Instruction: Generate impression based on findings.

Input: Note is made of mild ventricular dilatation involving the lateral, third, and fourth ventricles. The ventricles otherwise demonstrate normal morphology and there are no MRI findings suggestive of transependymal CSF resorption. Sagittal imaging demonstrates a patent aqueduct. There is focal thinning of the posterior body of the corpus callosum. Myelination is mature. There is no parenchymal gliosis or calcification. The cerebellar tonsils are in an appropriate position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. A small retention cyst is noted in the right maxillary sinus and minimal inflammatory changes are noted within scattered right mastoid air cells. Otherwise the remaining paranasal sinuses and left mastoid air cells are clear. Incidental note is made of bilateral staphyloma (right more prominent than left).

Output: 1.There is mild ventricular dilatation involving the lateral, third, and fourth ventricles. The ventricles otherwise demonstrate normal morphology and there are no MRI findings suggestive of transependymal CSF resorption. 2.There is focal thinning of the posterior body of the corpus callosum.3.There is no parenchymal gliosis or calcification.4.Minimal inflammatory changes are noted within scattered right mastoid air cells.


Instruction: Generate impression based on findings.

Input: 24 year old woman with history of syncope, abnormal RV wall motion on TTE referred for cardiac MRI to evaluate for ARVD. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is normalRight VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 177 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 85 ml (normal range 35+/-13). There is a focal wall motion abnormality in the distal RV free wall.Right AtriumThe right atrium is normalAortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is 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. The left ventricle is normal in size with normal systolic function (EF 60%).2. There is no late gadolinium enhancement to suggest the presence of an underlying inflammatory, infiltrative, fibrotic process in the myocardium.3. The right ventricle is normal in size with normal overall systolic function (EF 52%). However there is a focal wall motion abnormality present in the distal RV free wall.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke History: right UE and face weakness There is restricted diffusion area on the left basal ganglia and corona radiata without evidence of hemorrhagic transformation.Underlying brain shows multifocal scattered high signal intensity lesions on FLAIR images on bilateral basal ganglia indicating chronic ischemic lesions as well as non specific small vessel lesions on periventricular white matter.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.

Output: Acute ischemic infarction without evidence of hemorrhagic transformation on the left basal ganglia extended to the left corona radiata.Underlying bran shows multifocal chronic ischemic lesions and non specific small vessel ischemic lesions on FLAIR as described above.


Instruction: Generate impression based on findings.

Input: Developmental delay and epilepsy. Complicated birth history, born via C-section due to breech where mother's heart rate and blood pressure dropped and baby heart rate was non reassuring. The baby was born breech and with cyanosis. There is volume loss and high T2 signal involving the hippocampi and the deep gray nuclei bilaterally. There are scattered areas of high T2 signal in the cerebral white matter bilaterally. There is a diffuse background of mild cerebral volume loss, with thinning of the corpus callosum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild nonspecific mucosal thickening in the paranasal sinuses.

Output: Findings suggestive of perinatal hypoxic-ischemic injury in a central and peripheral pattern with associated diffuse cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: structural abnormality underlying seizures? History: seizures There is no 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, or 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.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8] / Jaw pain [R68.84], Reason for Study: ^Reason: pain and paresthesias right lower jaw post op dentale extraction, has lymph node right cervical, pease assess mass, infection, osteomyelitis, infectious process Hi There is no evidence of acute ischemic or hemorrhagic lesion.Multiple bihemispheric scattered high signal intensities on FLAIR/T2 images indicate non specific small ischemic disease.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: Non specific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion on this scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with pain radiating to the right lateral thigh and medial calf, then plantar medial. Tender right SI joint and paraspinous tissues at L2. Spinal alignment is anatomic. Vertebral body height is preserved. Degenerative endplate irregularity and signal change is seen at L5-S1, particularly on the left.Thickening of the cortex at the sacroiliac joints is seen, particularly on the right.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.T12-L1 through L3-4: Unremarkable.L4-5: Bilateral facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis.L5-S1: Bilateral facet arthropathy. Loss of disc height and mild disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Disc and posterior element degeneration are evident at L5-S1 but there is no significant spinal canal stenosis and only mild foraminal narrowing.2.Asymmetric sacroiliitis is suspected, right worse than left. The classic differential diagnosis for this finding would include psoriatic and reactive arthritis, along with other seronegative spondyloarthropathies and asymmetric osteoarthritis.


Instruction: Generate impression based on findings.

Input: MRI brain:There are punctate T2/FLAIR hyperintense foci in the subcortical bilateral frontal and anterior parietal white matter without associated diffusion restriction, susceptibility artifact, or pathologic enhancement. There are no similar lesions in the posterior fossa. Incidental note is made of congenital hippocampal sulcus remnants bilaterally of no clinical significance. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Right maxillary sinus retention cyst.MRI cervical spine:The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.At C2-C3, there is no significant spinal canal or neuroforaminal stenosis.At C3-C4, there is no significant spinal canal or neuroforaminal stenosis.At C4-C5, there is small left paramedian disc protrusion. There is no significant spinal canal or neuroforaminal stenosis.At C5-C6, there is no significant spinal canal or neuroforaminal stenosis.At C6-C7, there is annular tear and small left paramedian disc protrusion. There is no significant spinal canal or neuroforaminal stenosis.At C7-T1, there is no significant spinal canal or neuroforaminal stenosis.

Output: 1.Punctate subcortical T2/FLAIR hyperintense foci in the bilateral frontal and anterior parietal lobes. Differential diagnosis would most likely include small vessel ischemic disease, migraine sequelae, or residua from remote head trauma. Given lesion location and morphology, demyelinating disease is considered unlikely.2.Two small cervical spine disc herniations without significant mass effect or resulting stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Glioblastoma status post 2 cycles of PDL1 therapy. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination really demonstrate a large hemorrhagic enhancing residual GBM of the left posterior temporal parietal and occipital region. Tumor also extends extensively into the splenium of corpus callosum. There is complete encasement of the occipital horn and trigone of right lateral ventricle by the tumor. Very extensive surrounding vasogenic edema is again noted.There is interval increased size of tumor and more dense pattern of enhancement. The largest transverse diameter of tumor and including the corpus callosum component measures at 62 mm in transverse diameter compared to prior study measurement of 44. There is interval increase in tumor into the sparing splenule of the corpus callosum which extends on current exam further across the midline to the left with resultant extension to the ependymal lining of the trigone of left lateral ventricle. There is also interval decreased size of resected surgical cavity since prior study which could at least partially be secondary to interval increased size of tumor.There is also mild interval increase in vasogenic edema surrounding the tumor. There is trace deviation of midline to the left which is a new finding since prior exam.

Output: 1.Examination demonstrate interval increased size of a large hemorrhagic enhancing right hemispheric GBM. Further extension of tumor across the splenium of corpus callosum to the left and involvement of the ependymal lining of trigone of the left lateral ventricle.2.Slight interval increased surrounding edema, decreased surgical cavity size and traced the radiation of midline to the left.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: Left knee effusion/warmth History: swelling at the end of the day MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant articular cartilage thinning or focal defect. No abnormal bone marrow signal.LIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex are intact. EXTENSOR MECHANISM: Extensor mechanism is intact. ADDITIONAL

Output: Normal MRI of the knee.


Instruction: Generate impression based on findings.

Input: 71 years, Female. Reason: chronic distention and gas- may do upright and flat plate of abdomen History: rule out partial small bowel obstruction Nonobstructive bowel gas pattern. Slightly above average stool burden distributed throughout the colon. Degenerative changes and sclerotic changes affect the lumbar spine particularly at L4-L5, progressed since the MRI examination from 2008. The visualized lung bases are grossly clear.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on findings.

