensions and approximately 3.5 cm in the craniocaudal dimension with signal features consistent with fat and no suspicious enhancement. Paraspinous soft tissues are otherwise unremarkable.

Output: 1. Superficial soft tissue lesion in the right upper lumbar region is consistent with a lipoma.2. Mild degenerative changes at the L5-S1 level with disc protrusion, as described above.


Instruction: Generate impression based on findings.

Input: 5-year-old male with right elbow pain and fever. Evaluate for osteomyelitis. Peripherally enhancing, centrally low attenuation collection abutting the anterior margin of the distal humeral metaphysis measuring 4 x 9 x 31 mm, (series 1201, image 6). There is an additional nonspecific 5 x 7 mm enhancing focus within the soft tissues of the medial arm (series 1401, image 10).BONE AND MARROW: Cortex underlying the fluid collection appears intact. There is heterogeneous signal within the distal humerus which could represent the patient's red marrow, however, it is more heterogeneous than the signal of the ulna and radius. This could reflect osteitis.SYNOVIUM: Normal.MUSCULATURE: There is increased T2 signal within the brachioradialis muscle is compatible with edema/inflammation.ADDITIONAL

Output: 1. Peripherally enhancing, centrally low attenuation collection abutting the anterior margin of the distal humeral metaphysis likely representing an abscess.2. Heterogeneous signal within the distal humerus which could represent osteitis as the cortex underlying the abscess appears intact.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stenosis. Signs and symptoms: Low back pain and lumbar radiculopathy. Nonenhanced lumbar MRI:There is unremarkable signal intensity and normal anatomical alignment of the vertebral column.There is a slight generalized narrower than expected caliber of the lumbar spinal canal at L3 and L4 levels which is believed to represent a congenital anatomical variation.There is no appreciable degenerative disk disease and no evidence of disk protrusion/extrusion. Examination however demonstrate mild hypertrophic changes of the ligamentum flavum in a symmetrical fashion in the mid to lower lumber spine. Very mild facet degenerative changes and including minimal facet effusion is also suspected.There is no evidence of spinal stenosis or definitive neural foraminal compromise at any level.Partially visualized SI joints demonstrate no abnormality.The paraspinal musculature remains normal in signal intensity and morphology.

Output: 1.No evidence of spinal stenosis or definitive neural foraminal compromise.2.Mild hypertrophic changes of the ligamentum flavum and mild facet disease in the lower lumber spine is present3.Mild decreased caliber of the spinal canal at L3 and L4 levels likely representing a congenital anatomical variation.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:11/14/1944)Reason: patient with a history of met urothelial cancer, new right lesion in the right frontal cranial fossa, and new complaints of unilateral strength and functional problems. Please assess for disease progression History: met urothelial cancerPROVIDER/ATTENDING NAME: PETER H O'DONNELL PETER H O'DONNELL There is a large irregularly-shaped peripherally enhancing mass located in the right frontal lobe and measuring 51 x 50 mm axial dimensions. It is high signal on T2 and intermediate signal on FLAIR and low signal on diffusion imaging and T1 imaging. Signal intensity on T1 is slightly higher than spinal fluid. The enhancing component is dark on susceptibility imaging. There are irregularly-shaped serpiginous flow-voids on susceptibility imaging along the inferior and superior aspect of the lesion suggesting adjacent microvascular. There is associated mass effect with midline shift. There is a moderate degree of vasogenic type edema associated with this. The septum pellucidum is shifted approximately 9 mm to the left of midline. The uncus is shifted medially.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 is a large mass centered in the right frontal lobe which is concerning for neoplasm. It is associated with mass effect and midline shift and subfalcine herniation. Given the patient's clinical history of primary tumor elsewhere metastases is a significant consideration. A primary brain tumor is alternative explanation. Infection is less likely based on its imaging characteristics.


Instruction: Generate impression based on findings.

Input: 61-year-old female with right shoulder pain. Evaluate for rotator cuff issues. ROTATOR CUFF: There is thickening and increased signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. There is partial-thickness bursal surface tearing of the supraspinatus at the level of its myotendinous junction involving less than one half of the tendon fibers. There is increased edema type signal abnormality affecting the muscle belly of the infraspinatus. There is also marked fatty atrophy of the infraspinatus muscle. The infraspinatus tendon appears intact. The subscapularis and teres minor tendons and muscles appear intact.SUPRASPINATUS OUTLET: Mild to moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although this examination was not protocoled for evaluation of the glenoid labrum, no discrete labral tear is evident. There is a large glenohumeral joint effusion. Degenerative changes affect the glenohumeral joint. Note is made of multiple subchondral cysts within the humeral head.BICEPS TENDON: There is a large amount of circumferential fluid within the tendon sheath the long head of the biceps tendon which likely represents extension of fluid from the glenohumeral joint versus tenosynovitis. ADDITIONAL