Input: 68-year-old female with decreased abduction, pain with abduction and internal rotation ROTATOR CUFF: Intermediate signal intensity and mild thickening of the supraspinatus tendon indicating moderate tendinosis. Mild fatty atrophy of the distal myotendinous junction but otherwise the muscle appears intact. Mild increased signal intensity of the infraspinatus tendon suggests mild tendinosis. Mild fatty atrophy along the myotendinous junction but otherwise the muscle appears intact. Small cysts in the underlying humeral head. Teres minor muscle and tendon appears normal. Subscapularis muscle and tendon are within normal limits.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with small osteophytes resulting in minimal impression of the superior fibers of the supraspinatus muscle. Small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate osteoarthritis affects the glenohumeral joint with articular cartilage defects and small subchondral cysts in the glenoid. Small amount of fluid and/or synovitis within the glenohumeral joint. Increased signal intensity within the superior labrum likely represents degenerative fraying. Inferior labrum appears normal for age.BICEPS TENDON: Tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Osteoarthritis with rotator cuff and labral degeneration as described above.


Instruction: Generate impression based on findings.

Input: 44-year-old female with left AA dx in 2011. S/p partial resection, RT/TMZ + TMZ. Now off all tx for years, per chart since 2011. There is no restricted diffusion to indicate ischemic infarction.Again seen is increased FLAIR/T2 signal intensity in the left posterior frontal and parietal lobe extending from the cortex to the left lateral ventricle appearing similar to prior study. There is persistent internal enhancement which overall appears decreased in extent from MRI study dated 6/13/2014 and currently measures 25 mm x 19 mm. There is some intrinsic T1 signal within the region of enhancement. There are some internal foci of low signal on susceptibility weighted imaging which appear more conspicuous compared to prior study on 10/10/2014 likely representing evolution of blood products.There are no new intraparenchymal lesion is identified. There are no new areas of abnormal enhancement or signal intensity. There is no intraparenchymal hemorrhage. There is mild expansion of the trigone of the left lateral ventricle similar to prior exam with no mass effect or midline shift.

Output: Left posterior parietal and frontal lobe area of T2/FLAIR hyperintensity appears similar to prior study, however the extent of internal enhancement has decreased from study in 6/16/2014 and not significantly changed from the most recent MRI study on 2/11/2015.Note that the corrected relative cerebral blood volume sequence from perfusion imaging could not be generated. An addendum will be made to the report when this becomes available.


Instruction: Generate impression based on findings.

Input: 92 year-old female with altered mental status, respiratory distress. Rule out CVA. Multiple areas of subcortical and periventricular white matter hypodensity likely represent extensive small vessel ischemic disease, age indeterminate by CT. This appears to have progressed slightly since the prior examination. There is worsening of white matter hypodensity in the left frontal convexity, particularly along the superior frontal gyrus. Abnormal areas of attenuation are also noted in the cerebellar hemispheres appear worse compared to the prior examination. If there is concern for an acute stroke, an MRI is recommended for further evaluation. There is no evidence of intracranial hemorrhage or mass. Prominence of the ventricles and sulci indicate moderate to severe corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Extensive small vessel ischemic disease, age indeterminant, but with slight progression compared to the prior examination. If there is concern for acute stroke on an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, status post craniotomy for tumor resection. Since the prior examination, craniotomy has been performed at the high vertex. The previously seen enhancing tumor centered on the interhemispheric falx has been partially resected. It appears that all of the tumor to the left of the falx, and a majority of the tumor to the right of the falx, has been resected. Ill-defined enhancement along the left aspect of the resection cavity is nonspecific and could be related to surgical change. Thicker enhancement along the right aspect of the resection cavity likely reflects residual tumor.Vasogenic edema within the bilateral superior frontal gyri around the resection bed appears unchanged when compared to the immediate prior examination. No new areas of parenchymal edema are observed.Evidence of a prior large left frontal craniotomy are again seen. A resection cavity within the left middle frontal gyrus is unchanged. No abnormal enhancement is seen at this operative site to suggest recurrent tumor.An 8 mm extra-axial enhancing lesion along the dura overlying the left superior temporal gyrus is unchanged. A small area of enhancement within the left squamous temporal bone is unchanged and may represent a nonspecific osseous lesion or burr hole defect. No additional enhancing lesions are seen. No new areas of pathologic parenchymal signal abnormality are detected. The ventricular system is stable in size and morphology.

Output: 1.Expected postoperative findings status post craniotomy for resection of a falcine meningioma. Most of the lesion has been resected with only a small amount of suspected residual tumor along the right aspect of the resection margin. Associated vasogenic edema within the adjacent superior frontal gyri is unchanged.2.Evidence of prior left frontal tumor resection is redemonstrated without significant interval change. A small presumed meningioma overlying the left superior temporal gyrus is unchanged.


Instruction: Generate impression based on findings.

Input: Headache and dizziness with history of likely metastatic renal cell to the brain. There is an approximately 3.0 x 3.0 x 2.0 cm (AP by transverse by CC) heterogeneously enhancing extra axial mass abutting the dural wall of the right cavernous sinus, the anterior clinoid process, and the sphenoid wing. There is associated mass effect and edema involving the right mesial temporal lobe. Additionally, there is hemorrhage extending posteriorly within the right mesial temporal lobe with trace extension of hemorrhage into the temporal horn of the right lateral ventricle and a small amount of hemorrhage layering dependently within the occipital horn. The right M1 segment appears compressed by the lesion but not necessarily invaded or encased. The right A1 segment is not visualized, possibly hypoplastic. No additional enhancing lesions are identified. There is no evidence for hydrocephalus.

Output: Limited stealth MRI demonstrates an approximately 3 cm extra-axial mass abutting the right sphenoid wing and dural wall of the right cavernous sinus. There appears to be associated hemorrhage involving the mesial right temporal lobe with a small amount of hemorrhage extending into the temporal horn of the right lateral ventricle.


Instruction: Generate impression based on findings.

Input: Female 27 years old with positive pregnancy test and right lower quadrant abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly measuring 17.5 cm in craniocaudal dimension. No focal hepatic lesion, biliary ductal dilatation or ascites. The gallbladder is normally distended without cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus measures 9.3 x 6.9 cm in the sagittal plane. The endometrial canal contains heterogeneous T2 hyperintense material and a small amount of T1 hyperintense material. The cervix is open and the heterogeneous T2 material is collecting within the distended vaginal canal where there is also a fluid-fluid level.The left ovary contains a corpus luteal cyst. The right adnexa is unremarkable.BLADDER: Mildly distended and normal in appearance.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not well visualized but there are no secondary signs of acute appendicitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of pelvic free fluid.

Output: 1.The appendix is not well visualized but there are no secondary signs of acute appendicitis..2.The cervix is open and the endometrial canal and vagina contain blood products from ongoing abortion.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with elevated prolactin. Evaluate for pituitary mass. A hypoenhancing lesion is present within the left lateral sella potentially extending into the cavernous sinus. The lesion measures 6 x 6 x 6 mm and has decreased in size from the prior examination where it measured up to 8 mm in diameter. The pituitary gland is otherwise within normal limits. The pituitary stalk enhances normally and deviates very slightly towards the right. No evidence of significant suprasellar encroachment is seen.

Output: Interval decreased size of a hypoenhancing lesion in the left sella which, given the history, would be compatible with a microadenoma.


Instruction: Generate impression based on findings.

Input: Reason: evaluate AVM and aneurysm (see former CTA and CTH reports done at UCM) History: headache The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a partially calcified 19 x 12 mm lesion located in the left inferior parietal lobule which is associated with larger flow voids in the left MCA territory.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are suspicious for a small left inferior parietal AVM with suspected remote hemorrhage.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: There are extensive areas of T2 hyperintensity and restricted diffusion in a gyriform pattern involving left anterior frontal and left parietal lobe. Additional small scattered foci of diffusion abnormality are present throughout the bilateral cerebral hemispheres, bilateral caudate nuclei, left anterior corpus callosum, and perhaps in the left superior cerebellum. Many of these areas also demonstrate associated enhancement. There are punctate foci of encephalomalacia in the left cerebellum. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There may be minimal petechial hemorrhage in the left parietal region, but no gross acute intracranial hemorrhage. There is mild mucosal thickening in the left maxillary sinus as well as trace mucosal thickening in the ethmoid sinuses.