Output: 1. Large glenohumeral joint effusion. Partial-thickness bursal surface tearing of the supraspinatus without evidence of a full-thickness rotator cuff tear.2. Edema type signal abnormality and fatty atrophy of the infraspinatus tendon raises the question of a denervation injury. No masses are identified within the spinoglenoid or suprascapular notches. Parsonage-Turner syndrome is also a differential consideration. 3. Findings suggestive of adhesive capsulitis/frozen shoulder. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Glioblastoma. Status post resection in December 2015 and radiation treatment. On chemotherapy (TMZ and TTF). The right frontal surgical cavity is unchanged in size. However, the fluid within the surgical cavity is more T2-FLAIR hyperintense, which may reflect increased protein or debris content. The right frontal surgical cavity shows persistent contrast enhancement along the margin with evidence of hemosiderin staining. A relatively nodular area of contrast enhancement at the anterior aspect of the surgical cavity has slightly increased in size: on sagittal imaging, this component measures 15 mm x 11 mm compared to 14 mm x 9 mm previously. No clear elevated rCBV is seen in association with this nodule.The associated surrounding right frontal white-matter T2-hyperintensity is slightly increased as well as the mass-effect resulting in smaller overlying sulci. Otherwise, there is diffuse slight increase in the size of the ventricles and the other sulci, reflecting parenchymal volume loss. There is no new or separate contrast-enhancing brain lesion. There is no midline shift or brain herniation. The major intracranial vascular flow voids are preserved.There are findings of prior right frontal craniotomy with mild, contrast-enhancing dural thickening and minimal fluid. The orbits are grossly unremarkable.

Output: 1.The nodular contrast enhancement along the anterior resection margin has slightly increased since the prior examination. There is no significant change in the appearance of enhancing tissue along the remainder of the surgical cavity. Given the mild nature of the change and the short time interval since the most recent examination, it is difficult to determine the significance of the findings, which may still represent pseudoprogression versus true progression. 2.Increased T2 signal surrounding the surgical cavity is nonspecific, and may reflect evolving posttreatment change. Similarly, increased FLAIR signal of the fluid in the surgical cavity is nonspecific.


Instruction: Generate impression based on findings.

Input: Right flank pain, cystic lesion in the pancreatic tail ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Cystic nonenhancing lesion in the pancreatic tail measuring 2.1 x 1.2 cm (series 4, image 14). Communication with the main pancreatic duct is difficult to evaluate given the location of the lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Cystic lesion in the pancreatic tail; favor IPMN although mucinous cystadenoma is not entirely excluded.


Instruction: Generate impression based on findings.

Input: 28 year-old female with new onset worst headache in life. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Unremarkable contrast enhanced CT head.


Instruction: Generate impression based on findings.

Input: Male 20 years old Reason: Evaluate for DAI History: Fell off bicycle, possible DAI read on CT head. There is no evidence of intracranial hemorrhage. Hypoattenuating focus on CT corresponds to a focus of T2 hyperintensity in the subcortical white matter of the right frontal lobe. There are additional small foci of periventricular and subcortical white matter T2 hyperintensity in both frontal lobes and parietal lobes. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage. 2.Focus of T2 hyperintensity in subcortical white matter of the right frontal lobe with additional small foci of white matter T2 hyperintensity. These findings are nonspecific, but are unlikely related to nonhemorrhagic diffuse axonal injury. These findings may be seen in the setting of chronic migraine headaches, demyelinating disease, as well as migrational abnormalities. Clinical significance of this lesion is unclear.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: eval disk herniation Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation at this level as well as a disc bulge. There is partial effacement of the fat at the lateral recess bilaterally but worse on the right side when compared to the left with encroachment of the nerve roots at the right lateral recess.. There is bilateral facet hypertrophy at this level as well as some ligamentum flavum hypertrophy. These findings are stable and compared to the previous exam.At L4-5 there is no significant compromise to the neural foramina. There is loss of disc space height at this level associated with a disc bulge and disc desiccation as well as bilateral facet and ligamentum flavum hypertrophy. There is effacement of the fat at the left lateral recess at this level and encroachment of the nerve roots at the left lateral recess. There is partial effacement of the fat at the right lateral recess at this level. There is milder encroachment of the nerve roots of the right lateral recess at this level. These findings are stable and compared to the previous exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple cysts present along the kidneys. One along the left kidney measures approximately 30 mm in diameter. One along the right kidney measures approximately 23 mm in size. Another one along the left kidney is oblong and measures 17 x 45 mm in axial dimensions. These were also identified in the recent CT of the abdomen.

Output: There is redemonstration of multilevel degenerative changes in the lumbar spine predominantly at L4-5 and L5-S1. There is encroachment of the nerve roots of the right lateral recess at L5-S1 (probably right S1 nerve roots) and the left lateral recess at L4-5 (probably left L5 nerve roots) related to combination of disc bulge and facet and ligamentum flavum hypertrophy. These findings are stable when compared to the prior exam from 2012.


Instruction: Generate impression based on findings.

Input: 56-year-old male with a history of squamous cell carcinoma of the nasopharynx status post surgery and chemoradiation therapy with probable metastatic disease to the brain. Evaluate for shift. There is a heterogeneous soft tissue density in the right ethmoid sinus with associated destruction and invasion through the overlying right lamina papyracea consistent with the patient's history of sinonasal squamous cell carcinoma. Additionally, there is an air-fluid level in the left frontal sinus and left ethmoid sinus mucosal thickening.There is a 3-cm isodense mass in the right frontal lobe (10; series 4) with extensive surrounding vasogenic edema highly suspicious for metastatic disease, previously 2 cm on outside MRI examination, significantly enlarged. Additionally, note is made of a 9 x 13 mm focus of hyperdensity in the posterior aspect of the aforementioned mass which likely represents hemorrhage adjacent to the tumor. There is associated local mass-effect with a 6-mm local leftward midline shift of the inferior right frontal cortex. There is no evidence of extra-axial fluid collection. There is preservation of the gray-white matter interface. There is no evidence of acute territorial infarct. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells are within normal limits.

Output: 1. 3 cm mass in the right frontal lobe with extensive surrounding vasogenic edema consistent with intracranial extension of tumor from the ethmoid air cells. There is a hyperdense focus in the posterior aspect of the aforementioned mass which likely represents hemorrhage. There is associated local mass-effect with a focal leftward midline shift of the inferior right frontal cortex. 2. There is a heterogeneous soft tissue density in the right ethmoid sinus with associated destruction and invasion through the overlying right lamina papyracea consistent with the patient's history of sinonasal squamous cell carcinoma. Additionally, there is an air-fluid level in the left frontal sinus and left ethmoid sinus mucosal thickening.


Instruction: Generate impression based on findings.

Input: Vertebral body heights and alignment are maintained. No worrisome focal marrow signal abnormality is appreciated. Mild degenerative changes are seen throughout the cervical spine. The spinal cord is of normal caliber and signal. No evidence of epidural tumor. There is no pathological enhancement. Mild bilateral C3-C4 and mild left C7-T1 neural foraminal narrowing is seen. Otherwise no significant spinal canal or neural foraminal stenosis is appreciated in the cervical spine.THORACIC SPINE

Output: 1. No findings to suggest metastatic disease in the cervical, thoracic, or lumbar spine. No evidence of compression fractures, cord signal abnormality, or epidural tumor.2. Mild nonspecific edema and enhancement in the lower lumbar paraspinous musculature which may represent mild myositis.


Instruction: Generate impression based on findings.

Input: Evaluate for rotator cuff tear ROTATOR CUFF: There is a full-thickness tear of the supraspinatus from its insertion. There is a large amount of fluid in the subdeltoid and subacromial bursae. The supraspinatus muscle is severely atrophiedThe infraspinatus is unremarkable. The subscapularis is unremarkable.SUPRASPINATUS OUTLET: Note is made of degenerative changes at the acromioclavicular joint..GLENOHUMERAL JOINT AND GLENOID LABRUM: There is marked irregularity of the inferior labrum consistent with generations.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Marked atrophy of the supraspinatus with a large full-thickness tear. Large amount of fluid within the subdeltoid and subacromial bursae


Instruction: Generate impression based on findings.

Input: 58-year-old male with recurrent urothelial carcinoma and pelvic abscess. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild intrahepatic biliary dilatation and mild dilatation of the common bile duct is stable. Ill-defined hypodensities in the left lobe of the liver, best seen on image number 30, series number 3 is unchanged.SPLEEN: No significant abnormality notedPANCREAS: Small cystic lesion in the tail of the pancreas is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index left para-aortic node is unchanged, measuring 13 by 8mm image number 63, series number 3. And, more caudal index node is also unchanged, measuring 13 by 12-mm in width. Number 76, series number 3.BOWEL, MESENTERY: Also in the right and left lower quadrants. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy. Previously measured complex fluid collection containing air in drainage catheter and fistulizing into the skin is slightly increased, now measures 7.8 x 5.9 cm image number 121, series number 3. There is tissue defect in the midline pelvis.BLADDER: Ileal pouch is noted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Ill-defined enhancing lesion in the lower midline pelvis measuring 4.9 x 2.8 cm is suspicious for recurrent tumor. MRI may helpful for better characterization of this mass separate from the collection. The mass invades the base of the penis and abuts the pelvic bones.