Output: Extensive gyriform restricted diffusion in the left anterior frontal lobe and parietal lobe and several scattered left more than right punctate diffusion abnormality in the cerebral hemispheres, bilateral caudate nuclei, and left cerebellum. These findings are compatible with predominantly early subacute ischemic infarcts in watershed distributions, without gross hemorrhagic transformation or midline shift. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified epilepsy without mention of intractable epilepsy [345.90], Reason for Study: ^Reason: evaluate of seizures History: recurrent seizures There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement.There is focal tissue loss on the left basal ganglia with peripheral susceptibility artifacts indicating prior hemorrhagic lesion. There are multiple tissue losses on the right upper pons and bilateral external capsules with susceptibility artifacts indicating prior hemorrhagic lesions. In addition, there are multifocal nodular scattered susceptibility lesions indicating either small punctate hemorrhagic foci or mineralizations. Underlying brain shows diffuse mild brain atrophy which is age appropriate and patchy high signal intensities on bilateral periventricular white matter indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal prior hemorrhagic lesions including left basal ganglia and bilateral external capsule with tissue losses as described above.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 49 year old female with metastatic small cell lung cancer with brain/pancreatic METs and with altered mental status. Rule out bleed. Images through posterior fossa are unremarkable.Multiple small patchy areas of decreased attenuation are noted. One of these lesions in the right frontal lobe demonstrates internal area of high density which corresponds with previously noted hemorrhagic metastases on MRI from 3 -- 6 -- 09. The other subcortical and periventricular low attenuations may represent small vessel disease. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus.111

Output: No evidence of acute findings. Small vessel disease and right frontal lobe metastases as detailed


Instruction: Generate impression based on findings.

Input: Reason: y.o. female with a h/o crohn's disease s/p ileocecectomy in 2005, now with intermittent abd pain, N/V. Colonoscopy was concerning for narrowing but repeat imaging showed no thickening/narrowing. Please eval for active disease, stricture, or adhesions. History: intermittent abd pain, N/V ABDOMEN:LIVER, BILIARY TRACT: Mild hepatomegaly. Diffuse loss of signal on out of phase images suggest hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of ileocecectomy with a side-to-side anastomosis in the right lower quadrant.There is a long segment of mural hyperenhancement extending from the mid descending colon to the distal sigmoid colon which demonstrates diffusion restriction. There is irregular narrowing within this segment. No evidence of obstruction.There is a short segment of narrowing involving the distal neoterminal ileum measuring 2.3 cm in length with mild proximal dilatation up to 2.9 cm.Short segment of narrowing with mural hyperenhancement of the mid transverse colon.BONES, SOFT TISSUES: Mild ventral diastases.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple nabothian cysts. Small amount of free fluid in the pelvis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Long segment of mural hyperenhancement involving the mid and distal descending colon and sigmoid colon as well as a short segment in the mid transverse colon, suggestive of active disease.2.Short segment of narrowing of the distal terminal ileum with mural hyperenhancement likely represents stenosis with acute on chronic disease. There is mild proximal small bowel dilatation to the segment.


Instruction: Generate impression based on findings.

Input: 46 year old male with a history of left ventricular dysfunction, atrial flutter, and hypertension referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 260 ml (normal range 142+/-34), the LV end systolic volume index is 48 ml/m2 (normal range 25+/-9), the LVESV is 122 ml (normal range 47+/-19), the LV mass index is 96 g/m2 (normal range 85+/-15), and the LV mass is 245 g (normal range 164+/-36). There is mild left ventricular hypertrophy, predominantly involving the septum (mid septum 10-12mm). There is a thick patch of late gadolinium enhancement involving the basal inferoseptal wall. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying myocardial fibrosing, inflammatory, or infiltrative process. There is no evidence of myocardial iron overload.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 262 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 100 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.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 a small pericardial effusion. Extracardiac FindingsSmall bilateral pleural effusions 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. The left ventricle is normal in size with low normal systolic function (LVEF 53%). 2. The right ventricle is normal in size with normal systolic function (LVEF 62%). 3. There is mild left ventricular hypertrophy, predominantly involving the septum (mid septum 12-14mm). Within the thickened septum, there is a patch of late gadolinium enhancement involving the basal inferoseptal wall. The pattern of late gadolinium enhancement is atypical for prior myocardial infarction and suggests the presence of an underlying myocardial fibrosing, inflammatory, or infiltrative process.4. There is a small pericardial effusion. 5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Muscle weakness (generalized)Clinical question: cervical disc diseaseSigns and Symptoms: hyperreflexia on the left and weakness on the right The cervical vertebral bodies are appropriate in overall alignment and height. There is reversal of the normal cervical curvature present. There is multilevel disk dessication present. Findings raise the question of a punctate signal hyperintensity in the spinal cord at the C3-4 level (image #7 sequence 4) which cannot be confirmed on axial imaging due to motion artifact.The exam is partly compromised due to patient motion.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge at this level.At C3-4 there is a diffuse disk bulge present associated with effacement oof spinal fluid ventral and posterior to the spinal cord and mild flattening of the spinal cord. There is some narrowing of the neural foramina at this level.At C4-5 there is a diffuse disk bulge present associated with effacement oof spinal fluid ventral and posterior to the spinal cord and mild flattening of the spinal cord.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is very small.

Output: 1.The exam is partly compromised due to patient motion which may obscure more subtle abnormalities.2.There are disk bulges at C3-4 and C4-5 with moderate spinal stenosis (worse at C3-4). A punctate focus of signal change in the cord at C3-4 is of unclear significance due to patient motion.


Instruction: Generate impression based on findings.

Input: There are areas of T2 hyperintensity and restricted diffusion involving both grey and white matter structures, including the right basal ganglia, the right insular cortex, the right lateral periventricular white matter, the right posterior temporal lobe, right inferior frontal gyrus, and the right lateral occipital lobe. There is no midline shift or hemorrhagic transformation. There is a subcentimeter hypointense extra-axial lesion along the right frontal convexity, which may represent a meningioma. There is diffuse cerebral volume loss. Mild scattered foci of T2 hyperintensity in the cerebral white matter without restricted diffusion may represent chronic small vessel ischemic disease. There are a few punctate foci of susceptibility effect scattered in the brain parenchyma, which may represent chronic microhemorrhages. There is mild scattered fluid signal in the bilateral mastoid air cells.

Output: Scattered areas of acute infarction in the right middle cerebral artery territory without hemorrhagic transformation or midline shift.


Instruction: Generate impression based on findings.

Input: Merkel cell carcinoma, staging Innumerable subcutaneous nodules are identified along the left lower extremity. These lesions are slightly hyperintense to skeletal muscle on T1 sequences and hyperintense to skeletal muscle on T2 sequences. Following contrast administration, there is generally solid enhancement although some of the larger lesions demonstrates central areas of nonenhancement which likely the result of necrosis.Index lesions are as follows: -Medial soft tissues of the thigh, series 26 image 21/50. 4.9 x 3.9 x 2.7 cm in the greatest AP, transverse, and craniocaudal dimensions-Anterior thigh, series 26 image 8/50, 1.6 x 1.9 x 2.3 cm, -Medial to the patella, series 26 image 37/50, 1.3 x 2.1 x 2.1 cm The underlying marrow signal of the femur is normal. There is mild diffuse subcutaneous edema of the thigh particularly medially. A cystic lesion is identified within the medial subcutaneous tissues just the at the level of the distal metaphysis. This lesion demonstrates signal characteristics of a simple cyst with thin peripheral rim-like enhancement. Additionally, there are multiple enlarged inguinal and iliac chain lymph nodes. Index nodes are as follows:-Left iliac chain, series 25 image 8/51, 3 x 3 cm-Left iliac chain, series 25 image 10/51, 3.5 x 2.2 cm-Left inguinal canal, series 25 image 22/51, 3 x 2.6 cm

Output: 1. Innumerable subcutaneous nodules consistent with the known diagnosis of Merkel cell carcinoma.2. Multiple enlarged inguinal and pelvic lymph nodes reflecting metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 88 years old, with metastatic breast cancer to the brain status post SRS to left frontal and right parietal lesions on 06/30/16. Evaluate for response and for new lesions. A prior right basal ganglia lesion was not treated. The left precentral gyrus enhancing lesion has decreased in size, now measuring 3 mm in diameter, previously 9 mm. Associated edema has also improved. The right postcentral gyrus enhancing lesion has also decreased in size measuring about 2 mm in diameter, previously 7 mm. Associated edema has resolved. The enhancing lesion in the right caudate head has increased in size now measuring up to 5 mm, previously 3 mm.No new enhancing lesions are seen. No areas of significant generalized edema or mass effect are detected. Scattered nonspecific foci of T2 hyperintensity are not significantly changed. No abnormal extra-axial collections are detected. The ventricles remain normal in size and morphology.