Output: Interval increase in the size of the complex pelvic fluid collection. Retroperitoneal lymph nodes are stable.Possible pelvic mass, suspicious for recurrent disease. MRI of the pelvis may be helpful for better characterization of this lesion, if clinically indicated.


Instruction: Generate impression based on findings.

Input: Diagnosis: Demyelinating disease of central nervous system, unspecifiedClinical question: CNS demyelinating disease re evaluateSigns and Symptoms: None The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of signal hyperintensity along the lateral aspect of the right precentral gyrus predominantly involving white matter in the region measuring approximately 1 cm x 0.5 cm in axial dimensions is associated with a focus of susceptibility effect. There is no abnormal enhancement associated with this. The patient is status post burr hole placement in the adjacent overlying calvarium.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The MRI of the brain is stable compared to the prior exam. There is a small lesion in the right precentral gyrus which is stable compared to the prior exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Portable CT. Right temporal parietal bleed Extreme motion artifact obscure a significant amount of brain parenchyma and evaluation cannot be made. Note however is made of a hematoma measuring approximately 36 mm x 27.7-mm in the right posterior temporal. There is no evidence of surrounding vasogenic edema. To exclude possibility of a hemorrhagic mass MRI with infusion is recommended. The low-density of the edge of hematoma suggest its subacute state. Encephalomalacia along the course of right middle cerebral artery in the frontal region is consistent with an old stroke. There is ex vacuo dilatation of the right lateral ventricle.

Output: Very limited exam due to extensive motion. Right posterior temporal likely subacute hematoma and large area of cortical and subcortical right frontal encephalomalacia.


Instruction: Generate impression based on findings.

Input: 61-year-old male status post prostatectomy with detectable PSA who presents for evaluation for disease recurrence. PELVIS:PROSTATE: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: There is an ill-defined subcentimeter T2 hypoattenuating focus at the vesicoureteral junction (series 901, image 23), which raises concern for recurrent disease.OTHER: No significant abnormality noted.

Output: Subcentimeter focus at the vesicoureteral junction as detailed above raises concern for recurrent disease.


Instruction: Generate impression based on findings.

Input: 70 year-old male presenting with transient alteration of awareness and ataxia, with likely TIA. Evaluate for bleed or other cause. There is no evidence of intracranial hemorrhage, mass or edema. Soft tissue mass extending from the sella is identified, incompletely evaluated without contrast administration, resulting in mass effect upon the suprasellar cistern. No internal calcifications or adjacent bone erosion is evident. Further evaluation with MRI is recommended. The ventricles are midline, and demonstrate normal volume and morphology.The calvaria and skull base are radiographically normal. Crescentic high density is noted in the subcutaneous tissues along the superior aspect of the left parietal lobe, which may represent hematoma. No underlying fracture is evident. Partial opacification of the maxillary and sphenoid sinuses and numerous ethmoid air cells is evident.

Output: 1. Subcutaneous hematoma overlying the postero-superior left parietal bone, with no underlying fractures or intracranial hemorrhage. 2. Sellar mass as described above. Differential considerations include pituitary macroadenoma, among others. Further evaluation with MRI is recommended. 3. Sinus disease as described above.


Instruction: Generate impression based on findings.

Input: 39 year old woman with cardiomyopathy and echo suggesting 10% decrease in LVEF. Patient referred for reassessment of LVEF. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 113 ml/m2 (normal range: 65+/-11), the LVEDV is 216 ml (normal range 109+/-23), the LV end systolic volume index is 66 ml/m2 (normal range 18+/-5), the LVESV is 126 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 81 g (normal range 114+/-24). There is abnormal septal motion consistent with bundle branch block. Native myocardial T1 times are within normal limits.Left AtriumThe left atrium is dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 158 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsRenal cysts are noted (also present on prior study). 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. Severe left ventricular dilation with mildly reduced systolic function (LVEF 42%) with normal native myocardial T1 relaxation times suggesting the absence of significant underlying myocardial fibrosis or inflammation. 2. Normal right ventricular size and systolic function (RVEF 62%). 3. When compared to prior study from 1/26/2016, no change in LVEF.


Instruction: Generate impression based on findings.

Input: Reason: new L hip pain, eval for new mets History: above Post contrast images are not able to be obtained due to the patient's inability to tolerate further examination. Note is made of decreased bone marrow signal abnormality affecting the imaged portions of the L3 and L4 vertebrae on both T1 weighted images and fluid sensitive sequences. There is also decreased bone marrow signal abnormality along the right acetabulum which extends into the right ilium, abutting the right sacroiliac joint. There is also decreased signal abnormality on T1-weighted images and fluid sensitive sequences within the left ilium about the left sacroiliac joint. Given the diffuse decreased signal abnormality on all pulse sequences, these findings may represent treated metastases, although these are incompletely characterized due to lack of contrast enhanced imaging. There is restricted diffusion within the left ilium, left acetabulum, left ischium, left pubic bone, and left femoral head/neck extending to the level of the intertrochanteric and subtrochanteric regions of the femur. There is also diffuse restricted diffusion within the sacrum.

Output: Limited examination due to lack of contrast enhanced images. However, there are multiple foci of restricted diffusion affecting the bones of the left hemipelvis and left femur which are suspicious for osseous metastasis, although these are incompletely characterized on this noncontrast examination. Multiple foci of decreased signal abnormality on all pulse sequences within the right acetabulum, ilium and ischium may represent treated metastases, although these are also incompletely characterized on this noncontrast examination.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for mass or other abnormality. Signs and symptoms: Confusion and memory loss. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates patchy foci of flair hyperintensity only in the periventricular and convexity subcortical white matter of cerebral hemispheres. Although the findings are nonspecific considering patient's stated age of 73 they could represent microvascular ischemic disease of mild degree. The anatomical morphology and the signal intensity of the brain parenchyma is otherwise entirely within normal on all MRI sequences for patient's stated age.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces.Negative post enhanced images for any abnormal enhancement the brain parenchyma, the meninges, calvarium, soft tissues of the scalp or the orbits.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic small vessel ischemic strokes in the in the subcortical and periventricular white matter.3.Unremarkable pre-and post enhanced brain MRI as detailed otherwise.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 28-year-old female with right hip pain. Evaluate for right hip labral tear ACETABULAR LABRUM: There is a small nondisplaced tear of the anterior superior labrum (series 1101, image 13 and series 1401, image 12) noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: The soft tissues are unremarkable.ADDITIONAL

Output: Small nondisplaced tear of the anterior superior labrum.


Instruction: Generate impression based on findings.

Input: Myelofibrosis currently enrolled in clinical trial ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. The hepatic vasculature is patent. Status post cholecystectomy. No biliary ductal dilation.SPLEEN: Marked splenomegaly measuring 23 cm in length, unchanged. Multiple subcentimeter foci of T2 signal abnormality without enhancement are too small to further characterize but unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: L2, L3, and S1 hemangiomas, unchanged.

Output: Stable interval exam with marked splenomegaly.


Instruction: Generate impression based on findings.

Input: 35 year-old female with family history of breast cancer (mother and maternal and) present for screening MRI. Personal history of left breast biopsy-proven fibroadenoma. There is scattered fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.A clip is noted within the left retroareolar region pathologically proven to represent fibroadenoma. A second clip is noted in the left breast at the 3:00 position which was biopsied as usual ductal hyperplasia and focal apical metaplasia. There are postbiopsy changes adjacent to the 3:00 clip.The right breast is unremarkable.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Benign lesions in the left breast with no MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: S/p ventriculoscopy. Possible HCP. Examination demonstrates post operative changes of ventriculoscopy, including right frontal burr hole and air in the right frontal region and left frontal horn. A right frontal linear low density is present along the previous catheter tract. A cyst with peripheral calcification is present in the region of the pineal gland, which is unchanged in size from prior brain MRI. There is no intracranial hemorrhage, mass, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in size and are symmetric. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Expected postoperative change of ventriculoscopy. No evidence of a hydrocephalus or hemorrhage.2. Pineal cyst.


Instruction: Generate impression based on findings.

Input: cT1N2bM0 left base of tongue squamous cell carcinoma, p16+ s/p 3 cycles induction on OPTIMA. The left tongue base mass has decreased in size and is no longer measurable. There is no residual significant cervical lymphadenopathy. The thyroid and salivary glands are unremarkable. There is a disc-osteophyte complex at C5-6, which mildly indents the spinal cord. There is now inflammation at the site of the previously imaged subcutaneous cystic lesion in the posterior left neck. The orbits and imaged intracranial structures are unremarkable.