Output: 1.The treated left precentral and right postcentral gyrus lesions both demonstrate interval reduction in size.2.The untreated right caudate head lesion has increased slightly in size.3.No new lesions are seen.


Instruction: Generate impression based on findings.

Input: Reason: r/o stenosis History: hx of R ICA stenosis, left sided weakness MRI of the brainThere are approximately 10 punctate foci of diffusion restriction present in the medial aspect of the right frontal and parietal lobe and the right inferior parietal lobule. These are new since the prior exam. Prior foci of diffusion restriction in the watershed zone of the right hemisphere do not display diffusion restriction on today's exam. On T2 and FLAIR MRI sequences, there is redemonstration of hyperintense lesions in the right hemispheric watershed as well as small foci of hyperintensity in the basal ganglia, cerebellum and brain stem.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are punctate foci of signal loss on susceptibility imaging in the thalami, brainstem, left cerebellar hemisphere and basal ganglia.The right ICA flow void is absent. Normal vascular flow voids are present in the distal left carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The right internal carotid artery is occluded along the cavernous and opthalmic segments but reconstituted along the communicating segment via the PCOMA. This was also present on prior exams.Antegrade flow is present in the distal left internal carotid artery, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.Exam is degraded my motion artifact which may obscure subtle abnormalities.

Output: 1.The right internal carotid artery is occluded along the cavernous and opthalmic segments but reconstituted along the communicating segment via the left PCOMA. This was also present on prior exams.2.There are approximately 10 punctate foci acute infarction present in the medial aspect of the right frontal and parietal lobe and the right inferior parietal lobule. These are new since the prior exam and additive to prior watershed distribution punctate infarcts.3.Small lesions in the brainstem and basal ganglia most likely represent prior lacunar infarcts.4.Multiple micro-hemorrhages are present in the thalami, basal ganglia, brainstem and cerebellum suggesting a distribution suggestive of hypertension. 5.Periventricular and subcortical white matter changes of a mild degree are nonspecific but most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female, 23 years old, with seizures. Encephalomalacia and cystic degeneration is seen along the left parahippocampal gyrus and a portion of the inferior temporal gyrus. The amygdala and the hippocampal formation proper are relatively unaffected. The forniceal columns and mammillary bodies are of symmetric caliber bilaterally.Elsewhere brain parenchymal morphology is unremarkable. No additional focal signal abnormality, edema, or structural anomaly is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.

Output: 1.Encephalomalacia and cystic degeneration affecting the left parahippocampal gyrus and left inferior temporal gyrus are unchanged. These findings may reflect the sequelae of prior infection or inflammation.2.The remainder of the brain is unremarkable.


Instruction: Generate impression based on findings.

Input: Craniopharyngioma 1 year follow up. There are postoperative findings with extensive encephalomalacia and gliosis in the bilateral anterior frontal lobes. There is an unchanged heterogeneous nodule that measures up to 11 mm in the suprasellar cistern, along the tuber cinereum. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is moderate mucosal thickening in the left maxillary sinus.

Output: Post-treatment findings with unchanged tumor in the suprasellar cistern.


Instruction: Generate impression based on findings.

Input: 55 years, Female, tumor, seizure, examination for surgical planning. Examination is obtained for surgical planning with limited sequences of the brain. There is evidence of prior left frontotemporal craniotomy for biopsy/partial resection with a large peripherally enhancing mass in the left temporal lobe measuring approximately 6 cm x 5.2 cm in the AP and transverse dimensions and approximately 6.2 cm in the craniocaudal dimensions. Surrounding T2 hyperintensity is also seen extending superiorly to involve the insula and left basal ganglia. More infiltrative T2 hyperintensity is noted within the left temporal lobe including medially along the left hippocampus. Blood products within this region are better appreciated on prior complete brain MRI study. Associated mass effect including effacement of the left lateral ventricle which is slightly improved since 12/16/2015. There remains 5 mm rightward midline shift at the level of the foramen of Monro and left-sided uncal herniation. Again seen is left-sided extra-axial collection beneath the craniotomy measuring up to 9 mm in thickness. No hydrocephalus. Diffuse sphenoid sinus opacification again noted.

Output: Examination limited to sequences for surgical planning demonstrating a large enhancing mass centered in the left temporal lobe consistent with high-grade glioma. Mass effect includes effacement of the left lateral ventricle, rightward midline shift, and left-sided uncal herniation.


Instruction: Generate impression based on findings.

Input: 34-year-old female with persistent nausea and vomiting. Evaluate for etiology of the dilated common bile duct. ABDOMEN: Suboptimal arterial phase.LIVER, BILIARY TRACT: No focal hepatic enhancing lesions. Postoperative changes of cholecystectomy. Common bile duct is dilated to approximately 12 mm and is stable compared to the prior examination. Mild intrahepatic biliary ductal dilatation is also stable; there is questionable irregularity of the intrahepatic bile ducts. No choledocholithiasis, strictures, or obvious ampullary lesion. Portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is minimally prominent without evidence of a pancreatic head mass. The pancreas is normal in contour and demonstrates normal intrinsic T1 hyperintensity.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable dilated common bile duct with mild intrahepatic ductal dilatation. No evidence of choledocholithiasis, strictures, ampullary lesions, or pancreatic head mass.


Instruction: Generate impression based on findings.

Input: Large parapharyngeal mass. There is a well-defined right poststyloid parapharyngeal mass that measures up to approximately 5.5 cm. The tumor contains multiple prominent flow voids, has a "salt and pepper" appearance, and displaces the internal and external carotid arteries anteriorly. In addition, the right internal jugular vein is compressed by the tumor. The mass does not extend up to the skull base. There is narrowing of the oropharyngeal airway. There are multiple heterogeneously enhancing thyroid nodules, the largest of which measures up to 17 mm. There is a T2 hyperintense and enhancing nodule in the left parotid tail that measures up to 12 mm. The other major salivary glands are unremarkable. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is mild degenerative spondylosis at C4-5 and C5-6. The imaged intracranial structures and orbits are unremarkable.

Output: 1. A right poststyloid parapharyngeal mass that measures up to approximately 5.5 cm likely represents a paraganglioma. 2. Multiple nonspecific thyroid nodules.3. Nonspecific nodule in the left parotid tail that measures up to 12 mm.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:9/21/1960)Reason: L5-S1 anterolisthesis History: leg painTech Comments: pt complains of lower back pain with radiating pain on rt buttocksPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE 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 spondylolysis associated with spondylolisthesis. There is elongation the AP dimension of the spinal canal at this level and approximately 10 mm anterior subluxation of L5 on S1. There is narrowing of the neural foramina bilaterally at this level with encroachment of the nerve roots within the neural foramina. There is loss of disc space height this desiccation and uncovering of the disc. There are bilateral pars interarticularis defects at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height this desiccation and a disc bulge associated with endplate reactive changeAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Spondylolysis with spondylolisthesis at L5-S1 is associated with encroachment of the exiting nerve roots neural foramina bilaterally.2.Mild degenerative changes at L4-5.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB:2/24/1962)Reason: pain History: painPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. Overall the patient's cervical spinal canal is rather small on a congenital basis.There are large anterior osteophytes present at this level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is disc desiccation and a disc bulge present at this level associated with uncovertebral osteophytes. There is facet hypertrophy predominantly on the left side at this level. There is mild encroachment of the exiting nerve roots within the neural foramina at this level.At C4-5 there is some loss of disc space height and disc desiccation as well as endplate and uncovertebral osteophytes. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level and there is effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is a mild to moderate degree of spinal stenosis present. There is bilateral encroachment of exiting nerve roots within the neural foramina this level.At C5-6 there are endplate and uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and some encroachment of the exiting nerve roots.At C6-7 there are endplate and uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and some encroachment of the exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is some ligamentum flavum hypertrophy which does narrow the neural foramen bilaterally at this level.The vertebral artery flow voids appear to be intact.

Output: There are multilevel degenerative changes present in the cervical spine with encroachment of exiting nerve roots within the neural foramina at multiple levels from C4-5 down to C6-7 and some mild to moderate spinal stenosis at C4-5.


Instruction: Generate impression based on findings.

Input: 63 year old with hypertension and congestive heart failure presenting for evaluation of etiology of heart failure. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 122 ml/m2 (normal range: 65+/-11), the LVEDV is 263 ml (normal range 109+/-23), the LV end systolic volume index is 77 ml/m2 (normal range 18+/-5), the LVESV is 166 ml (normal range 31+/-10), the LV mass index is 50 g/m2 (normal range 67+/-11), and the LV mass is 109 g (normal range 114+/-24). The LV dysfunction is global. There is mid myocardial late gadolinium enhancement in the septum which can be seen with nonischemic cardiomyopathy to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is atypical for myocardial infarction. The native T1 times are mildly elevated at 1160 ms. Left AtriumThe left atrium is mild to moderately dilated.Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 106 ml/m2 (normal range 69+/-14), the RVEDV is 229 ml (normal range 110+/-24), the RV end systolic volume index is 56 ml/m2 (normal range 22+/-8), and the RVESV is 120 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%. The LV dysfunction is global. There is mid myocardial late gadolinium enhancement in the septum which can be seen with nonischemic cardiomyopathy to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is atypical for myocardial infarction. The native T1 times are mildly elevated at 1160 ms. This can be re-evaluated on MRI follow up in 6-12 months for reassessment.2. The right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 47%.


Instruction: Generate impression based on findings.

Input: 49-year-old woman with history of FNH and NASH. ABDOMEN:LIVER, BILIARY TRACT: There is a questionable, vague area of delayed enhancement corresponding to the previously seen lesion in the right lobe of the liver. There is a T2 hyperintense, lobulated lesion in segment 3 measuring 30 x 23 mm (series 6, image 21), previously measured 10 x 6 mm, and a T2 hyperintense lobulated lesion in segment 7 measuring 23 x 16 mm (series 6, image 12), previously measured 8 x 8 mm. These lesions gradually fill-in on later phases of contrast enhanced imaging. Diffuse loss of signal in the hepatic parenchyma on opposed phase imaging is noted. There is no intra or extrahepatic biliary duct dilatation. The gallbladder is normal.SPLEEN: The spleen is normal. Accessory splenule is noted.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a 21 x 17 mm exophytic lesion in the inferior pole of the right kidney (series 12, image 111) which is heterogeneous in appearance on T1 and T2-weighted images but demonstrates loss of signal on the opposed phase images (series 1102, image 111). Although not optimally visualized on the study from 2004, this lesion appears grossly stable. A punctate T2 hyperintense lesion in the left renal mid pole (series 9, image 23) is likely a cyst.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral ovarian cysts are noted.

Output: 1.Near completely resolved focal nodular hyperplasia of the liver. 2.Multiple hepatic hemangiomas, increased in size from 2004.3.Exophytic right renal lesion with imaging features favoring that of an AML, grossly stable from 2004.4.Fatty infiltration of the liver.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: 3 year old with new episodes of head pain, vomiting. Please evaluate for colloid cyst or structural etiology History: 3 year old with new episodes of head pain, vomiting. Please evaluate for colloid cyst or structural etiology. There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.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: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Hydrocephalus, unspecified [G91.9] / Headache [R51], Reason for Study: ^Reason: eval cyst size, eval flow though catheter, eval CSF flow History: headache, vision less, word finding difficulty No evidence of acute ischemic or hemorrhagic lesion.Redemonstration of right hemispherectomy with the ventricular catheter inserted through the right side ventricle and the tip location is at the left lateral ventricle occipital horn, unchanged.At least 3 separated CSF collecting cavity (previously called cysts) are redemonstrated. Comparing to prior scan performed on September 17, 2016, the maximum diameter of the largest cyst 3 sisters appear to be stable, unchanged.Previously shown, right extra-axial extradural fluid collection cavity adjustment to the ventricular catheter insertion point is again seen, unchanged in terms of its maximum diameter and MR characteristics.Extensive T2/FLAIR high signal intensity lesions on periventricular white matter are stable, unchanged.The paranasal sinuses and mastoid air cells are clear.CSF Flow studyCSF flow is seen mainly anterior aspect of brain stem and foramen magnum. Trans foramen magnum directional flow is visualized. In particular, cranio petal CSF flow through the foramen magnum is well visualized but craniofugal flow is not as conspicuous on this scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Unchanged maximum size and configuration of the left side ventricular cystic lesions since prior scan.3. Demonstration of bidirectional trans foramen magnum CSF flow, mainly shown on the anterior aspect of the foramen magnum.


Instruction: Generate impression based on findings.

Input: Female 30 years old Reason: 30yo female with left sided ulcerative colitis with suspected IPMN seen on CT abdomen/pelvis. Also with small liver lesions History: pancreas lesion on CT scan ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Lesion in segment 7 of the liver that is T2 hyperintense shows some peripheral nodular discontinuous enhancement is compatible with a small hemangioma. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology. Within the pancreatic tail there is a focal T2 hyperintense lesion measuring 1.2 cm without distortion of the adjacent pancreatic duct. The lesion does not show any appreciable central enhancement. The lesion does have a subtle central septation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of a 1.2 cm cystic lesion in the pancreatic tail. Differential considerations given its size and location and lack of definite communication with the underlying pancreatic duct suggests a small pancreatic mucinous neoplasm. An IPMN is still possible. This may be further evaluated within an EUS for aspiration.


Instruction: Generate impression based on findings.

Input: Female 17 months old with right thyroid mass present for at least 4 months and slowly growing. Evaluate for goiter or thyroglossal duct cyst.EXAMINATION: Sonogram thyroid 4/14/2016 RIGHT LOBE MEASUREMENTS: Not accurately measurableLEFT LOBE MEASUREMENTS: 2.0 x 0.6 x 1.2 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: There is a 4.2 x 2.4 x 3.1 cm hypoechoic multiloculated structure filled with echogenic debris which appears to be surrounded by a rim of thyroid tissue. It is noncompressible and has no flow on color Doppler images.LEFT LOBE: Normal echogenicity, no discrete nodule.ISTHMUS: Normal echogenicity, no discrete nodule.PARATHYROID GLANDS: Not identified.LYMPH NODES: Normal appearing cervical lymph nodes bilaterally.OTHER: No significant abnormality.

Output: The multiloculated lesion appears to be within the right thyroid lobe. Differential considerations include lymphatic malformation, branchial cleft cyst remnant and thymic cyst. It is not typical for thyroglossal duct cyst and unlikely an abscess.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with family history of multiple sclerosis and past medical history of optic neuritis and self-reported nonspecific white matter lesions. Scattered small foci of T2 hyperintensity are seen within the periventricular and, to a lesser extent, the subcortical white matter of both cerebral hemispheres. These lesions are largely punctate and not clearly radially oriented with respect to the ventricles. The corpus callosum is spared. Likewise, no definite lesions are seen in the brainstem or cerebellum.No evidence of parenchymal edema or mass effect is seen. Diffusion-weighted images are normal. No pathologic parenchymal or extra-axial enhancement is seen. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: Multiple scattered small white matter lesions are seen in the supratentorial brain which are nonspecific by imaging criteria. These could potentially represent demyelinating lesions, though the differential would also include sequelae of prior inflammation, vasculitis, and migraine headaches among others.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are no areas of restricted diffusion to suggest acute infarct. Encephalomalacia along the posterior aspect of the right insula, anterior/inferior aspect of the right parietal lobe, and posterior/inferior aspect of the right frontal lobe is again noted with associated T2/flair hyperintensity along the right centrum semiovale. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.Brain MRA: There is antegrade flow within the distal bilateral internal carotid arteries, the proxima bilateral anterior, middle and posterior cerebral arteries, distal bilateral vertebral arteries, and within the basilar artery. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. The right A1 is hypoplastic, the bilateral anterior cerebral arteries fill from left. There is fenestration of the anterior communicating artery with an appearance similar to prior studies. Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. The right internal carotid artery appears smaller in caliber when compared to the left, unchanged from prior. There is irregularity of the lumen of the distal cervical segment of the right internal carotid artery at the site of the prior vascular dissection, this appears unchanged. There are no vascular masses identified. The bilateral vertebral arteries are patent with no evidence of stenosis.