Output: 1. The left tongue base mass has decreased in size and is no longer measurable.2. No residual significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Pain BONE MARROW: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. JOINTS: Labrum is grossly normal. If high suspicion of labral abnormality MR arthrogram is the study of choice.ADDITIONAL

Output: Unremarkable pelvis. Labrum is grossly normal. If high suspicion of labral abnormality MR arthrogram is the study of choice.


Instruction: Generate impression based on findings.

Input: Diffuse atrophy involving the thoracic cord is again noted. There are multilevel laminectomies in the upper and lower thoracic spine as seen before. The upper aspect of the thoracic cord is posteriorly displaced and abuts the dura which may reflect scarring and similar to prior studies. The distal thoracic cord is also posteriorly displaced as before. Again seen is a syrinx extending throughout the thoracic cord. Catheter is present within the superior aspect of the thoracic syrinx and extends inferiorly to the T5 level. Catheter involving the inferior aspect of the syrinx terminates superiorly at the T9 level. Upper aspect of the thoracic syrinx has decreased in size compared to remote MRI study from 5/23/2013. For example at the mid T3 level, syrinx measures 3 x 8 mm, previously 7 x 8 mm. Syrinx at the T6 level measures 4 x 7 mm as before. Syrinx at the inferior T8 level measures 7 x 7 mm previously 6 x 7 mm. There is low T2 signal circumferentially along the dural margin as before which may be reflective scarring, hemosiderin, or mineralization.Thoracic vertebral height heights are maintained. There is straightening of the thoracic kyphosis. Bone marrow signal is benign. No significant spinal canal stenosis or neural foraminal stenosis is evident.LUMBAR SPINE

Output: 1. Compared to prior thoracic MRI from 5/23/2013, there is decrease in size of the upper thoracic syrinx and stable to minimal increase in size of the lower thoracic syrinx.2. There is diffuse volume loss of the thoracic cord with areas of posterior displacement involving the upper and lower aspects of the thoracic cord suggesting posterior adhesions. There is also evidence of arachnoiditis involving the cauda equina nerve roots similar to prior.3. Degenerative changes in the lumbar spine as described above including a new T12-L1 disc extrusion. There is no high-grade spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule-out acute intracranial bleed. Signs and symptoms: Acute altered mental status. CT of brain without infusion:Large vessel intracranial vascular calcification of carotids and vertebral arteries are again identified. Very minimal scattered patchy areas of low-attenuation in the periventricular and subcortical white matter of bilateral cerebral hemispheres are concerning for minimal small vessel disease. Age of these is strokes cannot be determined on CT. Precise comparison with the prior examination for detection of new or small vessel stroke is not possible. Small vessel disease was noted on prior CT and MRI exam.No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Findings consistent with small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 66 year old male with history of prostate cancer. PELVIS: Motion artifact limits evaluation.PROSTATE:Prostate Size: 3.0 x 4.5 x 2.5 cmPeripheral Zone: There is a T2 hypointense focus within the left mid gland/base with corresponding low ADC signal; this focus measures 1.1 x 1.7 cm (series 901, image 17). It does not demonstrate significant contrast enhancement. Additional right mid gland subcentimeter T2 hypointense focus with corresponding low ADC signal (series 503, image 384).Central Gland: Central gland is heterogeneous, compatible with benign prostatic hypertrophy.Seminal Vesicles: No evidence of extension into the seminal vesicles.Extracapsular Extension: There may be minimal right-sided extracapsular extension (series 901, image 17).BLADDER: No significant abnormality noted.LYMPH NODES: There are subcentimeter proximal external iliac chain lymph nodes. Additionally, there are large distal iliac chain lymph nodes with reference noted on the right measuring 1.8 x 1.4 cm (series 1701, image 57).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large left mid gland/base and subcentimeter right mid gland suspicious for neoplasm as detailed.2.Bilateral distal external iliac chain enlarged suspicious lymph nodes.


Instruction: Generate impression based on findings.