Output: 1.Nonenhanced MRI of the brain shows no evidence of acute intracranial process and no evidence of acute stroke. Stable foci of encephalomalacia in the posterior aspect of the right insula, anterior/inferior aspect of the right parietal lobe, and posterior/inferior aspect of the right frontal lobe from prior infarction.2.Stable findings of irregularity and mild narrowing of the distal cervical and proximal petrous segments of the right internal carotid - the site of previous dissection.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for spinal tumor recurrence. Signs and symptoms: Back pain and headache. Pre- and post enhanced cervical MRI:Examination demonstrates extensive post operative changes of spinal fusion. There is evidence of mild central spinal stenosis at C4-C5 level secondary to mass effect by posterior element at this level without evidence of tumor. Signal intensity and caliber of cervical cord remains within normal and without abnormal enhancement.There is a dural based mass with T2 hypointense and T1 isointense signal change with uniform diffuse enhancement along the clivus as well as noted on prior brain MRI exam without appreciable change.There is no detectable enhancing mass in the cervical region.Pre- and post enhanced thoracic MRI:There is a shallow dorsal dural based T2 hypointense and T1 isointense lesion along the dorsal aspect of the spinal canal extending from T1 inferiorly to approximately T4 level which could represent residual tumor or scarring from extensive surgery posteriorly. Extensive post operative expected enhancement of the posterior soft tissues of the neck at the level of surgery extending from lower cervical through upper thoracic which could obscure enhancement of dorsal dural based mass. This finding measures approximately 6 mm in maximum thickness which is at T2 level and results in partially effacement of the dorsal subarachnoid space at T2 level however without evidence of mass effect or displacement of the cord or significant central spinal stenosis. There are no prior exams for comparison, however if such studies are available and provided to radiology department and an addendum to this report will be submitted after comparison.There is exaggerated kyphosis of upper thoracic spine likely secondary to extensive postop changes. There is however no spinal stenosis or any additional detectable soft tissue abnormality or enhancement. No spinal stenosis at any level and normal signal intensity and caliber of thoracic cord.Pre- and post enhanced lumbar MRI:There is normal signal intensity and alignment of vertebral column.There is no detectable mass or abnormal signal intensity of conus or the cauda equina. There is extensive hypertrophic changes of the articulating facet at L4-L5 on the left with expected enhancement of the facet complex and minimally of the left ligamentum flavum. Unremarkable exam otherwise.

Output: 1.Pre- and post enhanced MRI of cervical spine demonstrate no evidence of a mass or abnormal enhancement are noted than expected enhancement of soft tissues of the lower cervical spine secondary to extensive prior surgery. This is study however partially visualizes previously known dural/epidural enhancing mass along the clivus similar to prior brain MRI exam from 5-21-15.2.Pre- and post enhanced MRI of thoracic spine demonstrate exaggerated kyphosis due to multilevel upper thoracic laminectomy for removal of tumor. Shallow dural base T2 hyperintense lesion along the dorsal aspect of thecal sac extending from T1 to T4 and with maximum thickness at T2 level of 6 mm which could represent residual tumor or postoperative scarring. No prior exams for comparison however if such studies are available and provided to radiology department and an addendum to this report will be submitted after review/comparison. No additional foci of abnormal signal or enhancement to suggest tumor. Normal signal intensity and caliber of the cord without enhancement or central spinal stenosis at any level.3.Pre and postcontrast enhanced MRI of lumbar spine demonstrate no evidence of tumor. There is however expected enhancement of severely degenerated left articulating facet and minimally of the left ligamentum flavum as detailed above. There is no evidence of spinal canal or neural foraminal compromise/stenosis at any level.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils are low-lying measuring up to 8 mm below the foramen magnum. There is however no significant crowding at the foramen magnum. CSF flow sequence was not obtained. The spinal cord is of normal caliber and signal without evidence of syrinx. The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. LUMBAR SPINE

Output: 1. Cerebellar tonsils measure up to 8 mm below the foramen magnum but with preservation of the subarachnoid spaces at the craniocervical junction. CSF flow sequence was not obtained and if clinically warranted, patient may return for this sequence without charge. 2. No evidence of syrinx in the cervical cord.3. Lumbar spine images demonstrate unchanged appearance of the low-lying spinal cord with suggestion of scarring at its distal aspect at the S2 level.4. Small extradural fluid collection posterior to the expanded dural sac at the S2-S3 levels measures 7 mm in the AP dimension and up to 2.7 cm in the craniocaudal dimensions which is increased since 7/21/2016 although smaller since 10/29/2015, suggesting a small persistent CSF leak. There is also small amount of fluid involving the superficial subcutaneous soft tissues at the S2 level which was also present on prior studies from 10/29/2015 and 7/21/2016, although demonstrates gradual decrease compared to the prior two studies.


Instruction: Generate impression based on findings.

Input: Hepatitis C with recurrent cirrhosis. Hepatocellular carcinoma screening ABDOMEN:LIVER, BILIARY TRACT: Susceptibility artifact in the left hepatic lobe limits evaluation of the medial and lateral segments of the left lobe. Status post liver transplant. Heterogeneous parenchymal signal compatible with recurrent chronic liver disease. The hepatic artery, hepatic veins, and portal vein are patent. No arterially enhancing lesions or suspicious lesions otherwise are seen. Mild common bile duct dilation is similar to prior, without intrahepatic biliary ductal dilation. Bulbous cystic duct remnant again seen.SPLEEN: Moderate splenomegaly.PANCREAS: The 7 x 5 mm nonenhancing pancreatic cystic lesion in the distal body is unchanged. Normal pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are mildly atrophic, similar to prior. Otherwise, no significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postoperative changes in the anterior abdominal wall. Otherwise, no significant abnormality noted.OTHER: Trace ascites. Extensive upper abdominal varices again noted.

Output: Limited study due to susceptibility artifact, without suspicious hepatic lesions identified.


Instruction: Generate impression based on findings.

Input: Prolactinoma status post craniotomy 3 months ago and cabergoline therapy subsequently. The images are partly degraded by dental brace artifact. There are postoperative findings related to transcranial resection of a pituitary tumor. There is now herniation of the optic apparatus and portions of the bilateral inferior frontal lobes into the expanded sella, where the heterogeneously enhancing residual pituitary tumor with extension into the left cavernous sinus has decreased in size, measuring up to 12 mm in thickness, previously 36 mm. The pituitary stalk appears to be intact. However, there are surrounding linear bands of tissue. There has been interval removal of the bilateral transfrontal approach biventricular drains. The third and lateral ventricles have decreased in size from the prior examination. There is encephalomalacia in the right frontal lobe and body of the corpus callosum, likely related to the surgical approach. There is no evidence of acute infarction, within the limits of artifact.

Output: 1. Postoperative findings related to resection of a pituitary tumor, now with herniation of the optic apparatus and portions of the bilateral inferior frontal lobes into the expanded sella, where there has been marked interval decrease in size of the treated tumor, with what may represent surrounding granulation tissue and adhesions. 2. The triventricular system is less dilated than before.


Instruction: Generate impression based on findings.

Input: Clinical question: Walking trouble, right leg weakness per history. Signs and symptoms: Spastic in legs and significant sensation loss. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse patchy foci of flair and T2 hyperintensity primarily in the periventricular and to a lesser degree subcortical as well as bilateral basal ganglia, left thalamus and pons without associated susceptibility signal changes. Considering patient's stated age of 76 findings are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.The slight prominence of ventricular system as well as the cortical sulci although may be at the upper limits of normal possibly show mild underlying parenchymal volume loss is suspected.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells as well as calvarium and soft tissues of the scalp.Nonenhanced cervical MRI:There is generalized smaller size of the spinal canal which is suspected to represent a congenital anatomical variation.There is mild to moderate degenerative changes of cervical spine however with normal alignment. Mild straightening of cervical lordosis is noted.Foramen Magnum demonstrate mild hypertrophy changes of posterior elements and ligamentous hypertrophy and including the posterior longitudinal ligament. Findings results in mild spinal stenosis at this level.C2 -- C3 demonstrate mild degenerative changes, mild central spinal stenosis and no neural foraminal compromise.C3 -- C4 demonstrate moderate loss of disk height, shallow centrally located osteophyte which results in slight flattening and deformity of the ventral aspect of the cord. There is mild central spinal stenosis and moderate right neural foraminal compromise.C4 -- C5 demonstrate mild disk disease with loss of disk height, broad-based central disk protrusion which in combination with moderate ligamentum flavum hypertrophy and congenitally small canal results in significant flattening deformity of the cord and central spinal stenosis. There is significant right and moderate left neural foraminal compromise at this level also. On sagittal T2 series there is suggestion of very subtle increased T2 signal intensity of the cord which could represent edema or myelomalacia.C5 -- C6 demonstrate minimal degenerative changes of the disk and facets as well as ligamentum flavum which in combination with congenitally narrow canal results in mild to moderate central spinal stenosis and moderate left and mild right neural foraminal compromise.C6 -- C7 demonstrate mild disk disease with loss of disk height shallow broad based bulge of disk and mild hypertrophic changes of posterior elements. There is resultant mild central spinal stenosis and mild bilateral neural foraminal compromise.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine through T3 are unremarkable.

Output: 1.Nonenhanced head brain MRI demonstrates no acute intracranial process. Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed. Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.2.Non-enhanced MRI of the cervical spine demonstrate generalized uniform smaller than expected caliber of the spinal canal suggestive of a congenital anatomical variation. Degenerative changes of cervical spine in combination with congenitally small canal results in multilevel central spinal stenosis and multilevel bilateral neural foraminal compromise (some significantly) as detailed per level. Spinal stenosis is most severe at C4 -- C5 and with resultant significant flattening deformity of the cord. There is suspected T2 hyperintensity of the cord at this level which could represent an cord edema on or myelomalacia. Please see detailed report above.


Instruction: Generate impression based on findings.

Input: Ms. Trimby is a 64-year-old female with biopsy-proven right breast cancer with disease positive right axillary lymph node. She presents for a baseline MRI prior to starting neoadjuvant therapy. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:In the right upper outer breast, there is an irregular enhancing mass measuring 1.8 x 1.4 x 2.3 cm. Susceptibility artifact from biopsy marker clip is seen within this mass, compatible with the biopsy proven malignancy. Located approximately 2.0 cm anterior to this biopsy-proven malignancy is an additional irregular enhancing mass measuring 0.9 x 0.9 x 1.0 cm. This is suspicious for an satellite lesion. Total span of enhancement (index lesion + suspected satellite lesion) measures approximately 4.2 cm in AP dimension.In addition, in the right inferior breast, there is a faint area of enhancement measuring 0.7 x 0.6 x 0.4 cm.A markedly enlarged right axillary lymph node is identified measuring approximately 3.2 cm in maximal dimension. This is presumed to be the previously biopsied disease positive lymph node at the outside hospital. No clip artifact is identified.LEFT BREAST:No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: (1) Biopsy-proven malignancy in the right upper outer breast measuring approximately 2.3 cm in maximal dimension. (2) Located approximately 2 cm to the biopsy-proven malignancy is an additional irregular enhancing mass, suspicious for a satellite lesion. An MR directed ultrasound is recommended for further evaluation. Of note, the patient did have an MR directed ultrasound later that day with a sonographic correlate identified. An ultrasound-guided biopsy with clip placement was performed. Pathology is pending.(3) 0.7 cm faint area of enhancement in the right inferior breast. An MR directed ultrasound is recommended for further evaluation.Of note, the patient did have an MR directed ultrasound with no sonographic correlate identified. A six-month follow-up MRI is recommended to confirm stability of this finding.(4) 3.2 cm abnormal right axillary lymph node, biopsy-proven to be disease positive. An ultrasound-guided clip placement was performed later that day.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of brain, unspecified [D33.2], Reason for Study: ^Reason: h/o low grade astrocytoma History: surveillance Redemonstration of the right centrum semiovale nonenhancing relatively well circumscribed T2/FLAIR high signal intensity lesion without surrounding edema, unchanged in terms of MR signal characteristics and maximum diameter [22.9mm(CC) x 14.4mm(RL) x 22.1mm(AP)] since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged in size and MR characteristics of the right centrum semiovale lesion since prior scan.No new abnormal enhancing lesion seen.No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 88 year-old male with AMS following a syncopal episode. Evaluate for ischemic event. MRI Brain:Images are limited by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a mild to moderate degree of periventricular and subcortical white matter T2/FLAIR hyperintensity consistent with moderate chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration for age. There is no midline shift or herniation. The major cerebral flow voids are intact. There is incidental empty sella.MRA Brain: There is mild irregularity and atherosclerotic disease of the right intracranial ICA. The left ICA is patent. The bilateral ACA and MCA are patent. Irregularity and moderate atherosclerotic narrowing of the proximal to mid right V4 segment likely secondary to atherosclerotic disease. There is a small right posterior communicating artery. The basilar artery and left vertebral artery are patent. Posterior cerebral arteries are unremarkable.

Output: 1.No evidence of acute ischemia.2.Mild to moderate chronic small vessel ischemic disease.3.Moderate narrowing of the proximal to mid right V4 segment.


Instruction: Generate impression based on findings.

Input: 28 year old with biopsy proven left breast IDC and DCIS, grade 3, with metastatic left axillary lymph node. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a strong enhancement at left nipple and periareolar region, measuring 22 x 30 mm (LR x CC), consistent with known Paget's disease. Diffuse non-mass enhancement is seen In the left breast, with overall measurement of 60 x 75 x 82 mm (AP x LR x CC), consistent with proven IDC with DCIS. An area of stronger enhancement at upper outer quadrant (30 x 15 x 19 mm) might suggest an invasive component. A marker clip is present at lower inner aspect and two clips are present side by side at far lateral axillary tail in the left breast. In the left axilla, there are two abnormally enlarged lymph nodes, measuring 19 mm and 13 mm. There is a metallic artifact from marker clip within the larger lymph node. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.

Output: 1. Diffuse non-mass enhancement in left breast with nipple periareolar enhancement, consistent with diffuse IDC with DCIS.2. Two abnormally enlarged lymph nodes in the left axilla, one of which is proven metastatic.3. No MR evidence for malignancy in the right breast or right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Constant headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered cerebral white matter T2 hyperintense lesions, which are nonspecific, but may represent chronic small vessel ischemic disease. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There has been prior right orbital trauma with phthisis bulbi and ocular prosthesis, as well as zygomaticomaxillary fracture repair.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Prior right orbital trauma with phthisis bulbi and ocular prosthesis, as well as zygomaticomaxillary fracture repair.


Instruction: Generate impression based on findings.

Input: 21-month-old female patient with tuberous sclerosis. Evaluate for renal cysts or angiomyolipoma. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No fat-containing lesions. There are multiple small subcentimeter bilateral cortically based cysts. No pathologically enhancing lesions.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple small cortical based cysts bilaterally without evidence of angiomyolipomas.


Instruction: Generate impression based on findings.

Input: Clinical question: stroke. Signs and symptoms: Facial droop. Nonenhanced head CT:There are is no detectable intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. If clinical concern for stroke persist recommend an MRI examination. CT is insensitive for detection of early strokes. Limited view of orbits, paranasal sinuses unremarkable. Calvarium is intact. Minimal bilateral opacification of mastoid air cells.