Input: History of left lumpectomy for breast cancer. Known right breast mass at 6:00 and bilateral masses/foci elsewhere for which short term follow up is performed. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. No suspicious enhancement is seen in either breast. Post-operative changes are noted on the lateral left breast and left axilla, including a seroma in the breast. Expected thin peripheral enhancement is present around the seroma. There are again noted to be numerous bilateral small masses and foci, in an overall pattern similar to the prior MRI allowing for the differences in technique between the studies and changes in her left breast pattern related to surgery. This includes a stable mildly enhancing right breast mass at 6:00 measuring 1 cm that was also seen on the recent ultrasound. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. No significant change in numerous bilateral foci and masses in the short term since the MRI from late last year. A 12 month follow up mammogram and MRI are recommended for these findings given her history of malignancy and this appearance. BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (1/22/15) performed at High Tech Medical Park. Per outside radiology report, the patient has a known left breast cancer. Breast MRI was performed with a protocol outlined in the outside radiology report.There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted in the right breast.A catheter port is placed in the right medial chest wall.In the left breast at lateral aspect, there is an extensive, segmental non-mass enhancement measuring 13 x 7 x 9 cm (AP x LR x CC) with diffuse skin thickening. Within this segmental non-mass enhancement, there are at least 2 irregularly shaped masses measuring 19 x 15 x 15 mm at posterior upper outer quadrant, and 15 x 14 x 11 mm at middle lower outer quadrant. These findings are compatible with patient's known left breast cancer. In the left axilla, there are at least 2 abnormally enlarged lymph nodes in the level 1 region, measuring 28 mm and 18 mm, and one abnormal lymph node at level 2 region, measuring 14 mm.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. Extensive non-mass enhancement with enhancing masses at lateral aspect in the left breast, and diffuse skin thickening, consistent with patient's known left breast cancer. At least 3 abnormal lymph nodes in the left axilla.2. No MR evidence for malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Head and neck cancer. Dry mouth. Head CT:There is no evidence of intracranial mass, hemorrhage or acute infarction. The enhancing focus in the left parietal lobe reported on the prior CT study is no longer well visualized. In this same area, there is subtle hypodensity, consistent with encephalomalacia, possibly from previous infarction. There are scattered areas of chronic infarction in the left cerebellum, left parietal lobe, right frontal lobe and right basal ganglia which are unchanged compared to prior study. There are new areas of hypodensity seen in the right frontal periventricular region, and at the left basal ganglia, with low density compatible with old infarctions that have evolved since the prior CT study. The lesion at the left basal ganglia was also seen on prior MRI brain of 9/26/2009. Scattered ill-defined cerebral white matter hypoattenuation is consistent with small vessel ischemic changes.Neck CT:The soft tissue thickening and asymmetry at the laryngeal region are unchanged compared to prior study. No pathological size lymph nodes, or necrotic lymph node is identified. Again noted is a diverticulum at the anterior aspect of the esophagus. There is degenerative disease of cervical spine. There is interval development of near-complete opacification of the right maxillary sinus, with mucosal thickening also seen in the left maxillary sinus.There are postsurgical changes in bilateral mastoid regions.

Output: 1. Multiple chronic infarctions in the brain as described above.2. Stable soft tissue asymmetry in the laryngeal region. No evidence of adenopathy.3. New bilateral maxillary sinus disease.


Instruction: Generate impression based on findings.

Input: History of appendiceal cancer presents for restaging. History of omental biopsy with metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Several too small to characterize punctate foci, probable cysts are unchanged. No suspicious parenchymal lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in size, signal intensity and enhancement without a focal lesion. Small splenules are noted adjacent to the anterior aspect of the spleen, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral percutaneous nephroureteral stents without hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post right hemicolectomy. Very small mesenteric lymph nodes are unchanged. Mild peritoneal surface thickening without discrete nodular enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is thickening of the peritoneal surfaces and serosal small bowel surfaces associated with mild restricted diffusion but no discrete nodular enhancement. The pelvic small bowel mesentery appears hazy.There is mild tethering of the small bowel to the level of the bladder dome without obstructive complication.In the region of the rectovesical pouch and site of patient's known seminal vesicle excision there is a 5.1 x 3.1 cm fluid pocket demonstrating restricted diffusion and wall enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No definite measurable solid disease is seen in the abdomen or pelvis.2. Peritoneal surface and serosal bowel wall surface thickening and pelvic small bowel mesentery haziness with associated restricted diffusion but no discrete nodular enhancement. Differential includes postsurgical changes from extensive peritoneal surface stripping although residual tumor is not excluded.3. Rectovesical pouch fluid pocket with restricted diffusion and wall enhancement is favored to be postoperative although residual disease cannot be entirely excluded. If the patient has signs and symptoms of infection an infected collection should be considered.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: Evaluate FLAIR lesions in R parietal and R temporal region History: Seizures Redemonstration of focal encephalomalacia on the right inferior parietal lobule in particular right supramarginal gyrus and angular gyrus as well as right inferior temporal gyrus, no change in terms of their extent and MR characteristics since prior scan.There is no evidence of acute hemorrhagic or ischemic lesion on this scan.There is no evidence of abnormal enhancement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.A retention cyst on the left maxillary sinus. Nasal septal deviation to the right is seen.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. No change of right inferior parietal lobule and right inferior temporal gyrus encephalomalacia with white matter T2/FLAIR high signal intensity lesions since prior scan.