Output: Negative head CT.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with metastatic lung cancer and brain metastases status post radiation. Again seen is a homogeneously enhancing lobular extra-axial mass along the undersurface of the right lateral tentorium. The most accurate measurements are obtained on sagittal images where the lesion measures 20 x 16 mm, unchanged from the prior study. The lesion abuts the right sigmoid sinus without evidence of significant narrowing or occlusion.Also stable is a tubular 8 x 6 mm enhancing structure along the anterior right temporal lobe. No additional enhancing lesions are seen. No new areas of cortical signal abnormality are detected. Minimal patchy periventricular T2 hyperintensity is unchanged and nonspecific. No restricted diffusion is seen. No significant parenchymal edema is detected. The ventricles are stable and normal in size.

Output: 1.Stable extra-axial mass arising from the undersurface of the right lateral tentorium.2.Stable tubular enhancement along the right anterior temporal lobe which may represent an incidental vascular lesion. Dedicated vascular imaging can be considered if clinically warranted.3.No new or concerning intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for left leg weakness. Signs and symptoms: Left leg weakness. Pre and post enhanced cervical MRI:There is normal signal intensity and anatomical alignment of the vertebral column.Foramen magnum is unremarkable.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative disease without spinal or neural foraminal compromise.C3-C4 demonstrate moderate disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophic changes. There is a central disc protrusion with mass effect and flattening deformity and posterior displacement of the cord and result in moderate central spinal stenosis. Moderate right and mild to moderate left neural foraminal compromise is also noted at this level. The signal intensity of the cord remains within normal at this level.C4-C5 demonstrate mild degenerative changes and a tiny central disc protrusion with resultant subtle deformity of the ventral aspect of the cord however without central spinal stenosis or neural foraminal compromise. Normal signal intensity of the cord at this level.C5-C6 demonstrates moderate disc disease and loss of disc height, minimal facet and ligamentum flavum hypertrophy and without spinal stenosis or neural foraminal compromise.C6-C7 demonstrate advanced disc disease with near complete loss of disc height, mild facet and ligamentum flavum degenerative changes. There is a central and left paramedian broad-based disc-osteophyte at this level with resultant mass effect, flattening deformity and posterior displacement of the cord, nearly complete effacement of subarachnoid space and moderate central spinal stenosis. Moderate right and mild left neural foraminal compromise is also detected. Examination at this level demonstrate linear increased T2 STIR signal intensity within the anterior cord which is best appreciated on sagittal T2 STIR series 5 image 11. Finding is highly suspected myelopathy secondary to degenerative spondylosis. Prior cervical MRI exam from MRI of River North dated 3-2-15 is of suboptimal quality and without sagittal T2 STIR series.C7-T1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.Degenerative changes of cervical spine and loss of disc height results in mild reversal of cervical lordosis. Incidental note is made of a small fluid signal intensity cyst like lesion in the superior left nasopharynx suspected of a Tornwaldt cyst.There is a well-demarcated enhancing focus of T2/T2 STIR hyperintense ( 7 x 5.5 mm sagittal T2 series 3 image 9) and mildly hyperintense on T1-weighted images in the vertebral body of C5. Post enhanced images demonstrate expected subtle enhancement of degenerative changes.Pre and post enhanced thoracic MRI: There is normal anatomical alignment of vertebral column.There is no appreciable significant degenerative changes of thoracic spine.There is no evidence of spinal canal or neural foraminal compromise at any level.There is normal signal intensity and caliber of the thoracic cord without abnormal enhancement.There is a small focus of T2 STIR hyperintensity (10 x 6 mm on axial T2 series 2 and T2 image 8) and T1 hypointense with enhancement in the posterior aspect of T9 vertebral body. Additional punctate focus of enhancement noted in the T7 vertebral body which cannot be identified with certainty on any other MRI sequence.Pre and post enhanced lumbar spine:The alignment of the vertebral column is normal and with evidence of grade 2 anterolisthesis at L5-S1 level. Examination demonstrates extensive postoperative changes of a posterior approach for spinal fusion. There are fixating rods as well as transpedicular screw placement on the right at L3, bilaterally at L4, bilaterally at S1 levels.There is no evidence of spinal stenosis. However significant bilateral neural foraminal compromise at L5-S1 level is detected.There is normal signal intensity and morphology of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement. Note should be made that extensive metallic hardware artifact makes precise evaluation difficult.

Output: 1.MRI of cervical spine demonstrate diffuse degenerative changes with reversal of cervical lordosis, disc protrusion and disc-osteophyte complex which results in mild to moderate central spinal stenosis at C3-C4 and moderate stenosis at C6-C7 levels. Increased T2 STIR signal intensity of the cord at C6-C7 level suspected for myelopathy. Multilevel neural foraminal compromise as detailed per level above. Please see detailed report above.2.Pre and post enhanced MRI of thoracic spine demonstrate normal signal intensity and caliber of thoracic cord without abnormal enhancement. No intravenous or spinal stenosis or neural foraminal compromise.3.Pre and post enhanced MRI of lumbar spine demonstrate extensive postoperative changes of posterior fusion and including placement of posterior rods and transpedicular screws for grade 2 anterolisthesis at L5-S1 level. No spinal stenosis is detected. Significant bilateral neural foraminal compromise bilaterally at L5-S1 is present.4.Small foci of marrow signal changes with enhancement noted in the vertebral bodies of C5, T7 and T9 levels. The appearance is suggestive of a benign process however less likely possibility of metastatic disease should also be considered and follow-up exams is recommended. Please see detailed report /measurements above.5.There is no detectable abnormal enhancement of the cord or the leptomeninges.


Instruction: Generate impression based on findings.

Input: Female; 54 years old. Reason: PSC History: Pruritus. LIVER, BILIARY TRACT: Extensive areas of focal dilatation and stricturing involving the intrahepatic biliary tree with pruning. Areas of beading are most pronounced near the origin of the left hepatic duct (series 701, image 73). Irregularity of the common bile duct appears more prominent than on prior MRI.Right percutaneous biliary catheter is noted, with new and significant soft tissue thickening seen along its course which demonstrates increased signal on T2 and diffusion weighted images. Associated diffuse circumferential thickening of the CBD and intrahepatic bile ducts which enhances on arterial and delayed phase images is also present, most pronounced in the right hepatic lobe. No discrete intraductal or hepatic masses identified. Small hemangiomas in segments 6 and 7 are not significantly changed. Gallstone and sludge in the gallbladder. Prominent right cardiophrenic lymph node. SPLEEN: No significant abnormality noted. Small splenule is present. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter bilateral renal cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable subcentimeter T2 hyperintense focus in the right T12 vertebral body, likely representing an atypical hemangioma. OTHER: No significant abnormality noted.

Output: 1.Persistent dilatation/stricturing of the intra and extrahepatic biliary tree as described above, compatible with primary sclerosing cholangitis. 2.New extensive soft tissue thickening along the course of the biliary catheter and diffuse circumferential thickening of the CBD and intrahepatic bile ducts, both of which demonstrate increased T2 weighted signal and delayed enhancement. Even though no discrete mass is seen, findings may represent peribiliary spread of tumor and further evaluation with ERCP/endoscopic biopsy is recommended.


Instruction: Generate impression based on findings.

Input: Status post craniotomy for seizure focus resection. Evaluate for hemorrhage and resection. There are postoperative findings related to a left craniotomy for resection of seizure focus. There is overlying soft tissue swelling, blood products along the resection cavity, and left frontal convexity and small extra-axial collection in the left hemisphere measuring 7mm in width. There is associated diffusion restriction and susceptibility artifact along the resection cavity, likely related to hemorrhage and ischemia. There is minimal left to right midline shift of 2 mm. There remains a focal area of prominent cortical thickening in the depths of a left posterior frontal lobe middle frontal sulcus. The ventricles and basal cisterns are unchanged in size and configuration. There is no herniation. There is fluid signal in the mastoid air cells.

Output: Postoperative findings related to resection of seizure focus with apparent residual area cortical dysplasia in the depths of a left posterior frontal lobe middle frontal sulcus with superimposed edema. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.