Instruction: Generate impression based on findings.

Input: Patient with history of breast cancer. Lytic bone lesion at S1. Please provide biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: S1 left sacral ala bone biopsy under CT guidance. Samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Assess for intracranial abnormality. New onset GTC seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal myelination pattern. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: 64-year-old female with right arm weakness Hypodense area is seen in the high left frontoparietal area that is consistent with vasogenic edema. MRI with contrast is recommended for further characterization ischemic change versus mass. No hemorrhage or mass-effect is seen.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Hypodense area consistent with vasogenic edema identified in the left high frontoparietal area. An MRI with contrast is recommended for further characterization. Discussed with ER staff at time of dictation.


Instruction: Generate impression based on findings.

Input: 29-year-old female with weeks pregnant and is having worsening of baseline HA and hx of miscarriage; evaluate for cerebral venous thrombosis. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: Somewhat limited exam secondary to motion. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: There is loss of signal involving the origins of the vertebral and carotid arteries in the neck but this is secondary to technique. The visualized common carotid arteries and cervical internal carotid arteries are normal in course and caliber. There is no evidence of stenosis or occlusion.MRV Neck:Limited exam secondary to lack of intravenous contrast. The dural venous sinuses and visualized deep cerebral veins show normal flow related enhancement compatible with patency. There is no evidence of venous thrombosis.

Output: Within the limitations of the exam described above, the brain and vasculature of the brain and neck appear within normal limits.


Instruction: Generate impression based on findings.

Input: 38-year-old female with a history of ALL with new right sided hemiparesis, prior MCA stroke with left side hemiparesis one month ago. Also exclude leukemic meningitis. Compared to prior MRI, there is slight interval increase in FLAIR signal abnormality involving the right inferior frontal lobe and anterior insula compatible with evolution of infarct. There is enhancement in the infarcted region compatible with the subacute age. An additional punctate focus of FLAIR signal abnormality and enhancement in the right posterior frontal lobe corresponds to an additional focus of diffusion abnormality present previously and also compatible with subacute infarct. Nodular focus of enhancement along the right caudate head is also favored to represent subacute ischemia. There is punctate focus of susceptibility at the right frontal operculum which may represent minimal prior hemorrhage associated with the infarct.There is no evidence of acute infarct on the current study. No intracranial mass or mass effect. There is no abnormal parenchymal or meningeal enhancement to indicate infection. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute infarct. No imaging evidence of infection or intracranial leukemia but would suggest correlation with lumbar puncture.2.Expected evolution of the recent infarcts involving the right inferior frontal lobe and insula with additional punctate foci in the right MCA distribution as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, history of left submandibular mass, FNA was likely adenoid cystic. A well circumscribed T1 hypointense, T2 hyperintense and uniformly enhancing mass is present within or adjacent to the left submandibular gland. This lesion measures 18 x 11 mm in the axial plane and up to 16 mm in the coronal plane.Although there are no pathologically enlarged lymph nodes in the neck, a 7-mm node just posterior to the left submandibular gland (image 23 series 1401), and even smaller nodes more posteriorly (image 26 series 1401) do enhance more than other lymph nodes in the neck.The remaining salivary glands and thyroid are unremarkable. The aerodigestive mucosal tissues are free of mass lesions. Signal characteristics are within normal limits.

Output: A well circumscribed, homogeneously enhancing nodule within or immediately adjacent to the left submandibular gland is clearly of different tissue composition than the gland itself and is therefore highly suspicious for tumor. Both benign and malignant tumors would be in the differential.There are no pathologically enlarged lymph nodes in the neck. However, two small lymph nodes at level 2 on the left do show enhancement which is more intense than that of other normal-appearing lymph nodes, and as such these nodes are suspicious.


Instruction: Generate impression based on findings.

Input: 70-year-old male. History of bladder cancer status post cystectomy. Evaluate for new or metastatic lesion. ABDOMEN:LIVER, BILIARY TRACT: Scattered punctate T2 hyperintensities, too small to characterize, unchanged and likely cysts. Cholelithiasis. No biliary ductal dilatation.SPLEEN: No significant abnormality noted. Small splenule is noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Diffuse nonspecific mild thickening of the adrenal glands, unchanged.KIDNEYS, URETERS: Postsurgical findings of prior cystectomy and diverting ileostomy in the right lower quadrant.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes, unchanged. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.